19 commercial payer policies list Q5133. See each policy's status for the code and its official source. Listing a code is not a coverage decision: read each policy’s source for the requirements that apply.
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19 policies from 11 payers
Summary of the payer’s published policy. Not a coverage determination — confirm with the payer before submitting.
Codes labeled “Inferred from policy title” are not listed in the policy document; Backwork attached them because the policy title names the drug.
| Policy | Effective | Status of Q5133 |
|---|---|---|
| Tocilizumab Intravenous (Actemra, Avtozma, Tyenne, Tofidence) non-oncology | Feb 1, 2026 | Prior auth requiredInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
| Tocilizumab Intravenous (Actemra, Tyenne, Tofidence) non-oncologyEffective 10/01/2025 - 01/31/2026 | Oct 1, 2025 | Prior auth requiredInferred from policy title |
| Tocilizumab Intravenous (Actemra, Tyenne, Tofidence)Effective 10/01/2024 - 02/28/2025 | Oct 1, 2024 | Prior auth requiredInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
|---|
| Policy | Effective | Status of Q5133 |
|---|---|---|
| Specialty Medication Administration Site of Care | Jan 1, 2026 | Covered |
| Tocilizumab and Associated Biosimilar(s) | Apr 1, 2026 | Covered |
| Policy | Effective | Status of Q5133 |
|---|---|---|
| Specialty Medication Administration Site of Care | Jan 1, 2026 | Covered |
| Tocilizumab and Associated Biosimilar(s) | Apr 1, 2026 | Covered |
| Policy | Effective | Status of Q5133 |
|---|---|---|
| Specialty Medication Administration Site of Care | Jan 1, 2026 | Covered |
| Tocilizumab and Associated Biosimilar(s) | Apr 1, 2026 | Covered |
| Policy | Effective | Status of Q5133 |
|---|---|---|
| Specialty Medication Administration Site of Care | Jan 1, 2026 | Covered |
| Tocilizumab and Associated Biosimilar(s) | Apr 1, 2026 | Covered |
| Policy | Effective | Status of Q5133 |
|---|---|---|
| Provider Administered Drugs – Site of Care | Oct 1, 2026 | Covered |
| Tocilizumab Injection for Intravenous Infusion | Jul 1, 2026 | Covered |
| Policy | Effective | Status of Q5133 |
|---|---|---|
| Provider Administered Drugs – Site of Care | Oct 1, 2026 | Covered |
| Tocilizumab Injection for Intravenous Infusion | Jul 1, 2026 | Covered |
| Policy | Effective | Status of Q5133 |
|---|---|---|
| Cigna MedOnc Master Drug List.pdf | Not recorded | Prior auth required |
| Policy | Effective | Status of Q5133 |
|---|---|---|
| Q4 - 2026 JHP MedOnc Master Drug List.pdf | Not recorded | Prior auth required |
| Policy | Effective | Status of Q5133 |
|---|---|---|
| Tocilizumab: Actemra; Tofidence; Tyenne; Avtozma; Tocilizumab-anoh§; Tocilizumab-aazg§ | Not recorded | Covered with conditionsInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
| Policy | Effective | Status of Q5133 |
|---|---|---|
| Tocilizumab Injection for Intravenous Infusion | Jul 1, 2026 | Covered |