Notification of Drug Policy Revisions Effective May 1, 2025 (Posted March 1, 2025) | Providers

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Notification of Drug Policy Revisions Effective May 1, 2025 (Posted March 1, 2025)

Medical Drug Policy Name	Revised Criteria
Tocilizumab (Actemra®) and Tocilizumab Biosimilars “Notification”	Added requirement within continuation criteria for trial and failure of a preferred tocilizumab biosimilar product (i.e., Tyenne [tocilizumab-aazg]) and listed non-preferred tocilizumab products to include Actemra (tocilizumab) and Tofidence (tocilizumab-bavi). Included within trial and failure criteria in continuation section the allowance for presence of a documented serious adverse event requiring medical intervention from the preferred tocilizumab biosimilar product that is not anticipated with the requested non-preferred tocilizumab product, with required submission of an FDA MedWatch Adverse Event Reporting Form. Policy notification given 3/1/2025 for effective date 5/1/2025.

Medical Drug Policy Name

Revised Criteria

Tocilizumab (Actemra®) and Tocilizumab Biosimilars “Notification”

Added requirement within continuation criteria for trial and failure of a preferred tocilizumab biosimilar product (i.e., Tyenne [tocilizumab-aazg]) and listed non-preferred tocilizumab products to include Actemra (tocilizumab) and Tofidence (tocilizumab-bavi). Included within trial and failure criteria in continuation section the allowance for presence of a documented serious adverse event requiring medical intervention from the preferred tocilizumab biosimilar product that is not anticipated with the requested non-preferred tocilizumab product, with required submission of an FDA MedWatch Adverse Event Reporting Form. Policy notification given 3/1/2025 for effective date 5/1/2025.

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