Limited coverage criteria – tocilizumab for active polyarticular juvenile idiopathic arthritis
Last updated on May 27, 2025
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Biosimilar transition initiative
PharmaCare is changing coverage of tocilizumab for active polyarticular juvenile idiopathic arthritis. To maintain PharmaCare coverage, patients currently covered for the originator tocilizumab biologic product, Actemra®, must, in consultation with their prescriber, switch to the approved biosimilar product, Tyenne®.
Prescribers can request a list of their patients who are receiving PharmaCare coverage for Actemra, so they can contact them to start the switch to Tyenne.
May 27, 2025
All new Special Authority (SA) requests, including renewals, for tocilizumab will only be approved for Tyenne.
May 27, 2025 to November 27, 2025
During the six-month transition period, patients with PharmaCare coverage for the originator tocilizumab (Actemra) who wish to maintain their coverage must transition to the biosimilar tocilizumab (Tyenne). A new SA request is not required until the next scheduled renewal date (if applicable). To maintain patients' coverage, prescribers must write a new prescription for their patients on Actemra, indicating the transition to Tyenne.
November 28, 2025
Actemra is no longer an eligible PharmaCare benefit and only Tyenne is authorized for continued coverage.
SA requests for patients who are unable to transition to Tyenne will be considered on an exceptional case-by-case basis.
Generic name |
tocilizumab |
|---|---|
Strength & form |
80 mg/4 mL, 200 mg/10 mL, 400 mg/20 mL, intravenous infusion vial 162 mg/0.9 mL pre-filled syringe, autoinjector pen1 |
Special Authority criteria |
Approval period |
|---|---|
|
For the treatment of moderate to severe active polyarticular juvenile idiopathic arthritis (pJIA) for patients 2 years and older who, due to intolerance or lack of efficacy, have not adequately responded to methotrexate |
1 year |
Practitioner exemptions
- Special Authority requests must be submitted by a pediatric rheumatologist. A Collaborative Prescribing Agreement (CPA) is available to a limited number of pediatric rheumatology practitioners. Each CPA must be signed by the pediatric rheumatologist who is requesting coverage and not a delegate
- PharmaCare covers tocilizumab for patients with pJIA who meet the limited coverage criteria and whose prescription has been written by a pediatric rheumatologist who has entered into a CPA
- Pediatric rheumatologists who have not signed a CPA may submit a Special Authority request if the patient meets the limited coverage criteria above. These prescriptions will not be covered automatically. Special Authority requests submitted by a rheumatologist who has not signed a CPA must include a Childhood Health Assessment Questionnaire Disability Index (CHAQ-DI) and a Visual Analogue Scale (VAS)
Special notes
- 1The pre-filled syringe with needle safety device (PFS + NSD) can be used to treat pediatric patients of all approved ages. The autoinjector should not be used to treat pediatric patients < 12 years of age
- Treatment should be 8 mg/kg (for patients ≥ 30 kg) or 10 mg/kg (for patients < 30 kg) IV once every 4 weeks or 162 mg subcutaneously every 2 to 3 weeks
- PharmaCare covers a maximum of 28 days’ supply per fill for the IV formulation, and up to 84 days' supply for the SC formulation when dosed at 21-day intervals
Special Authority request form(s)