Medicare Part D spending · FDA facts · help paying
Actemra (tocilizumab): what Medicare Part D spends and the dated federal facts we hold
CMS's Medicare Part D spending dataset lists Actemra under 2 names; the sum of their gross spending is $368.05 million in 2024, across 91,107 claims. 2 non-manufacturing label changes are dated in the last 12 months in the FDA's file.
Medicare Part D spending
CMS's Medicare Part D spending dataset lists Actemra under 2 names; the sum of their gross spending is $368.05 million in 2024, across 91,107 claims. CMS's dataset states spending is gross drug cost and does not reflect manufacturers' rebates or other price concessions. Spending is the total paid by Medicare, plans and beneficiaries for the drug's claims, not what a patient pays.
| Year | Gross spending | Claims |
|---|---|---|
| 2024 | $368.05 million | 91,107 |
| 2023 | $320.36 million | 78,425 |
| 2022 | $254.24 million | 66,359 |
| 2021 | $216.91 million | 56,383 |
| 2020 | $184.13 million | 47,120 |
Names CMS reports it under
| Name in the CMS file | Year | Gross spending | Claims |
|---|---|---|---|
| Actemra Actpen | 2024 | $236.14 million | 56,900 |
| Actemra* | 2024 | $131.90 million | 34,207 |
Source: CMS Medicare Part D spending by drug (data-year-2024, modified 2026-06-25), read November 7, 2026. CMS dataset page. All manufacturers combined; the figures are a drug-level aggregate of claims and say nothing about a formulary or coverage.
Medicare Part B payment limit
CMS publishes a quarterly payment limit for the HCPCS code that its NDC crosswalk links to Actemra. It is a ceiling for providers who bill Medicare Part B, not a price a patient pays, and a code's presence says nothing about whether Medicare covers a product.
| HCPCS code | Quarter | Payment limit | Per dosage descriptor | Effective | Read |
|---|---|---|---|---|---|
| J3262 | 2026 Q4 | $5.33 | 1 MG | October 1, 2026 through December 31, 2026 | November 7, 2026 |
Source: CMS ASP pricing files (october-2026-medicare-part-b-payment-limit-files-final.zip and the matching NDC-HCPCS crosswalk). CMS ASP pricing files page.
Biosimilar status
- Actemra (tocilizumab) is a reference product in the FDA Purple Book (BLA 125276, approved January 8, 2010). The Purple Book lists 3 biosimilars and 2 interchangeable products that name it as their reference product.
Biosimilars: Tyenne, approved March 5, 2024; Tofidence, approved September 29, 2023; Tyenne, approved March 14, 2025
Interchangeable: Avtozma, interchangeable since January 24, 2025; Avtozma, interchangeable since January 24, 2025 - Actemra (tocilizumab) is a reference product in the FDA Purple Book (BLA 125472, approved October 21, 2013). The Purple Book lists 3 biosimilars and 2 interchangeable products that name it as their reference product.
Biosimilars: Tyenne, approved March 5, 2024; Tofidence, approved September 29, 2023; Tyenne, approved March 14, 2025
Interchangeable: Avtozma, interchangeable since January 24, 2025; Avtozma, interchangeable since January 24, 2025
This is what the FDA Purple Book lists on the read date. It is a record, not a forecast of when any product will launch or be substituted.
Source: FDA Purple Book (purplebook-2026-10), read November 7, 2026. Purple Book data file.
FDA safety program (REMS)
- Actemra (application BLA125276): listed as released, without Elements to Assure Safe Use. Program dated January 8, 2010, last modified August 18, 2015. REMS@FDA program page.
- Actemra (application BLA125472): listed as released, without Elements to Assure Safe Use. Program dated January 8, 2010, last modified August 18, 2015. REMS@FDA program page.
A REMS is a safety program the FDA can require for a drug. Some restrict how it is prescribed or dispensed, for example through certified prescribers or pharmacies. This lists what the FDA's REMS@FDA files tie to the application; it does not say which prescribers or pharmacies take part, or whether a given patient needs the program.
Source: FDA REMS@FDA data files (rems-fda-files-2026-11-07-products-20a9945448dd), read November 7, 2026. REMS@FDA product file.
Rare-disease (orphan) designations
The FDA's orphan drug database lists 5 designations for tocilizumab, 4 with an approval recorded. A designation is not an approval and not a statement that the drug treats the condition; the status column is the database's own.
| Designated | Designated use | Status | Sponsor |
|---|---|---|---|
| December 5, 2025 | treatment of Takayasu arteritis | Designated | ODDIFACT SAS |
| August 1, 2017 | Treatment of chimeric antigen receptor (CAR) T cell-induced cytokine release syndrome | Designated/Approved | Genentech Inc., a member of the Roche Group |
| April 17, 2013 | Treatment of systemic sclerosis | Designated/Approved | Genentech, Inc. |
| July 31, 2012 | Treatment of pediatric patients (age 16 years and younger) with polyarticular-course juvenile idiopathic arthritis | Designated/Approved | Genentech, Inc. |
| July 31, 2012 | Treatment of pediatric patients (age 16 years and younger) with polyarticular-course juvenile idiopathic arthritis | Designated/Approved | Genentech, Inc. |
Source: FDA Orphan Drug Designations and Approvals database, read November 7, 2026. FDA orphan drug search.
