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
TARGETED IMMUNOMODULATORY BIOLOGICS
Also known as:
ACTEMRA ACTPEN
ACTEMRA
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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| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
|
Everyday Bronze
via Actemra |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Elite Bronze
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 |
|
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 |
|
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 Expanded Bronze + Vision + Adult Dental
via Actemra |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Standard Silver + Vision + Adult Dental
via Actemra |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Focused Silver with Atrium Health
via Actemra |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Standard Gold + 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 with Atrium Health + Vision + Adult Dental
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 |
|
Standard Silver with Atrium Health + Vision + Adult Dental
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 |
|
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 |
AmeriHealth Caritas NC
30 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
|
AmeriHealth Caritas Next Silver Signature + No Referrals
via Actemra |
Tier 5 - Specialty | ✓ | — | — | PA |
|
AmeriHealth Caritas Next Silver Signature + No Referrals
via Avtozma |
Tier 5 - Specialty | ✓ | — | — | PA |
|
AmeriHealth Caritas Next Gold Premier + No Referrals
via Avtozma |
Tier 5 - Specialty | ✓ | — | — | PA |
|
AmeriHealth Caritas Next Bronze Signature + No Referrals
via Actemra |
Tier 5 - Specialty | ✓ | — | — | PA |
|
AmeriHealth Caritas Next Bronze Essential + No Referrals
via Actemra |
Tier 5 - Specialty | ✓ | — | — | PA |
|
AmeriHealth Caritas Next Silver Off-Marketplace Low + No Referrals
via Avtozma |
Tier 5 - Specialty | ✓ | — | — | PA |
|
AmeriHealth Caritas Next Silver Premier + No Referrals
via Avtozma |
Tier 5 - Specialty | ✓ | — | — | PA |
|
AmeriHealth Caritas Next Gold Signature + No Referrals
via Actemra Actpen |
Tier 5 - Specialty | ✓ | — | — | PA |
|
AmeriHealth Caritas Next Bronze Essential + No Referrals
via Actemra Actpen |
Tier 5 - Specialty | ✓ | — | — | PA |
|
AmeriHealth Caritas Next Silver Off-Marketplace Low + No Referrals
via Actemra Actpen |
Tier 5 - Specialty | ✓ | — | — | PA |
|
AmeriHealth Caritas Next Silver Premier + No Referrals
via Actemra Actpen |
Tier 5 - Specialty | ✓ | — | — | PA |
|
AmeriHealth Caritas Next Silver Essential + No Referrals
via Actemra Actpen |
Tier 5 - Specialty | ✓ | — | — | PA |
|
AmeriHealth Caritas Next Silver Off-Marketplace High + No Referrals
via Actemra Actpen |
Tier 5 - Specialty | ✓ | — | — | PA |
|
AmeriHealth Caritas Next Silver Signature + No Referrals
via Actemra Actpen |
Tier 5 - Specialty | ✓ | — | — | PA |
|
AmeriHealth Caritas Next Bronze Signature + No Referrals
via Actemra Actpen |
Tier 5 - Specialty | ✓ | — | — | PA |
|
AmeriHealth Caritas Next Gold Premier + No Referrals
via Actemra Actpen |
Tier 5 - Specialty | ✓ | — | — | PA |
|
AmeriHealth Caritas Next Bronze Premier + No Referrals
via Actemra Actpen |
Tier 5 - Specialty | ✓ | — | — | PA |
|
AmeriHealth Caritas Next Silver Off-Marketplace Low + No Referrals
via Actemra |
Tier 5 - Specialty | ✓ | — | — | PA |
|
AmeriHealth Caritas Next Gold Premier + No Referrals
via Actemra |
Tier 5 - Specialty | ✓ | — | — | PA |
|
AmeriHealth Caritas Next Silver Essential + No Referrals
via Actemra |
Tier 5 - Specialty | ✓ | — | — | PA |
|
AmeriHealth Caritas Next Silver Premier + No Referrals
via Actemra |
Tier 5 - Specialty | ✓ | — | — | PA |
|
AmeriHealth Caritas Next Bronze Premier + No Referrals
via Actemra |
Tier 5 - Specialty | ✓ | — | — | PA |
|
AmeriHealth Caritas Next Silver Off-Marketplace High + No Referrals
via Actemra |
Tier 5 - Specialty | ✓ | — | — | PA |
|
AmeriHealth Caritas Next Gold Signature + No Referrals
via Actemra |
Tier 5 - Specialty | ✓ | — | — | PA |
|
AmeriHealth Caritas Next Bronze Premier + No Referrals
via Avtozma |
Tier 5 - Specialty | ✓ | — | — | PA |
|
AmeriHealth Caritas Next Silver Essential + No Referrals
via Avtozma |
Tier 5 - Specialty | ✓ | — | — | PA |
|
AmeriHealth Caritas Next Gold Signature + No Referrals
via Avtozma |
Tier 5 - Specialty | ✓ | — | — | PA |
|
AmeriHealth Caritas Next Bronze Essential + No Referrals
via Avtozma |
Tier 5 - Specialty | ✓ | — | — | PA |
|
AmeriHealth Caritas Next Silver Off-Marketplace High + No Referrals
via Avtozma |
Tier 5 - Specialty | ✓ | — | — | PA |
|
AmeriHealth Caritas Next Bronze Signature + No Referrals
via Avtozma |
Tier 5 - Specialty | ✓ | — | — | PA |
Cigna
60 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
|
Connect myDiabetesCare Bronze
via Actemra |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Connect Bronze RD 6000 Indiv Med Deductible
