Alternatives to Actemra If You Can't Fill Your Prescription

When Actemra (tocilizumab) isn't available at your pharmacy or infusion center, it's natural to worry about what comes next. The good news: patients who rely on Actemra have more options than ever in 2026, thanks to FDA-approved biosimilars and a growing menu of alternative biologic and oral treatments. This guide breaks down what's available and what questions to ask your doctor.

Option 1: Actemra Biosimilars (Same Drug, Different Brand)

The most straightforward alternative when brand-name Actemra is unavailable is one of its FDA-approved biosimilars. Biosimilars are highly similar versions of the original biologic, manufactured by a different company, and approved by the FDA based on rigorous evidence of comparable safety and efficacy.

Three tocilizumab biosimilars are currently approved and available in the U.S.:

• Tofidence (tocilizumab-bavi) — Made by Biogen/Bio-Thera, FDA approved September 2023. Available in IV formulation.
• Tyenne (tocilizumab-aazg) — Made by Fresenius Kabi, FDA approved March 2024. Available in both IV and SC formulations.
• Avtozma (tocilizumab-anoh) — Made by Celltrion, FDA approved January 2025. IV launched October 2025; SC available in 2026.

Important: These are not generics. They require a new prescription. Your prescriber must write specifically for the biosimilar by name, or your insurance may require a biosimilar before covering brand Actemra. The good news is that many insurance plans now prefer biosimilars and may cover them at lower cost to you.

Option 2: Switch Between IV and SC Formulations of Tocilizumab

If IV Actemra is unavailable at your infusion center, the American College of Rheumatology (ACR) has supported substituting the subcutaneous (SC) form — and vice versa. The two formulations contain the same active drug but differ in dose and route of administration. The SC form (162 mg prefilled syringe or ACTPen) is self-injected at home, weekly or every other week. This switch requires a new prescription and guidance from your provider, but it can keep your treatment continuous.

Option 3: Sarilumab (Kevzara) — Another IL-6 Inhibitor

Sarilumab (brand name Kevzara), made by Sanofi and Regeneron, is the only other FDA-approved IL-6 receptor antagonist for rheumatoid arthritis. It works by the same general mechanism as Actemra — blocking the IL-6 receptor — but was not approved for COVID-19 or CRS. It is available only as a subcutaneous injection and is FDA approved for moderate-to-severe RA.

Sarilumab may be a reasonable option for RA patients who cannot access any tocilizumab product, but it is not approved for the other conditions Actemra treats (GCA, SSc-ILD, JIA, CRS). Discuss with your rheumatologist whether this is appropriate for your specific diagnosis.

Option 4: JAK Inhibitors — Oral Alternatives for RA

For rheumatoid arthritis specifically, a class of oral medications called JAK inhibitors (Janus kinase inhibitors) can be used when biologic drugs like Actemra aren't available or aren't working. These are pills taken daily at home — no injections or infusions required.

• Baricitinib (Olumiant) — Once-daily oral JAK1/2 inhibitor. Also FDA approved for severe alopecia areata and atopic dermatitis.
• Tofacitinib (Xeljanz) — Twice-daily oral JAK1/3 inhibitor. FDA approved for RA, psoriatic arthritis, UC, and juvenile idiopathic arthritis.
• Upadacitinib (Rinvoq) — Once-daily selective JAK1 inhibitor. FDA approved for RA, psoriatic arthritis, atopic dermatitis, UC, Crohn's disease, and ankylosing spondylitis.

Note: JAK inhibitors carry a class-wide FDA boxed warning about cardiovascular events, malignancy, and thrombosis risk, particularly in patients over 50 with cardiovascular risk factors. Your rheumatologist will weigh these risks against the benefits for your situation.

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Option 5: TNF Inhibitors — If You Haven't Tried Them

TNF (tumor necrosis factor) inhibitors are the most widely prescribed biologics for RA and are generally easier to access than tocilizumab. Common options include adalimumab (Humira and many biosimilars), etanercept (Enbrel), certolizumab (Cimzia), and golimumab (Simponi). These drugs work by blocking a different inflammatory protein (TNF-alpha) rather than IL-6. If you haven't tried a TNF inhibitor, your rheumatologist may suggest one as a more accessible alternative.

What to Tell Your Doctor

When discussing alternatives with your rheumatologist, be specific about why you can't get Actemra — is it a supply issue, an insurance issue, or a cost issue? The answer affects which alternative makes the most sense. Key questions to ask:

• Is my condition approved for any of the tocilizumab biosimilars?
• Can I switch from IV to SC while waiting for IV supply?
• Would a JAK inhibitor or TNF inhibitor be safe given my medical history?
• How quickly can we get prior authorization for an alternative?

Before you switch, it's also worth making sure Actemra genuinely isn't available. Read our guide to how to find Actemra in stock near you, or use medfinder to check pharmacies near you.