GREAT WESTERN HOSPITALS NHS FOUNDATION TRUST. Formulary Working Group 2.00pm 16 th July 2015 Seminar Room 5, The Academy, GWH

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1 Formulary Working Group 2.00pm 16 th July 2015 Seminar Room 5, The Academy, GWH The 3T s Formulary Swindon CCG & Wiltshire CCG Great Western Hospitals NHS Foundation Trust (In collaboration with Avon and Wiltshire Mental Health Partnership and Oxford Health NHS Foundation Trust Attendees: Dr Ravi Chinthapalli () (chair) Lisa King () Dr Rachel Hobson () Kathryn Buchanan (KB) Dr Peter Mack (PM) Dr Nirmalan Arulanantham (NA) Apologies: Paul Clarke (PC) Consultant Paediatrician & Chair, GWHNHSFT Formulary Pharmacist, GWHNHSFT Formulary Pharmacist, Wiltshire CCG Pharmacist, Swindon CCG GP representative, Swindon CCG (meeting Chair) Locum Consultant, GWHNHSFT Pharmaceutical Advisor, Swindon CCG In attendance: Veronika Oross, Medicines optimisation Pharmacists, Swindon Dr Tom Hyde (TH) Consultant Cardiologist Agenda Item 1 APOLOGIES Description Action by whom Action by when MINUTES OF LAST MEETING The minutes of May meeting were agreed as accurate. to upload pdf version to formulary website and forward to TPC for information. MATTERS ARISING Lisdexamphetamine SCA approved subject to amending typos and reference to brand on p4. To be uploaded on formulary website once amendments made. Sodium chloride 5% p/f eye drops and 5% ointment - approved for use subject to clarification of indication and place in therapy (to be circulated out of meeting). Prescription requests from GWH need to be clearly documented. Ciclosporin eye ointment - subject of a forthcoming NICE TA so no action for FWG at this stage. Octasa GI consultants happy to support switches in primary care as long as patients are informed and offered the opportunity for discussion. They request no referrals back to secondary care before next routine appointment for discussions on changing brand. Alogliptin Suggestion that gliptin section is reviewed. Dr Vaks to provide info. Dr Tom Hyde in attendance. Proposal that ticagrelor replaces clopidogrel as 1 st line post NSTEMI treatment. Currently ticagrelor placed lower down our treatment pathway. NICE TA does not specify where it should sit in pathway. Impact on budgets would be significant ( 500k-1m per annum). Business case will need to go to Swindon & Wiltshire CCG clinical executive committees for decision. KB / VV TH T:\Pharmacy\3 T's Formulary\FWG Meetings\FWG Minutes\Mins_2015\FWG_Minutes_16 July_2015.Doc Page 1 of 5

2 CHAPTER/SECTION UPDATES Management of Lipids Meetings had with Dr Vaks and Dr Colley. Still issues to be resolved around the biochemistry measurements on offer. Meeting with Trust planned before next FWG. Primary care Antibiotic Guidance. Short version is just about ready for sign off but discrepancies between GWH, UHB and SFT around pivmecillinam and ability to use. Intention is therefore to send out without the pivmecillinam addition. to forward final version for circulation to FWG and approval outside of meeting. Fosfomycin change in supply route as it is now licensed. Can now go through FP10 and community pharmacies, although will still be on microbiology recommendation only. CCGs to inform prescribers and website information to be updated to reflect. Microbiology also needs to be informed. COPD Guidance V19 is latest version and will be circulated for final comments before approval outside of meeting. Final version of inhaler guide will also be sent. GWH Respiratory team has commented on COPD guidance but has not yet seen inhaler guide. Dr Stanton had asked for additional inhalers to be included in COPD guidance. FWG agreed that, in view of time constraints and need for more detailed discussion about additional inhalers, these would not make this edition of COPD guidance, but discussions could be had ahead of next edition. to discuss with Dr Stanton. Inhaler guide to be circulated to GWH Respiratory team; a no comment will be taken as approval from the respiratory team. CCGs keen for a respiratory strategy covering use of branded generics in particular as significant potential for savings this year. to suggest extra-ordinary respiratory meeting in August (previous FWG date) as would be helpful to know the respiratory team s views ahead of North Wiltshire training sessions. Wiltshire traffic light status analysis has identified some key drug areas where the traffic light status and associated advice is different between GWH, SFT & UHB and has requested reviews by the out of line Trust for those conflicting areas. Straightforward changes e.g. where blue needs to go to green are to be done by outside of meeting. More complex cases are to be ed around the group out of meeting for discussion / decision. Aim to be circulated by 20 th August Pressure on Wilts to have consistency now because of new primary care software system in place (First Databank), although where there are specific reasons for a drug to have a different TLS on a particular formulary (e.g. due to different commissioning arrangements), it remains possible to direct prescribers to individual formulary advice. KB /All KB / 5 NEW DRUG Update The UKMI NDO Newsletters for May and June 2015 were tabled for discussion. Drugs of note: T:\Pharmacy\3 T's Formulary\FWG Meetings\FWG Minutes\Mins_2015\FWG_Minutes_16 July_2015.Doc Page 2 of 5

