The Surrey Heartlands Integrated Care System Area Prescribing Committee (APC) has agreed to support the use of biosimilar ranibizumab to the Surrey Heartlands Health economy in the following licensed indications, in line with the National commissioning recommendations following the national procurement for medical retinal vascular medicines

• Wet Age-Related Macular degeneration (Wet AMD)
• Central Retinal Vein Occlusion (CRVO)
• Branch Retinal Vein Occlusion (BRVO)
•  Diabetic Macular Oedema (DMO)
• Myopic Choroidal Revascularisation (CNV)

Ranibizumab biosimilar should be used (in line with original NICE guidance) instead of the originator ranibizumab (Lucentis®) where this is clinically appropriate and there is capacity to do so. If ranibizumab biosimilar is contraindicated or not clinically appropriate for the specific patient or there are specific clinical considerations then, subject to the criteria specified in the relevant NICE technology appraisal guidance, clinicians should consider aflibercept, brolucizumab or faricimab.

Originator ranibizumab should not be used for new initiations

Clinicians should consider switching patients on originator ranibizumab to biosimilar ranibizumab with patient consent.

The Prescribing Clinical Network recommends the use of ranibizumab as an option for treating visual impairment due to choroidal neovascularisation secondary to pathological myopia in patients in line with NICE TA 298 criteria.

Ranibizumab should be used only by specialists and as such is considered as RED on the traffic light system.

Ranibizumab is excluded from the National Tariff when administered for its licensed indication. It should only be administered within a hospital setting by suitably trained specialists, and will not be transferred to primary care. Providers should apply for funding using the Blueteq system.