Trurapi biosimilar as the best value preferred insulin aspart pre-filled pen device.
Trurapi 3ml pre-filled pen devices are the best value, preferred insulin aspart pre-filled pen device in Dorset. In line with NHSE recommendations, PCN teams are asked to ensure that generic biosimilar insulin aspart accounts for at least 50% of all insulin aspart prescribing in primary care.
Clinical appropriateness should always be considered, and any switches should be discussed and agreed with patients through shared decision-making.
Exclusion criteria:
- < 18 years of age
- Patients prescribed Fiasp products (trurapi is NOT interchangeable with Fiasp products)
- Patients prescribed NovoRapid FlexTouch pre-filled pen device
- Patients on insulin pumps
- Patients who are pregnant or planning to become pregnant
- Documented intolerance or allergy to any excipient listed in the Trurapi SPC or have failed a previous trial of Trurapi
Extra care should be taken when considering Truapi switch for patients:
- who have not had a HbA1c blood test or diabetes review in the last 12 months
- living with cognitive impairment, learning disability, dementia or Alzheimer's.
- Biosimilar insulin aspart (Trurapi) is now available in the UK and is significantly cheaper than Novorapid and generic originator insulin aspart products
- A biosimilar medicine is a biological medicine which has been shown not to have any clinically meaningful differences from the originator medicine in terms of quality, safety and efficacy. Where NICE has already recommended the originator biological medicine, the same guidance applies to a biosimilar of that originator. NHS England aims to drive a step change in the uptake of biosimilar medicines by integrated care systems (ICS)
- Switching to insulin biosimilars will help PCN teams care for patients within their NHS England financial envelope and hence release funds to improve unmet needs in prevention.
- Early switching is recommended to maximise cumulative in year cost savings
Notify community pharmacy colleges of the intention to switch to Trurapi biosimilar prefilled pens.
Work with community pharmacy colleagues to ensure sufficient stock of Trurapi is available to support the switching programme and minimise disruption to patients, GP and community pharmacy teams.
Run the SystmOne searches provided to identify existing patients prescribed branded Novorapid and generic insulin aspart pre-filled pen products other than Trurapi.
Dorset SystmOne GPs>PINH 2627> 4a Biosimilar insulin>4c Work to do: T2DM with insulin aspart prefilled pens RPT consider switching to Trurapi biosimilar prefilled pens
Dorset SystmOne GPs>PINH 2627> 4a Biosimilar insulin>4c Work to do: T1 diabetes with insulin aspart prefilled pens RPT consider switching to Trurapi biosimilar prefilled pens
A risk management approach should be taken, to any batch-switching arrangement, which includes safeguards which enable patients to have a review, should they have any queries or changes to their condition.
Agree a patient-centred process for switching patients within the practice and convert patients accordingly.
Switch patients to the appropriate Trurapi device as below:
| Originator insulin | Switch to equivalent biosimilar insulin product |
|---|---|
| NovoRapid FlexPen (insulin aspart 100units/ml solution for injection) 3ml pre-filled pens | Prescribe Trurapi Solostar (insulin aspart 100units/ml solution for injection) 3ml pre-filled pens |
| Generic insulin aspart 100units/ml solution for injection, 3ml pre-filled pens | Prescribe Trurapi Solostar (insulin aspart 100units/ml solution for injection) 3ml pre-filled pens |
Ensure all insulins including biosimilar insulins are prescribed by brand name and provide the strength or the provided insulin.
Switching a patient from NovoRapid to Trurapi can be done unit-to-unit based on the previous fast-acting insulin dose.
Patients should continue to monitor their blood glucose as usual and continue to use their current insulin needles.
Encourage patients to use up existing insulin supplies prior to starting their new biosimilar insulin.
Safety net the patient to report any concerns about glucose levels to the practice diabetes team.
Update the repeat prescription template and summary care record
Update the patient's insulin passport.
For further information and advice for healthcare professionals when starting treatment with a biosimilar, the MHRA has guidance on minimising the risk of medication error with high-strength, fixed combination and biosimilar insulin products, which ensures the risk of medication errors with insulins is minimised. Biosimilar insulins are black triangle drugs. Report any suspected adverse effects to the MHRA via the Yellow Card reporting scheme Yellow Card | Making medicines and medical devices safer.
