tocilizumab

Generic: Actemra

162 mg/0.9 mL, 200 mg/10 mL (20 mg/mL), 400 mg/20 mL (20 mg/mL), 80 mg/4 mL (20 mg/mL) — Vial

Also known as: ACTEMRA ACTPEN ACTEMRA

Coverage by Insurer

Informational only — Coverage rules change frequently; verify tier placement and restrictions with your plan or pharmacy before acting.

Ambetter (Centene)

29 plans

Source: CMS QHP JSON · Formulary date: Jan 1, 2026 · Checked: 3 hours, 37 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
Standard Expanded Bronze + Vision + Adult Dental via Actemra	Tier 5 - Specialty	✓	—	✓	PA \| QL
Standard Gold with Atrium Health + Vision + Adult Dental via Actemra	Tier 5 - Specialty	✓	—	✓	PA \| QL
Focused Silver with Atrium Health + Vision + Adult Dental via Actemra	Tier 5 - Specialty	✓	—	✓	PA \| QL
Complete Gold with Atrium Health + Vision + Adult Dental via Actemra	Tier 5 - Specialty	✓	—	✓	PA \| QL
Standard Silver + Vision + Adult Dental via Actemra	Tier 5 - Specialty	✓	—	✓	PA \| QL
Standard Silver with Atrium Health + Vision + Adult Dental via Actemra	Tier 5 - Specialty	✓	—	✓	PA \| QL
Standard Expanded Bronze with Atrium Health + Vision + Adult Dental via Actemra	Tier 5 - Specialty	✓	—	✓	PA \| QL
Standard Gold + Vision + Adult Dental via Actemra	Tier 5 - Specialty	✓	—	✓	PA \| QL
Complete Gold via Actemra	Tier 5 - Specialty	✓	—	✓	PA \| QL
Enhanced Asthma/COPD Care Silver with $0 Drug Options via Actemra	Tier 5 - Specialty	✓	—	✓	PA \| QL
Everyday Bronze via Actemra	Tier 5 - Specialty	✓	—	✓	PA \| QL
Elite Bronze via Actemra	Tier 5 - Specialty	✓	—	✓	PA \| QL
Clear Silver with $0 Insulin Options via Actemra	Tier 5 - Specialty	✓	—	✓	PA \| QL
Standard Expanded Bronze via Actemra	Tier 5 - Specialty	✓	—	✓	PA \| QL
Standard Silver via Actemra	Tier 5 - Specialty	✓	—	✓	PA \| QL
Standard Gold via Actemra	Tier 5 - Specialty	✓	—	✓	PA \| QL
Everyday Bronze with Atrium Health via Actemra	Tier 5 - Specialty	✓	—	✓	PA \| QL
Elite Bronze with Atrium Health via Actemra	Tier 5 - Specialty	✓	—	✓	PA \| QL
Focused Silver with Atrium Health via Actemra	Tier 5 - Specialty	✓	—	✓	PA \| QL
Complete Gold with Atrium Health via Actemra	Tier 5 - Specialty	✓	—	✓	PA \| QL
Standard Expanded Bronze with Atrium Health via Actemra	Tier 5 - Specialty	✓	—	✓	PA \| QL
Standard Silver with Atrium Health via Actemra	Tier 5 - Specialty	✓	—	✓	PA \| QL
Standard Gold with Atrium Health via Actemra	Tier 5 - Specialty	✓	—	✓	PA \| QL
Enhanced Asthma/COPD Care Silver with $0 Drug Options + Vision + Adult Dental via Actemra	Tier 5 - Specialty	✓	—	✓	PA \| QL
Complete Gold + Vision + Adult Dental via Actemra	Tier 5 - Specialty	✓	—	✓	PA \| QL
Everyday Bronze + Vision + Adult Dental via Actemra	Tier 5 - Specialty	✓	—	✓	PA \| QL
Elite Bronze + Vision + Adult Dental via Actemra	Tier 5 - Specialty	✓	—	✓	PA \| QL
Everyday Bronze with Atrium Health + Vision + Adult Dental via Actemra	Tier 5 - Specialty	✓	—	✓	PA \| QL
Elite Bronze with Atrium Health + Vision + Adult Dental via Actemra	Tier 5 - Specialty	✓	—	✓	PA \| QL

