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UPMC Health Plan ACTEMRA Prior Authorization Form IF THIS IS AN URGENT REQUEST, Please Call UPMC Health Plan Pharmacy Services. Otherwise, please return completed form to: UPMC HEALTH PLAN PHARMACY
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How to fill out Actemra - UPMC Health?

01
Start by carefully reading the instructions provided with the Actemra medication.
02
Gather all the necessary materials, including the Actemra medication, syringe, alcohol swabs, and any other items mentioned in the instructions.
03
Wash your hands thoroughly with soap and water before handling the Actemra medication.
04
Choose a clean and well-lit area to prepare and administer the Actemra injection.
05
Open the Actemra medication package and remove the prefilled syringe.
06
Inspect the syringe visually. Make sure the solution is clear and free of any particles. Do not use the syringe if it appears damaged or has expired.
07
Clean the injection site with an alcohol swab and allow it to air dry.
08
Hold the syringe by the body and remove the needle cap. Avoid touching the needle or allowing it to come into contact with any surfaces.
09
With one hand, gently pinch the skin at the injection site to create a small fold.
10
Using your other hand, hold the syringe like a pen and insert the needle into the skin at a 45 to 90-degree angle, depending on the instructions provided.
11
Slowly push the plunger down to inject the Actemra medication. Make sure to inject all the contents of the syringe.
12
Once the injection is complete, carefully remove the needle from the skin.
13
Dispose of the used syringe and needle in a sharps container as per local regulations.
14
Apply gentle pressure to the injection site with an alcohol swab or cotton ball. Do not rub the area.
15
If bleeding occurs, continue applying pressure until it stops, and cover the site with a bandage if necessary.
16
Wash your hands thoroughly after completing the injection.
17
Keep track of the date, time, and location of each Actemra injection in a journal or on a calendar.
18
It is essential to follow the prescribed dosing schedule as directed by your healthcare provider.

Who needs Actemra - UPMC Health?

01
Actemra is a medication primarily used for the treatment of certain autoimmune diseases, such as rheumatoid arthritis and giant cell arteritis.
02
Individuals who experience symptoms like joint pain, swelling, stiffness, and fatigue associated with rheumatoid arthritis may benefit from Actemra.
03
Actemra can also be prescribed for individuals with giant cell arteritis, a condition characterized by inflammation of the blood vessels in the head and neck.
04
A healthcare professional, such as a rheumatologist or a specialist in autoimmune diseases, can determine whether Actemra is the appropriate treatment option based on an individual's medical history and symptoms.
05
Actemra is typically prescribed when other medications, such as nonsteroidal anti-inflammatory drugs (NSAIDs) or disease-modifying antirheumatic drugs (DMARDs), have not provided sufficient relief or have caused undesirable side effects.
06
It is important to consult with a healthcare provider to discuss your specific condition and determine whether Actemra is suitable for your treatment plan.
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