Biologic or Biosimilar Medicines

• The following biologic or biosimilar medicines are designed to block parts of your child’s immune system—the part of their body designed to fight germs that make them sick. This is necessary when your child’s immune system is fighting too hard and hurts healthy parts of their body.
• Biologic medicines block the immune system to reduce pain and swelling (inflammation) in their joints and body tissues. We want to reduce inflammation to prevent joint and tissue damage.

• A biosimilar is a Food and Drug Administration (FDA)-approved copycat version of familiar biologic medicines. Once the patent on a biologic expires, drug companies can make their own version of that biologic. While they are very similar, biosimilars may come in different packaging or autoinjectors.
• Usually, an insurance company has picked a drug company to contract with to get the best price and will require that you try their preferred biosimilar.
• Biosimilar medicines are available for several of the biologic medicines listed below. Since there are several and these keep changing, we have not specified brand names.
• In this handout, the term biologic can also apply to biosimilar.

This handout gives examples of brand name medicines next to the generic; this is not a full list.

Please note that we may offer a biosimilar drug for any of the options below.

The drugs listed below follow this pattern:

Type of cell the drug targets   • Generic (Brand name) – how you take it

• Adalimumab (Humira, Hadlima, Amjevita, Hyrimoz, Simlandi) – injection
• Certolizumab (Cimzia) – injection
• Etanercept (Enbrel) – injection
• Infliximab (Remicade, Avsola, Inflectra, Renflexis) – infusion
• Golimumab (Simponi) – injection or infusion

• Anakinra (Kineret) – daily injection
• Canakinumab (Ilaris) – monthly injection
• Rilonacept (Arcalyst) – injection

• Tocilizumab (Actemra, Tyenne, Tofidence) – infusion or injection
• Sarilimumab (Kevzara) – injection

• Belimumab (Benlysta) – infusion or injection
• Rituximab (Rituxan, Ruxience, Truxima) – infusion
• Ocrelizumab (Ocrevus) – infusion

Abatacept (Orencia) – infusion or injection

Secukinumab (Cosentyx) – infusion or injection

Usetekinumab (Stelara, Steqeyma, Yesintek) – injection

• Your child will take biologic medicines by needle (injection, usually under the skin or subcutaneous) or an IV (intravenous) tube into their body (called infusion). Some injectable medicines may sting. Please call the nurse line for information about ways to help decrease the stinging.
• Your child can get infusions at an infusion center, or you can do them at home, depending on what your insurance covers. Many children over the age of 12 years tolerate infusions at home well.

• Before your child starts a biologic medicine, we require a TB (tuberculosis) skin test or blood test called QuantiFERON Gold.
• If the results are positive, your child may need further tests before they start the medicine.

• You get biologic medicines from specialty mail order pharmacies. When the medicine arrives at your home, please put it in your refrigerator right away.
• Always keep biologic medicines refrigerated, but never freeze them.
• Take the medicine out of the refrigerator 30 to 60 minutes before giving your child the injection.

• Biologic medicines cost a lot of money. All insurance companies need to authorize the drug before they will cover the cost (prior authorization). On average, it can take 4 weeks to get the medicine approved.
• If your insurance company does not approve the biologic medicine, your healthcare provider can help you ask again (file an appeal). Sometimes the drug companies will cover the cost. Use the websites listed below to learn more.
• If you ever change insurance, please contact our office right away, so we can get a new prior authorization.

• Your child should not have any live vaccines while they are taking a biologic medicine, including FluMist (nasal spray flu vaccine), MMR (measles/mumps/rubella), OPV (oral polio vaccine), rotavirus, smallpox, typhoid, chickenpox (varicella), yellow fever and zoster.
• Non-live or killed vaccines like the flu shot, polio shot, COVID vaccines, and Hepatitis A are OK while taking a biologic medicine.

• It is common to see local injection or infusion site reactions such as stinging, redness, or itching.
• Icing the site before and after the injection can help with this.
• If you notice any site reactions, call the Rheumatology nurse line at 206-987-2193 Monday to Friday, 8 a.m. to 5 p.m.

The companies that make these medicines often have special programs to help you pay for them and learn how to use them.

• Co-pay Savings Cards: If you have insurance through a job or a plan you bought yourself, you can often get a co-pay card. These cards can make your medicine much cheaper, sometimes costing you only a few dollars.
• Patient Support Programs: These programs offer extra help beyond just money. They can connect you with a nurse to teach you how to take your medicine or help you with insurance paperwork.

The best way to find help is to go online and search for the name of your medicine plus the word "savings" or "support." Always make sure you are looking at the official company website to get the right information.