ACTEMRA® (Tocilizumab)
Order Form

ACTEMRA® (Tocilizumab)

ACTEMRA® is a prescription infusion medication designed to treat adults with rheumatoid arthritis (RA), giant cell arteritis (GCA), and children with active polyarticular juvenile idiopathic arthritis (PDIA) or active systemic juvenile idiopathic arthritis (SJIA).

Please refer to Actrema’s full Prescribing Information.

Note: Please speak with your healthcare provider for more information if you think this therapy might be right for you.

How do I make a referral or transition my treatment to Infusion Associates?

1. Ask your healthcare provider to fax us a completed order form for your medication, clinical notes, demographics and your insurance card to (833) 996-4888.

2. Providers can find order forms on our medications page.

3. One of our intake specialists will contact your healthcare provider to confirm receipt of your referral.

4. We will then verify benefits, obtain any required prior authorizations, and contact you to schedule an appointment.