Ensuring familiarity with the area

Pharmacy teams and individuals planning on using tocilizumab biosimilar should prepare themselves carefully. Make sure you are aware of, and where necessary read and understand, the following.

National guidelines

Ensure you are familiar with:

• Tocilizumab for the treatment of systemic juvenile idiopathic arthritis (NICE TA238)
• Tocilizumab for the treatment of rheumatoid arthritis (NICE TA247)
• Abatacept, adalimumab, etanercept and tocilizumab for treating juvenile idiopathic arthritis (NICE TA373)
• Adalimumab, etanercept, infliximab, certolizumab pegol, golimumab, tocilizumab and abatacept for rheumatoid arthritis not previously treated with DMARDs or after conventional DMARDs only have failed (NICE TA375)
• Tocilizumab for treating giant cell arteritis (NICE TA518)
• Casirivimab plus imdevimab, nirmatrelvir plus ritonavir, sotrovimab and tocilizumab for treating COVID-19 (NICE TA878)

National commissioning policies

Ensure you are familiar with NHS England clinical commissioning policies:

• Tocilizumab for Takayasu Arteritis 
• Tocilizumab for the treatment of adult-onset Still’s disease refractory to second-line therapy 
• Biologic Therapies for the treatment of Juvenile Idiopathic Arthritis 

Product characteristics

Ensure you are familiar with the Summary of Medicinal Product Characteristics:

• Tyenne 162 mg solution for injection in pre-filled pen
• Tyenne 162 mg solution for injection in pre filled syringe
• Tyenne 20mg/mL concentrate for solution for infusion

SPS resources on biosimilar background

SPS has produced materials to help understand the background to biological and biosimilar medicines as well as the evidence for tocilizumab biosimilar.

SPS resources on pipeline medicines

Be aware of information on pipeline tocilizumab biosimilars. Detail is available from:

• Our annual planning advice for new medicines

Developing an implementation plan

Developing an implementation plan will require working collaboratively across integrated care systems. This will include work within pharmacy as well as with prescribing clinicians, specialist nurses, business managers, finance and contracting teams, pharmaceutical industry and homecare providers.

Identify patients receiving tocilizumab

This work will need to be undertaken with clinicians. You should have an understanding of the number of patients in your organisation receiving tocilizumab currently.

Identify patients eligible for tocilizumab biosimilar

Continue working with clinicians to identify the opportunity for biosimilar introduction. Identify those patients suitable for tocilizumab biosimilar as well as those for whom it would be clinically inappropriate to use the biosimilar.

Ensure use in local pathway of care

To ensure tocilizumab biosimilar can be used within a local care pathway, you should consider a number of factors across the integrated care system; these include:

Staff familiarity

Ensure everyone is comfortable with Understanding biological and biosimilar medicines and the license and supporting evidence for tocilizumab biosimilar. Give opportunity to identify, discuss and address any clinician concerns with both the evidence and its implementation.

Service capacity

Extra capacity may be required to support additional work associated with the introduction so that existing services are not adversely affected.

Consider the potential effects for:

• operational aspects associated with changing homecare provider
• the number of clinic visits, infusions and or injections, and the ability to deliver services safely
• the operational impact for clinicians and specialist nurses on other related clinical services
• pharmacy capacity to dispense and store the medicine
• pharmacy capacity to support, implement and monitor the introduction

Processes

Consider the need to:

• involve homecare leads early – most of the current usage of subcutaneous tocilizumab is delivered by homecare and change of provider may be necessary
• establish processes with clinicians and patients to ensure shared decision making is possible supported by written materials, information sessions, education and patient alert cards
• ensuring staff responsible for implementation prepare themselves using any necessary materials, including information sessions and education
• ensure a workable process for actions to take when reviewing, switching and discontinuing treatments in line with the national recommendations for these medicines

Savings

Ensure savings can be used effectively to offset costs, incentivise change and improve patient care.