via Actemra |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Connect Silver 3500 Indiv Med Deductible
via Actemra |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Connect Bronze RD 5000 Indiv Med Deductible
via Actemra |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Connect Silver RD 3500 Indiv Med Deductible
via Actemra |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Connect Bronze 7000 HSA Indiv Med Deductible
via Actemra |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Connect Silver 4400 Indiv Med Deductible
via Actemra |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Connect Silver RD 5000 Indiv Med Deductible
via Actemra |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Connect Silver 3000 Indiv Med Deductible
via Actemra |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Connect Bronze 6500 Indiv Med Deductible
via Actemra |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Connect Silver CMS Standard
via Actemra |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Connect Silver RD CMS Standard
via Actemra |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Connect Gold CMS Standard
via Actemra |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Connect Bronze RD CMS Standard
via Actemra |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Connect Gold RD CMS Standard
via Actemra |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Connect Bronze CMS Standard
via Actemra |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Connect myDiabetesCare Silver
via Avtozma |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Connect Silver RD 2200 Indiv Med Deductible
via Avtozma |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Connect Gold 1500 Indiv Med Deductible
via Avtozma |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Connect myDiabetesCare Bronze
via Avtozma |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Connect Bronze 5500 Indiv Med Deductible
via Avtozma |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Connect Bronze RD 6000 Indiv Med Deductible
via Avtozma |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Connect Silver 3500 Indiv Med Deductible
via Avtozma |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Connect Bronze RD 5000 Indiv Med Deductible
via Avtozma |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Connect Silver RD 3500 Indiv Med Deductible
via Avtozma |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Connect Bronze 7000 HSA Indiv Med Deductible
via Avtozma |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Connect Silver 4400 Indiv Med Deductible
via Avtozma |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Connect Silver RD 5000 Indiv Med Deductible
via Avtozma |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Connect Silver 3000 Indiv Med Deductible
via Avtozma |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Connect Bronze 6500 Indiv Med Deductible
via Avtozma |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Connect myDiabetesCare Silver
via Actemra Actpen |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Connect Silver RD 2200 Indiv Med Deductible
via Actemra Actpen |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Connect Gold 1500 Indiv Med Deductible
via Actemra Actpen |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Connect myDiabetesCare Bronze
via Actemra Actpen |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Connect Bronze CMS Standard
via Actemra Actpen |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Connect Gold RD CMS Standard
via Actemra Actpen |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Connect Bronze RD CMS Standard
via Actemra Actpen |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Connect Gold CMS Standard
via Actemra Actpen |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Connect Silver RD CMS Standard
via Actemra Actpen |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Connect Silver CMS Standard
via Actemra Actpen |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Connect Bronze CMS Standard
via Avtozma |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Connect Gold RD CMS Standard
via Avtozma |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Connect Bronze RD CMS Standard
via Avtozma |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Connect Gold CMS Standard
via Avtozma |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Connect Silver RD CMS Standard
via Avtozma |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Connect Silver CMS Standard
via Avtozma |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Connect Bronze 6500 Indiv Med Deductible
via Actemra Actpen |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Connect Silver 3000 Indiv Med Deductible
via Actemra Actpen |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Connect Silver RD 5000 Indiv Med Deductible
