Specialty Drug


TOCILIZUMAB is used to treat rheumatoid arthritis (RA) and certain types of arthritis in children. This medicine helps reduce joint pain and swelling. This medicine is often used with other medicines. Compare interleukin antagonists.

Tocilizumab Medicare Coverage


Does Medicare cover Actemra?

53% of Medicare Part D and Medicare Advantage plans cover this drug, so it's pretty much a toss-up.

How much is my Actemra co-pay with Medicare?

It depends. Which coverage stage are you in? Click on a tab below…

Donut Hole
Post-Donut Hole
Co-Pay Range
$888 – $2182
In the Deductible co-pay stage, you are responsible for the full cost of your prescriptions. Your Medicare deductible cannot exceed $360 in 2016.
Co-Pay Range
$90 – $2182
In the Typical co-pay stage, your deductible has been satisfied, and Medicare pays the majority of your drug costs.
Co-Pay Range
$400 – $2182
In the Donut Hole (also called the Coverage Gap) stage, you’ll pay more for your prescriptions. In 2016, the Donut Hole begins once you’ve spent $3,310 in one year.
Co-Pay Range
$15 – $2182
In the Post-Donut Hole (also called Catastrophic Coverage) stage, Medicare will cover most of your drug costs. In 2016, this stage begins once you have spent $4,850.
Want an exact price for your co-pay?

Ways to Save on Tocilizumab

Here are some ways that may lower the cost of your Actemra prescription.

Manufacturer Coupon
Pay as little as $5 per co-pay with insurance.
Patient Assistance Program
Receive your prescription at no charge if you are eligible.

Find Your Tocilizumab Medicare Co-Pay

Here are average co-pays for some of the most popular Medicare plans. Be sure to add your plan to see your specific co-pay. If a price is shown in red, GoodRx has found discount prices that are lower than your Medicare co-pay.

Average Co-Pay for 2 vials (10ml) of Actemra 20mg/ml

Medicare Plan Name Average Co-Pay
AARP MedicareComplete (HMO) $254
AARP MedicareComplete Plan 1 (HMO) $267
AARP MedicareComplete SecureHorizons (HMO) $246
AARP MedicareRx Preferred (PDP)Lower price available $2182
AARP MedicareRx Saver Plus (PDP)Lower price available $2182
Aetna Medicare Rx Saver (PDP)Lower price available $2182
Cigna-HealthSpring Preferred (HMO)Lower price available $2182
Cigna-HealthSpring Rx Secure (PDP)Lower price available $2182
Cigna-HealthSpring Rx Secure-Extra (PDP)Lower price available $2182
EnvisionRxPlus Silver (PDP) $229
Express Scripts Medicare - Value (PDP) $231
First Health Part D Value Plus (PDP)Lower price available $2182
Humana Enhanced (PDP)Lower price available $2182
Humana Preferred Rx Plan (PDP)Lower price available $2182
Humana Walmart Rx Plan (PDP)Lower price available $2182
Kaiser Permanente Senior Advantage (HMO) $90
MedicareBlue Rx Standard (PDP)Lower price available $2182
SilverScript Choice (PDP)Lower price available $2182
Symphonix Value Rx (PDP) $230
WellCare Classic (PDP)Lower price available $2182
Don't see your Medicare plan above?

Find and configure your plan to see exact co-pay prices for your meds.

Tocilizumab Medicare Formulary Information & Restrictions

Are there any restrictions on coverage?

Some Medicare plans have restrictions on coverage of Actemra that may include:

Prior Authorization

Most Medicare plans will require you to obtain their authorization before they will provide coverage for this prescription. You’ll need to contact your plan and they may require you to have your doctor fill out paperwork indicating why you need this prescription. If you do not receive authorization or don’t want to go through this process, you may want to consider using a GoodRx discount instead of Medicare to find the best price for this prescription.

What drug tier is Actemra typically on?

Tier 5

Medicare plans typically list Actemra in Tier 5 of their formulary. Tier 5 drugs are usually non-preferred brand-name drugs. Tier 5 drugs cost more than Tier 1, 2, 3 and 4 drugs.

Does your plan have restrictions?

See discount prices that can save you money when your Medicare plan doesn't work for you.

Medicare prices are provided by the Centers for Medicare and Medicaid Services (CMS). If you encounter any issues, please let us know.
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