Tocilizumab: Supply issue

Supply issue Active

Roche has advised it is temporarily unable to supply New Zealand with tocilizumab. Roche is the global supplier of tocilizumab.

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Update 23 November 2021: Alternative tocilizumab IV

From 1 December 2021, additional pharmacodes of alternative tocilizumab stock will be listed on the Pharmaceutical Schedule. 

This stock will be supplied by Link Pharmaceuticals. It is not Medsafe approved  and will need to be supplied under section 29 of the Medicines Act 1981.

More about supplying section 29 medicines – Medsafe website(external link)

Medsafe-approved tocilizumab must be used before the unapproved stock can be used. 

We will be communicating directly to DHB hospitals with more information as needed.

Tocilizumab stock shortage

Roche has informed us that it is temporarily unable to provide New Zealand with tocilizumab. This is due to massive increase in demand worldwide as tocilizumab is being used to treat more severe cases of COVID-19. 

Roche has said it will not be able to re-supply New Zealand until January 2022.

This affects about 400 people currently receiving tocilizumab treatment for a range of clinical conditions. Pharmac is working closely with Roche NZ and DHB hospitals to preserve the stock we currently have and manage supplies to enable continued use for people who are at high risk without treatment.

We have 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.

We will continue to update people as the situation evolves. 

Funded alternatives to tocilizumab

We ask prescribers to consider moving patients currently taking tocilizumab to an alternative funded treatment, where one is available. This allows the remaining stock to be preserved for those without an alternative treatment.

If everyone who can move to an alternative does, we anticipate that stock of tocilizumab can last until January 2022, when resupply is expected.

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 are listing upadacitinib tablets to provide an alternative option for patients from 1 October 2021. This decision will allow us to preserve the remaining tocilizumab stock and ensure people have continued access to treatment. This decision is 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.

We ask that prescribers do not start any new patients on tocilizumab if there is an alternative funded treatment available.

Tocilizumab approved to treat COVID-19

From 1 October 2021, access to tocilizumab will be widened to treat moderate to severe cases of COVID-19.

Pharmac has funded tocilizumab for more than 30 patients through our exceptions decision-making processes for treatment of COVID-19.

Read more about funded 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