J6259 Insurance Policy Changes

Intravenous tocilizumab products (Revised)

Humana Medicare Advantage updated its intravenous tocilizumab prior authorization policy (effective January 1, 2019; revised June 24, 2026). The policy covers four tocilizumab products (Actemra, Tyenne, Tofidence, Avtozma) for five FDA-approved indications: moderately to severely active rheumatoid arthritis (with prior DMARD therapy requirement), systemic juvenile idiopathic arthritis, polyarticular juvenile idiopathic arthritis, cytokine release syndrome, and giant cell arteritis. Key exclusion: combination therapy with other biologics is not covered. Prior authorization is required for all covered indications.