Provide appropriate counselling where appropriate.
Sanofi offer a pre-filled pen recycling programme. More information can be found here : RePen – | Sanofi Diabetes Patients Website
How to communicate this to patients:
Use the template patient text message and letter in SystmOne to notify patients of the change. Ensure patient is counselled appropriately.
Patient text message:
NovoRapid FlexPen:
"NHS Dorset have asked GP teams to review prescriptions for Novorapid Flexpens and switch to a new pen Trurapi Solostar. Trurapi Solostar pen is a biosimilar insulin and is the preferred insulin aspart in Dorset. Trurapi is considered clinically interchangeable with NovoRapid. The dosage will not change, and the insulin will work in the same way. Please use up your existing insulin supply prior to starting the new Trurapi solostar pen. Please read the patient information leaflet provided and if you have any questions regarding this change, please discuss with you community pharmacist or GP practice team".
Template patient letter:
Insulin aspart prefilled pen to trurapi template letter
References:
NHS England » What is a biosimilar medicine?
Biosimilar-uptake-patient-letter-template-Jul24.docx
Trurapi® ▾ | Sanofi Diabetes Patients Website
RePen – | Sanofi Diabetes Patients Website
NHS England » Biosimilar medicines
NHS Dorset Biosimilar documents can be found on the front page of the Dorset Formulary
Dorset adult insulin formulary for type 1 & type 2 diabetes
NICE NG17: type 1 diabetes in adults: diagnosis and management
Tracking achievement:
Numerator divided by Denominator from SystmOne searches x 100 for %
Trurapi biosimilar as the best value preferred insulin aspart cartridge. Switches to be completed in clinic as part of scheduled diabetes review. New disposable pen device to be provided during review.
Trurapi is the best value, preferred insulin aspart product in Dorset. In line with NHSE recommendations, PCN teams are asked to ensure that generic biosimilar insulin aspart accounts for at least 50% of all insulin aspart prescribing in primary care.
Clinical appropriateness should always be considered, and any switches should be discussed and agreed with patients through shared decision-making.
Exclusion criteria:
- < 18 years of age
- Patients prescribed Fiasp products (trurapi is NOT interchangeable with Fiasp products)
- Patients prescribed NovoRapid PumpCart 1.6ml cartridges
- Patients on insulin pumps
- Patients who are pregnant or planning to become pregnant
- Patients who use a smart insulin pen device with their insulin cartridges
- Documented intolerance or allergy to any excipient listed in the Trurapi SPC or have failed a previous trial of Trurapi
Extra care should be taken when considering Truapi switch for patients:
- who have not had a HbA1c blood test or diabetes review in the last 12 months
- living with cognitive impairment, learning disability, dementia or Alzheimer's.
- Biosimilar insulin aspart (Trurapi) is now available in the UK and is significantly cheaper than Novorapid and generic originator insulin aspart products
- A biosimilar medicine is a biological medicine which has been shown not to have any clinically meaningful differences from the originator medicine in terms of quality, safety and efficacy. Where NICE has already recommended the originator biological medicine, the same guidance applies to a biosimilar of that originator. NHS England aims to drive a step change in the uptake of biosimilar medicines by integrated care systems (ICS)
- Switching to insulin biosimilars will help PCN teams care for patients within their NHS England financial envelope and hence release funds to improve unmet needs in prevention.
- Early switching is recommended to maximise cumulative in year cost savings
Notify community pharmacy colleges of the intention to switch to Trurapi biosimilar cartridges.
Work with community pharmacy colleagues to ensure sufficient stock of Trurapi is available to support the switching programme and minimise disruption to patients, GP and community pharmacy teams.
Patients using insulin aspart cartridges will require a new reusable pen device when switching to Trurapi. Pens can be ordered direct from Sanofi into GP practices. It is therefore recommended that patients are switched opportunistically to Trurapi cartridges as part of standard diabetes reviews. Reusable pens can be ordered into GP practices in advance and given to patients at the time of prescribing Trurapi cartridges.
