Limited coverage criteria - tocilizumab for rheumatoid arthritis

Last updated on May 27, 2025

Special Authority requests can now be submitted online. It's simple and quick!

Biosimilar transition initiative

PharmaCare is changing coverage of tocilizumab for rheumatoid 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.

HLTH 5839 – Tocilizumab patient list request (PDF, 968KB)

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 pen

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 pen

Special Authority criteria	Approval period
For the treatment of rheumatoid arthritis (RA) when: A Special Authority request is submitted by a rheumatologist AND Prescribed according to established criteria (as indicated on relevant Special Authority form below)	Initial: 1 year Renewal: 1 year to indefinite

Special Authority criteria

Approval period

For the treatment of rheumatoid arthritis (RA) when:

A Special Authority request is submitted by a rheumatologist

AND

Prescribed according to established criteria (as indicated on relevant Special Authority form below)

Initial: 1 year

Renewal: 1 year to indefinite

Practitioner Exemptions

None

Special Notes

PharmaCare covers a maximum of 28 days’ supply per fill for the IV formulation, and up to 56 days for the SC formulation when dosed at 14-day intervals. Coverage is limited to 800 mg every 4 weeks for the IV formulation or 162 mg once weekly for the SC formulation

Special Authority request form(s)

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