Health Net
Actemra (tocilizumab)
Drugs for Pain and Fever : Arthritis and Pain Drugs
  • Prior Authorization: Adult Onset Stills Disease (AOSD):
    Documented Diagnosis: Yes
    Duration: 6 Month(s)
    Reauthorization Required: Yes

    Juvenile Idiopathic Arthritis:
    Documented Diagnosis: Yes
    Medical Test Required: Yes
    Age Requirement: >= 2
    Duration: 6 Month(s)
    Reauthorization Required: Yes

    Rheumatoid Arthritis (RA):
    Documented Diagnosis: Yes
    Medical Test Required: Yes
    Age Requirement: >= 18
    Duration: 6 Month(s)
    Reauthorization Required: Yes

  • Step Therapy: Adult Onset Stills Disease (AOSD):
    ST Multiple Generics

    Juvenile Idiopathic Arthritis:
    ST Multiple Brands

    Rheumatoid Arthritis (RA):
    ST Generic and Brand

  • Adult Onset Stills Disease (AOSD):
    Duration: 6 Month(s)
    Specialist Required: Yes
    Documented Diagnosis: Yes
    Medical Test Required: No
    Specialist Type(s): Appropriate Specialist
    Reauthorization Required: Yes
    Duration of Reauthorization: = 12 month(s)

    Juvenile Idiopathic Arthritis:
    Age Requirement: >= 2
    Duration: 6 Month(s)
    Specialist Required: Yes
    Documented Diagnosis: Yes
    Medical Test Required: Yes
    Specialist Type(s): Rheumatologist
    Reauthorization Required: Yes
    Duration of Reauthorization: = 6 month(s)
    TB Test required: Yes

    Rheumatoid Arthritis (RA):
    Age Requirement: >= 18
    Duration: 6 Month(s)
    Specialist Required: Yes
    Documented Diagnosis: Yes
    Medical Test Required: Yes
    Specialist Type(s): Rheumatologist
    Reauthorization Required: Yes
    Duration of Reauthorization: = 6 month(s)
    TB Test required: No

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