via Actemra Actpen |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Connect Silver 4400 Indiv Med Deductible
via Actemra Actpen |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Connect Bronze 7000 HSA Indiv Med Deductible
via Actemra Actpen |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Connect Silver RD 3500 Indiv Med Deductible
via Actemra Actpen |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Connect Bronze RD 5000 Indiv Med Deductible
via Actemra Actpen |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Connect Gold 1500 Indiv Med Deductible
via Actemra |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Connect Bronze 5500 Indiv Med Deductible
via Actemra |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Connect Silver 3500 Indiv Med Deductible
via Actemra Actpen |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Connect Bronze RD 6000 Indiv Med Deductible
via Actemra Actpen |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Connect Bronze 5500 Indiv Med Deductible
via Actemra Actpen |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Connect myDiabetesCare Silver
via Actemra |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Connect Silver RD 2200 Indiv Med Deductible
via Actemra |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
Medicare Part D
36 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
|
Longevity Health Plan (HMO I-SNP)
via Actemra Actpen |
Tier 1 - Preferred Generic | ✓ | — | ✓ 3.6 per 28 days | PA | QL |
|
Longevity Health Plan (HMO I-SNP)
via Actemra |
Tier 1 - Preferred Generic | ✓ | — | ✓ 3.6 per 28 days | PA | QL |
|
Alignment Health smartHMO (HMO)
via Actemra Actpen |
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 |
|
Blue Medicare PPO Enhanced (PPO)
via Actemra Actpen |
Tier 5 - Specialty | ✓ | — | ✓ 3.6 per 28 days | PA | QL |
|
Blue Medicare Essential Plus (HMO-POS)
via Actemra Actpen |
Tier 5 - Specialty | ✓ | — | ✓ 3.6 per 28 days | PA | QL |
|
Blue Medicare Enhanced (HMO-POS)
via Actemra Actpen |
Tier 5 - Specialty | ✓ | — | ✓ 3.6 per 28 days | PA | QL |
|
Blue Medicare Choice (HMO)
via Actemra Actpen |
Tier 5 - Specialty | ✓ | — | ✓ 3.6 per 28 days | PA | QL |
|
Blue Medicare Essential (HMO)
via Actemra Actpen |
Tier 5 - Specialty | ✓ | — | ✓ 3.6 per 28 days | PA | QL |
|
Experience Health Medicare Advantage (HMO)
via Actemra Actpen |
Tier 5 - Specialty | ✓ | — | ✓ 3.6 per 28 days | PA | QL |
|
Healthy Blue + Medicare (HMO-POS D-SNP)
via Actemra Actpen |
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 |
|
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 |
|
Alignment Health Platinum (HMO)
via Actemra Actpen |
Tier 5 - Specialty | ✓ | — | ✓ 3.6 per 28 days | PA | QL |
|
Alignment Health NC Duals (HMO-POS D-SNP)
via Actemra Actpen |
Tier 5 - Specialty | ✓ | — | ✓ 3.6 per 28 days | PA | QL |
|
Alignment Health Heart & Diabetes NCPlus (HMO-POS C-SNP)
via Actemra Actpen |
Tier 5 - Specialty | ✓ | — | ✓ 3.6 per 28 days | PA | QL |
|
Alignment Health Platinum Select (HMO)
via Actemra Actpen |
Tier 5 - Specialty | ✓ | — | ✓ 3.6 per 28 days | PA | QL |
|
Alignment Health Heart & Diabetes Care (HMO C-SNP)
via Actemra Actpen |
Tier 5 - Specialty | ✓ | — | ✓ 3.6 per 28 days | PA | QL |
|
Alignment Health AVA (PPO)
via Actemra Actpen |
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 |
|
Troy Medicare (HMO)
via Actemra Actpen |
Tier 5 - Specialty | ✓ | — | ✓ 3.6 per 28 days | PA | QL |
|
Troy Medicare for Dual-eligible Beneficiaries (HMO D-SNP)
via Actemra Actpen |
Tier 5 - Specialty | ✓ | — | ✓ 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 |
|
AmeriHealth Caritas VIP Care (HMO D-SNP)
via Actemra Actpen |
Tier 5 - Specialty | ✓ | — | ✓ 3.6 per 28 days | PA | QL |
NC Medicaid PDL
1 planNC State Health Plan
3 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
|
NC State Health Plan - 80/20 Plus PPO 2026
via Actemra |
Not Covered | — | — | — | None |
|
NC State Health Plan - 70/30 Standard PPO 2026
via Actemra |
Not Covered | — | — | — | None |
|
NC State Health Plan - HDHP 2026
via Actemra |
Not Covered | — | — | — | None |
Oscar Health
20 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
|
Silver Classic | with Atrium Health
via Actemra |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Bronze Elite + PCP Saver Plus | with Atrium Health
via Actemra |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Bronze Classic 4700 | with Atrium Health
via Actemra |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Secure | with Atrium Health
via Actemra |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Silver Simple Diabetes
via Actemra |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Gold Elite Saver Plus
via Actemra |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Silver Simple PCP Saver
via Actemra |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Bronze Classic 4700
via Actemra |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Silver Classic