Medicaid use by state
CMS's State Drug Utilization Data records, for 2025, how many prescriptions each state's Medicaid program paid for under this drug's packages and what it reimbursed. The 10 states with the largest reimbursement are shown. Reimbursement is before the rebates manufacturers pay states, so it is not a net cost and not a price a patient pays.
| State | Medicaid-paid prescriptions | Medicaid reimbursed | Covers |
|---|---|---|---|
| ME | 103 | $417,730 | All record types |
| OK | 84 | $276,193 | Fee-for-service only |
| NE | 145 | $267,077 | All record types |
| AR | 192 | $242,076 | All record types |
| SD | 57 | $227,109 | All record types |
| IA | 53 | $169,173 | All record types |
| NC | 68 | $146,650 | Fee-for-service only |
| AK | 89 | $112,645 | Fee-for-service only |
| GA | 268 | $109,831 | Fee-for-service only |
| MS | 45 | $23,294 | Fee-for-service only |
Where the publisher suppresses small managed-care cells, a state's figure covers fee-for-service claims only and understates use (6 state and package figures are marked that way here). A state missing from the table means its figures were suppressed or not reported, not zero use. 157 older-year figures are held and left out of the table.
Source: CMS State Drug Utilization Data (State Drug Utilization Data 2025, modified 2026-07-13T15:28:32Z), read November 7, 2026. CMS dataset page. State-reported data compiled by CMS; aggregate by state and package, no provider or patient data.
Medicaid spending
CMS's Medicaid spending dataset reports $123.79 million for Actemra in 2024. CMS's dataset states spending includes Federal and State reimbursement and dispensing fees and is not reduced by Medicaid rebates paid to the states. Spending is what Medicaid paid, not what a patient pays.
| Year | Spending | Claims |
|---|---|---|
| 2024 | $123.79 million | 46,974 |
| 2023 | $123.53 million | 46,774 |
| 2022 | $95.24 million | 37,724 |
| 2021 | $88.69 million | 35,219 |
| 2020 | $76.10 million | 31,884 |
Source: CMS Medicaid spending by drug (data-year-2024, modified 2026-06-25), read November 7, 2026. CMS dataset page. A national drug-level aggregate; it says nothing about any state's coverage rules.
Federal formulary status
TRICARE
The Defense Health Agency's TRICARE formulary files include 2 packages of Actemra in the uniform formulary class TARGETED IMMUNOMODULATORY BIOLOGICS. Each row counts packages by the list that names them and the status it gives. A status is a TRICARE listing, not a statement about what a plan will pay for you.
| List | Status | Packages |
|---|---|---|
| Non-Formulary Drug List | NON-FORMULARY | 2 |
| Tier 4 / Not Covered Drug List | NOT COVERED | 2 |
Source: TRICARE formulary files (tricare-formulary-2026-10), read November 7, 2026. TRICARE formulary page.
VA national formulary
The VA's national formulary files list the ingredient tocilizumab, which covers every maker's product with that ingredient, not only Actemra. Each row is a VA national drug file entry and its status.
| VA entry | Status | Active NDCs |
|---|---|---|
| TOCILIZUMAB INJ,SOLN | Non-formulary | 6 |
Source: VA Pharmacy Benefits Management national formulary (va-formulary-2026-09), read November 7, 2026. VA formulary page.
Where help paying exists
No program in our finder currently lists this drug as open to new patients.
Label changes
FDA actions on the applications behind Actemra dated since November 11, 2025, leaving out manufacturing (CMC) changes. 2 changes in the window.
| Date | Class | Application | Submissions | FDA documents |
|---|---|---|---|---|
| December 10, 2025 | Labeling | BLA125276 | 147 | Label (PDF) posted December 12, 2025FDA letter posted December 11, 2025 |
| December 10, 2025 | Labeling | BLA125472 | 59 | Label (PDF) posted December 12, 2025FDA letter posted December 11, 2025 |
Source: FDA Drugs@FDA data file, read November 7, 2026. Dates are the FDA action dates; the documents are on FDA's own site. FDA data file. All recent changes across these drugs: label changes feed.
Questions
Does Medicare have a negotiated price for Actemra?
The CMS negotiated-price file we read does not list Actemra, so this page shows no negotiated price. A drug appears in that file only when CMS selects it for negotiation, and not being listed says nothing about what it costs a patient.
Is there help paying for Actemra?
No program in our finder lists this drug yet.
How much does Medicare Part D spend on Actemra?
CMS's Medicare Part D spending dataset lists Actemra under 2 names; the sum of their gross spending is $368.05 million in 2024, across 91,107 claims. CMS's dataset states spending is gross drug cost and does not reflect manufacturers' rebates or other price concessions. Spending is the total paid by Medicare, plans and beneficiaries for the drug's claims, not what a patient pays.
For developers: this drug as data
One call returns the generic-entry upper bound, label history, recalls, trials, assistance and Part D spending, and where facts exist the FDA safety program (REMS), DEA schedule, orphan designations, safety notices and Medicaid use by state, each with receipts.
Example file: https://omnirx.org/api/v1/dossier/actemra.json
The licence page sets out what a data licence covers, and the API page documents these files.
Evaluation files with receipts; contract may change; not clinical advice.
Sources and terms. This drug is not in the CMS negotiated-price file, so no price source is used. Program details read from each program's own pages; CMS Medicare Part D spending by drug; CMS Medicaid spending by drug; TRICARE and VA formulary files; CMS ASP pricing files; FDA Purple Book; FDA Drugs@FDA and Orange Book data files. Figures are stored with their sources in the OmniRx library (edition 2026-11). Free to cite with attribution. Not medical, legal or financial advice. Report an error through the contact page. Licence the data.