Tocilizumab: Supply issue resolved
Roche has advised Pharmac it expects to meet New Zealand demand for intravenous tocilizumab (Actemra) for the second half of 2022. This means supply management is now returning to usual systems from July 2022.
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Update 21 July 2022
Supply of IV tocilizumab is returning to standard supply processes.
Roche has advised Pharmac it expects to meet New Zealand demand for tocilizumab (Actemra IV) for the second half of 2022. This means supply management is now returning to usual systems from July 2022.
- If people meet the Special Authority criteria for tocilizumab (including non-COVID-19 indications), treatment with tocilizumab can be initiated. No approval from Pharmac is required.
- Some people with rheumatoid arthritis (RA) were transitioned to upadacitinib as a result of the tocilizumab shortage. For the small percentage of people experiencing intolerable side effects or not receiving adequate benefit, treatment with tocilizumab can be restarted without approval from Pharmac.
We will continue to work with Roche to monitor supply of tocilizumab and the impact of ongoing usage for COVID-19.
Tocilizumab stock shortage October 2021
In late 2021, Roche informed us that it is temporarily in short supply of tocilizumab. This was due to massive increase in demand worldwide as tocilizumab is used to treat more severe cases of COVID-19. Roche is the global supplier of tocilizumab.
Throughout this time, Roche continued to deliver some stock of tocilizumab to ensure people could access treatment. Pharmac secured alternative unapproved supply from other sources. This was not used or needed.
This affected about 400 people currently receiving tocilizumab treatment for a range of clinical conditions. Pharmac working closely with Roche NZ and DHB hospitals to preserve the stock we hand and manage supplies to enable continued use for people who were at high risk without treatment.
We received advice that people with the following conditions do not have an alternative to tocilizumab treatment.
- polyarticular juvenile idiopathic arthritis
- systemic juvenile idiopathic arthritis
- adult-onset Still’s disease who have trialled the funded alternatives
- idiopathic multicentric Castleman’s disease who have trialled the funded alternatives
- cytokine release syndrome
- in hospital with moderate to severe COVID-19
- accessing tocilizumab via the Named Patient Pharmaceutical Assessment (NPPA) pathway.
Thank you
We acknowledge the impact this disruption has on people. Thanks to all those across the healthcare sector who are supporting this work. We appreciate the work everyone is doing to minimise the impact of this disruption.
Funded alternatives to tocilizumab
We asked prescribers to consider moving patients currently taking tocilizumab to an alternative funded treatment, where one was available. This allowed the remaining stock to be preserved for those without an alternative treatment.
There are several alternative funded treatments listed on the Pharmaceutical Schedule.
| Indication | Funded alternative treatments |
|---|---|
| Rheumatoid arthritis | Adalimumab, etanercept, rituximab, infliximab, upadacitinib |
| Adult-onset Still’s disease | Adalimumab, etanercept |
| Idiopathic multicentric Castleman’s disease | Siltuximab |
Patient does not meet Special Authority criteria
You can apply for a Special Authority waiver if you would like to prescribe your patient a funded alternative and they do not currently meet the Special Authority criteria. We will process these requests as rapidly as possible to minimise delay for patients.
If you would like to apply for a waiver, email the relevant Special Authority form for the medicine and indication you are seeking funding for to waivers@pharmac.govt.nz with confirmation that your patient has an active Special Authority approval for tocilizumab.
Read more about our waiver process
You can find all the Special Authority forms here(external link)
Upadacitinib: treatment option for rheumatoid arthritis patients
We listed upadacitinib tablets to provide an alternative option for patients from 1 October 2021. This decision helped preserve the remaining tocilizumab stock while ensuring people could continue to access treatment. This decision was based on advice from rheumatology clinical experts.
Read the full decision (including funding criteria)
As always, it is for health care professionals to decide on the best treatment for the people in their care.
Although we have received additional stock of tocilizumab since the initial notification of a stock shortage in 2021, we ask that prescribers only start new patients on tocilizumab if there are no suitable funded alternative treatments available.
Tocilizumab approved to treat COVID-19
From 1 October 2021, access to tocilizumab was widened to treat moderate to severe cases of COVID-19.
Pharmac had funded tocilizumab before that (for more than 30 patients) through our exceptions decision-making processes for treatment of COVID-19.
Tocilizumab datasheet - Medsafe [PDF](external link)
Medsafe's update on applications for COVID-19 treatments(external link)
New Zealand's portfolio of COVID-19 treatments
Who to contact
If you take tocilizumab, talk to your doctor or specialist. They can discuss the best treatment options with you.
If you have questions about the supply of tocilizumab, contact Roche on 0800 656 464
If you have questions about the supply of upadacitinib, contact AbbVie on 0800 848 243
If you have any questions about the funding of medicines, you can email us at enquiry@pharmac.govt.nz