Cigna

2 plans

Source: PDF · Formulary date: Jan 1, 2026 · Checked: 3 hours, 37 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
Cigna Plus NC 4-Tier Formulary 2026 via Actemra	Tier 4 - Specialty	✓	—	✓ Limited Distribution; Specialty Pharmacy Required	PA \| QL
Cigna Plus NC 4-Tier Formulary 2026 via Actemra Actpen	Tier 4 - Specialty	✓	—	✓ Limited Distribution; Specialty Pharmacy Required	PA \| QL

Medicare Part D

18 plans

Source: CMS QHP JSON · Formulary date: Mar 18, 2026 · Checked: 3 hours, 37 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
Longevity Health Plan (HMO I-SNP) via Actemra	Tier 1 - Preferred Generic	✓	—	✓ 3.6 per 28 days	PA \| QL
AmeriHealth Caritas VIP Care (HMO D-SNP) via Actemra	Tier 5 - Specialty	✓	—	✓ 3.6 per 28 days	PA \| QL
Alignment Health Platinum Select (HMO) via Actemra	Tier 5 - Specialty	✓	—	✓ 3.6 per 28 days	PA \| QL
Alignment Health Heart & Diabetes Care (HMO C-SNP) via Actemra	Tier 5 - Specialty	✓	—	✓ 3.6 per 28 days	PA \| QL
Alignment Health AVA (PPO) via Actemra	Tier 5 - Specialty	✓	—	✓ 3.6 per 28 days	PA \| QL
Troy Medicare (HMO) via Actemra	Tier 5 - Specialty	✓	—	✓ 3.6 per 28 days	PA \| QL
Troy Medicare for Dual-eligible Beneficiaries (HMO D-SNP) via Actemra	Tier 5 - Specialty	✓	—	✓ 3.6 per 28 days	PA \| QL
Blue Medicare PPO Enhanced (PPO) via Actemra	Tier 5 - Specialty	✓	—	✓ 3.6 per 28 days	PA \| QL
Blue Medicare Essential Plus (HMO-POS) via Actemra	Tier 5 - Specialty	✓	—	✓ 3.6 per 28 days	PA \| QL
Blue Medicare Enhanced (HMO-POS) via Actemra	Tier 5 - Specialty	✓	—	✓ 3.6 per 28 days	PA \| QL
Blue Medicare Choice (HMO) via Actemra	Tier 5 - Specialty	✓	—	✓ 3.6 per 28 days	PA \| QL
Blue Medicare Essential (HMO) via Actemra	Tier 5 - Specialty	✓	—	✓ 3.6 per 28 days	PA \| QL
Experience Health Medicare Advantage (HMO) via Actemra	Tier 5 - Specialty	✓	—	✓ 3.6 per 28 days	PA \| QL
Healthy Blue + Medicare (HMO-POS D-SNP) via Actemra	Tier 5 - Specialty	✓	—	✓ 3.6 per 28 days	PA \| QL
Alignment Health Platinum (HMO) via Actemra	Tier 5 - Specialty	✓	—	✓ 3.6 per 28 days	PA \| QL
Alignment Health NC Duals (HMO-POS D-SNP) via Actemra	Tier 5 - Specialty	✓	—	✓ 3.6 per 28 days	PA \| QL
Alignment Health smartHMO (HMO) via Actemra	Tier 5 - Specialty	✓	—	✓ 3.6 per 28 days	PA \| QL
Alignment Health Heart & Diabetes NCPlus (HMO-POS C-SNP) via Actemra	Tier 5 - Specialty	✓	—	✓ 3.6 per 28 days	PA \| QL

NC State Health Plan

3 plans

Source: PDF · Formulary date: Apr 1, 2026 · Checked: 3 hours, 37 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
NC State Health Plan - HDHP 2026 via Actemra	Not Covered	—	—	—	None
NC State Health Plan - 70/30 Standard PPO 2026 via Actemra	Not Covered	—	—	—	None
NC State Health Plan - 80/20 Plus PPO 2026 via Actemra	Not Covered	—	—	—	None

TRICARE

1 plan

Source: Excel (XLSX) · Formulary date: Jan 5, 2026 · Checked: 3 hours, 37 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
TRICARE Uniform Formulary 2026	Tier 3 - Non-Formulary	✓	—	✓	PA \| QL

UnitedHealthcare

1 plan

Source: PDF · Formulary date: Jan 1, 2026 · Checked: 3 hours, 37 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
UnitedHealthcare NC Individual & Family 2026 via Actemra Actpen	Unknown	✓	—	✓	PA \| QL