Check patients get the intended insulin with the correct delivery device for that insulin and are trained on how to use it.
Trurapi cartridges should only be used with the following pens:
- JuniorSTAR which delivers Trurapi in 0.5 unit dose increments
- Allstar PRO which delivers Trurapi in 1 unit dose increments
Contact Sanofi 0800 035 2525 for supplies of durable pens and patient information leaflets prior to converting patients to Trurapi.
Run the SystmOne searches provided to identify existing patients prescribed branded Novorapid and generic insulin aspart cartridges and consider switch to Trurapi:
Dorset SystmOne GPs>PINH 2627> 4a Biosimilar insulin>4c Work to do: T2DM with Insulin aspart cartridges RPT consider switching to Trurapi biosimilar cartridges
Dorset SystmOne GPs>PINH 2627> 4a Biosimilar insulin>4c Work to do: T1 diabetes with Insulin aspart cartridges RPT consider switching to Trurapi biosimilar cartridges
Agree a patient-centred process for switching patients within the practice and convert patients accordingly.
Switch patients to the appropriate Trurapi device as below:
| Originator insulin | Switch to equivalent biosimilar insulin product |
|---|---|
| NovoRapid Penfill (insulin aspart 100units/ml solution for injection) 3ml cartridges | Trurapi (insulin aspart 100units/ml solution for injection) 3ml cartridges |
| Generic insulin aspart 100units/ml solution for injection, s OR 3ml cartridges | Prescribe Trurapi (insulin aspart 100units/ml solution for injection) 3ml cartridges |
Ensure all insulins including biosimilar insulins are prescribed by brand name and provide the strength or the provided insulin.
Switching a patient from NovoRapid to Trurapi can be done unit-to-unit based on the previous fast-acting insulin dose.
Patients should continue to monitor their blood glucose as usual and continue to use their current insulin needles.
Encourage patients to use up existing insulin supplies prior to starting their new biosimilar insulin.
Safety net the patient to report any concerns about glucose levels to the practice diabetes team.
Update the repeat prescription template and summary care record
Update the patient's insulin passport.
For further information and advice for healthcare professionals when starting treatment with a biosimilar, the MHRA has guidance on minimising the risk of medication error with high-strength, fixed combination and biosimilar insulin products, which ensures the risk of medication errors with insulins is minimised. Biosimilar insulins are black triangle drugs. Report any suspected adverse effects to the MHRA via the Yellow Card reporting scheme Yellow Card | Making medicines and medical devices safer.
Provide appropriate counselling where appropriate.
How to communicate this to patients:
Use the template patient text message and letter in SystmOne to notify patients of the change. Ensure patient is counselled appropriately.
Patient text message:
NovoRapid cartridges:
"NHS Dorset have asked GP teams to review prescriptions for Novorapid Cartridges and switch to a new cartridge Trurapi. Trurapi Solostar pen is a biosimilar insulin and is the preferred insulin aspart in Dorset. Trurapi is considered clinically interchangeable with NovoRapid. The dosage will not change, and the insulin will work in the same way. Please use up your existing insulin supply prior to starting the new Trurapi cartridges. To administer the Trurapi, you will require a new insulin pen, this will be provided to you with instructions for how to use this. Please read the patient information leaflet provided and if you have any questions regarding this change, please discuss with you community pharmacist or GP practice team".
Template patient letter:
Insulin aspart CARTRIDGES patient template letter
How to monitor progress:
Volume of patients switched to best value will be published within the DiiS Prescribing Improvement in Neighbourhood Health 26 27 dashboard
References:
NHS England » What is a biosimilar medicine?
Trurapi® ▾ | Sanofi Diabetes Patients Website
Biosimilar-uptake-patient-letter-template-Jul24.docx
NHS England » Biosimilar medicines
NHS Dorset Biosimilar documents can be found on the front page of the Dorset Formulary
Dorset adult insulin formulary for type 1 & type 2 diabetes
NICE NG17: type 1 diabetes in adults: diagnosis and management
Tracking achievement:
Numerator divided by Denominator from SystmOne searches x 100 for %