3 Perampanel additional licensed indication as adjunct in tonic clonic seizures in over 12s. using in under 12s occasionally New Drug Requests Vesomni Mr Iacovou Previous request to formulary was denied. Information regarding the patent expiry of solifenacin had been submitted as way of appeal. The committee turned down the formulary application for a number of reasons 1) Generally combination products are not seen as advantageous, particularly because of the inflexible dosing (is the case with Vesomni) 2) Applicable to small numbers of patients therefore a small cost saving in primary care balanced against the time involved in switching now and also in a few years when switching back to generic when patent expires. to feedback to Mr Iacovou. Fesoterodine Mr Beck requested consideration of fesoterodine on formulary on behalf of Urology. If there is additional evidence from previous submission, this should be submitted through the formal channels. to send urologists Newcastle tables with comparative costs of OAB drugs for information. to feedback to Mr Beck. Ganciclovir 0.15% eye ointment Mr Smith This was added to the formulary as an AMBER drug, for use in Herpes Simplex Viral Keratitis resistant to Aciclovir. There is no other available treatment for this condition. NICE NICE TAs TA 341 Apixaban for the treatment and secondary prevention of deep vein thrombosis and/or pulmonary embolism. This will be added to formulary as AMBER drug. Guidance will need to be updated also. TA 339 Omalizumab for previously treated chronic spontaneous urticarial. This will be added to the formulary as a RED drug. Given cost need to ensure it been discussed at TPC. TA 340 Ustekinumab for treating active psoriatic arthritis. This will be added to formulary as RED. TA 342 Vedolizumab for treating moderately to severely active ulcerative colitis. This will be added to formulary as a RED drug, but need to confirm pt group with TPC. 8 MHRA Drug Safety Updates Relevant links from the formulary to the alerts will be added for erythropoietin, SGLT2 inhibitors, Ibuprofen and IUDs. T:\Pharmacy\3 T's Formulary\FWG Meetings\FWG Minutes\Mins_2015\FWG_Minutes_16 July_2015.Doc Page 3 of 5

4 9 AOB Longtec new strengths are available and use being endorsed in primary care; 15mg mg mg mg Formulary to be updated accordingly. Melatonin GWH are considering using a particular brand of unlicensed liquid for Trust use as it is cheaper than the licensed Circadin, often used off label in children. to check with CD re appropriateness of this decision; concerns 1) unlicensed preparation where licensed available 2) liquid requests passed to primary care are likely to go through as more expensive specials. Concern raised at amount of prescribing passed onto primary care despite traffic light status agreed as RED. Primary care data to be shared. KB / Infliximab biosimilars gastroenterology and rheumatology are ready to start using. Inflectra is in stock. 3Ts wording will remain as infliximab. Dicycloverine to be removed from formulary as per previous correspondence as rarely initiated now but high cost. Fluoxetine dispersible stocked recently as cheaper than fluoxetine liquid. Group happy to keep website entry non-specific with regard to formulation. Insulin Degludec Group are happy with degludec formulary status switching from RED to AMBER for 1) pre insulin pump patients or 2) where a high volume of insulin is required. This is subject to the audit of existing 16 patients who have been initiated. Swindon team are happy to help with the audit if nec. Family Planning proposing to switch Microgynon / Rigevidon to Maexeni Lucette to Acondro Cerelle to Feanolia Need to check savings to whole health economy from switching. Swindon have been switching to Consilient brands for some time, Wiltshire have made similar decision more recently so may be disruptive and confusing to change again now. KB Rachel has been successful in securing a position as a NICE TAG advisor in addition to Wiltshire role. Dr Arulanantham is leaving GWH and this will be his last FWG meeting in attendance. T:\Pharmacy\3 T's Formulary\FWG Meetings\FWG Minutes\Mins_2015\FWG_Minutes_16 July_2015.Doc Page 4 of 5

5 Next FWG Meeting: Next meeting is 17 th September pm Seminar Room 5, The Academy, GWH Future Meetings: 19 th November 2015 Seminar Room 7, The Academy, GWH pm Agreed as an Accurate Record: Chair: T:\Pharmacy\3 T's Formulary\FWG Meetings\FWG Minutes\Mins_2015\FWG_Minutes_16 July_2015.Doc Page 5 of 5