Tyenne will be preferred tocilizumab biosimilar product for most commercial members, starting June 1

We will change how we manage Actemra^® and Actemra biosimilar products, starting June 1, 2025. This change will affect most Blue Cross Blue Shield of Michigan and Blue Care Network commercial members covered under pharmacy and medical benefits.

How this will affect members under pharmacy benefits

Actemra (tocilizumab) subcutaneous, or SC, injection will no longer be covered for all commercial fully insured and self-funded groups using the Custom, Custom Select and Clinical drug lists. Tyenne^® (tocilizumab-aazg) will be the preferred (tocilizumab) biosimilar product.

Authorizations for Actemra will remain in effect until May 31, 2025. If members decide to use Actemra on or after June 1, they’ll be responsible for the full cost. New authorizations for Tyenne SC will be approved June 1, 2025, and active through May 31, 2026, so members can continue therapy without interruption.
Members on a plan using the Preferred Drug List are excluded from this change. This change doesn’t apply to Medicare Advantage groups or members.

Filling the prescription

We’ll only pay for Tyenne when filled through Walgreens Specialty Pharmacy, an independent company that provides specialty pharmacy services to Blue Cross and BCN.

Members who currently fill their Actemra SC prescriptions at the Michigan Medicine Specialty Pharmacy may continue filling there.

If members are currently filling Actemra SC through Walgreens Specialty Pharmacy:

• Walgreens Specialty Pharmacy will obtain a new prescription for Tyenne SC from their doctor, if needed.
• Walgreens Specialty Pharmacy will fill the prescription with Tyenne SC, starting April 1. 

If members are currently filling their prescriptions through a pharmacy other than those mentioned above:

• Walgreens Specialty Pharmacy will send affected members a welcome letter. The letter will include the pharmacy phone number.
• A representative from Walgreens Specialty Pharmacy will call the member to set up a profile.
• Walgreens Specialty Pharmacy will obtain a new prescription for Tyenne SC from their doctor.

Prescribers can send a new prescription for Tyenne SC by one of the following methods:

How this will affect members under medical benefits

For dates of service on or after June 1, 2025, TyenneIV and SC (tocilizumab-aazg), HCPCS code Q5135, will be the preferred tocilizumab biosimilar product.

The nonpreferred tocilizumab products are Tofidence™ IV (intravenous), Avtozma^® IV and SC and Actemra^® IV and SC.

Members who have active authorizations for a nonpreferred tocilizumab product are authorized to continue their current therapy through May 31, 2025.

We’re issuing authorizations for Tyenne from June 1, 2025, to May 31, 2026, to avoid any interruptions in care.

To determine whether a group participates in the prior authorization program, see the Specialty Pharmacy Prior Authorization Master Opt-in/out Group list.

How to submit prior authorization requests

For a self-administered ustekinumab SC product (covered under pharmacy benefits), submit the request using an electronic prior authorization, or ePA, tool such as CoverMyMeds^® or Surescripts^®.

For an ustekinumab IV product that requires administration by a health care provider (covered under medical benefits), submit the request through the NovoLogix^® online tool.

NovoLogix^® is an independent company that provides an online prescription drug prior authorization tool for Blue Cross Blue Shield of Michigan and Blue Care Network.

Walgreens Specialty Pharmacy is an independent company that provides specialty pharmacy services covered under the pharmacy benefit for various Blue Cross Blue Shield of Michigan and Blue Care Network members with commercial plans.