Table 2.

Criteria used to Identify Tocilizumab in Final Algorithm

Hierarchy*	Criterion (applied sequentially)	Additional Criterion	Frequency of claims meeting these criteria
1	|Observed – expected| unit price <=0.0001	None	9.5%
2	|Observed – expected| total allowed amount <= 0.08**	None	64.8%
3	Unit values (dose) are a linear combination of 80 and 200, excluding 200, 400, 600, 800***	None	4.4%
4	|Observed – expected| unit price allowed amount <= $0.033****	Diagnosis for RA (714.X)	2.1%
5	|Observed – Expected | total allowed amount <= $26.40**	Diagnosis for RA (714.X)	19.3%

^*The hierarchy describes the order in which the criteria were applied. Claims were classified as TCZ if they met the criteria in ANY of these rows.

^**This constant was obtained from the previous row, multiplied by 800 (the maximum recommended TCZ dose)

^***certolizumab pegol is typically administered as a 400mg (200mg × 2) injection; exact multiples of 200mg are therefore not specific for TCZ

^****derived from Figure 1