via Actemra |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Bronze Elite + PCP Saver Plus
via Actemra |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Gold Classic Standard | with Atrium Health
via Actemra |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Silver Classic Standard | with Atrium Health
via Actemra |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Bronze Classic Standard | with Atrium Health
via Actemra |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Gold Classic Standard
via Actemra |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Silver Classic Standard
via Actemra |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Bronze Classic Standard
via Actemra |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Secure
via Actemra |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Gold Elite Saver Plus | with Atrium Health
via Actemra |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Silver Simple PCP Saver | with Atrium Health
via Actemra |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
Silver Simple Diabetes | with Atrium Health
via Actemra |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
TRICARE
2 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
| TRICARE Uniform Formulary 2026 | Tier 3 - Non-Formulary | ✓ | — | ✓ | PA | QL |
|
TRICARE Uniform Formulary 2026
via tocilizumab-anoh |
Tier 3 - Non-Formulary | ✓ | — | — | PA |
UnitedHealthcare
26 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
|
UHC Silver Advantage ($0 Virtual Urgent Care, $3 Tier 2 Rx, No Referrals)
via Actemra |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
UHC Gold Advantage + ($0 Virtual Urgent Care, $1 Tier 2 Rx, Dental + Vision, No Referrals)
via Avtozma |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
UHC Gold Advantage ($0 Virtual Urgent Care, $1 Tier 2 Rx, No Referrals)
via Avtozma |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
UHC Bronze Essential ($0 Virtual Urgent Care, No Referrals
via Avtozma |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
UHC Gold Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, No Referrals)
via Avtozma |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
UHC Bronze Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, No Referrals)
via Avtozma |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
UHC Bronze Standard (No Referrals)
via Avtozma |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
UHC Gold Standard (No Referrals)
via Avtozma |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
UHC Silver Advantage + ($0 Virtual Urgent Care, $3 Tier 2 Rx, Dental + Vision, No Referrals)
via Avtozma |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
UHC Bronze Standard+ Dental + Vision (No Referrals)
via Avtozma |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
UHC Silver Value + ($0 Virtual Urgent Care, Dental + Vision, No Referrals)
via Avtozma |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
UHC Silver Value ($0 Virtual Urgent Care, No Referrals)
via Avtozma |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
UHC Silver Advantage ($0 Virtual Urgent Care, $3 Tier 2 Rx, No Referrals)
via Avtozma |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
UHC Silver Standard (No Referrals)
via Avtozma |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
UHC Silver Advantage + ($0 Virtual Urgent Care, $3 Tier 2 Rx, Dental + Vision, No Referrals)
via Actemra |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
UHC Silver Value + ($0 Virtual Urgent Care, Dental + Vision, No Referrals)
via Actemra |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
UHC Bronze Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, No Referrals)
via Actemra |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
UHC Silver Standard (No Referrals)
via Actemra |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
UHC Gold Advantage + ($0 Virtual Urgent Care, $1 Tier 2 Rx, Dental + Vision, No Referrals)
via Actemra |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
UHC Bronze Standard+ Dental + Vision (No Referrals)
via Actemra |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
UHC Gold Standard (No Referrals)
via Actemra |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
UHC Gold Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, No Referrals)
via Actemra |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
UHC Bronze Standard (No Referrals)
via Actemra |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
UHC Bronze Essential ($0 Virtual Urgent Care, No Referrals
via Actemra |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
UHC Gold Advantage ($0 Virtual Urgent Care, $1 Tier 2 Rx, No Referrals)
via Actemra |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |
|
UHC Silver Value ($0 Virtual Urgent Care, No Referrals)
via Actemra |
Tier 5 - Specialty | ✓ | — | ✓ | PA | QL |