DORSET MEDICINES ADVISORY GROUP Recommendation Summary

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Tabitha Chase
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1 DORSET MEDICINES ADVISORY GROUP Recommendation Summary Formerly the Bournemouth, Dorset and Poole Health Technologies Forum, DMAG represents the four provider Trusts and GPs within the Clinical Commissioning Group (CCG). It provides recommendations to the CCG s clinical commissioning committee (CCC) on the prescribing and commissioning of medicines. Summary of recommendations considered at a meeting of the group on 7 th November Formulary entries and associated documents can be accessed at PRODUCT DECISION COMMENTS 1. Products re-categorised Alginates: Melgisorb Sorbsan Urgosorb Hydrofibres: Aquacel Extra Aquacel Extra Ribbon 2 Hydrating dressings: Purilon Gel Aquaform Gel Actiform Cool Hydrocolloids: Duoderm 1

2 Comfeel Plus without adhesive border Hydrocoll Basic Wound contact layers: Mepitel Antimicrobials: Silver dressings. Aqaucel Ag range Biatain Ag Protease modulating matrix: Promogran Topical negative pressure therapy: Vacutex Ascorbic Acid At the last DMAG meeting, it had been recommended that ascorbic acid be reclassified from green to not recommended on the formulary. It was noted by the formulary working group that there were a small number of patients admitted every year with scurvy, it was proposed by the working group that this be reclassified to red for scurvy patients only. Previous discussions at this DMAG meeting had come to the same conclusion. It was therefore agreed to recategorise ascorbic acid to red for patients with scurvy. simethicone (Infacol and other brands) for endoscopy use only Members were asked to note that there had been work done by the Medicines Optimisation team on BNF drugs classified as Less Suitable to Prescribe. It was noted that the Formulary Working Group would continue to review and make recommendations to other working groups for consideration on the suitability and appropriateness of these drugs to remain on the Formulary or to consider their formulary classification. From this list the group recommends that simethicone (Infacol and other brands) be re-categorised as red for endoscopy use only. 2

3 Formulary entry for Ferrous Fumarate vancomycin for the treatment of C. difficile liothyronine Formulation to be removed from the Formulary entry n amber drug Approved for new patients, amber for patients who cannot be stopped after specialist review and red for mental health indications The group had considered the formulary entry for ferrous fumarate as this specifies syrup but the tablets represent a cost-effective alternative to ferrous sulphate in primary care. It was proposed that mention of the formulation should be removed from the formulary. Members approved the recommendation from the Antimicrobial Working Group to re-classify oral vancomycin for the treatment of C. difficile from red to amber. it was recommended that until the outcome of the NHSE low clinical value consultation was known, liothyronine should be re-categorised as non-formulary for new patients, but for those patients who cannot be stopped after specialist review, to be categorised as amber with shared care guidelines, in order to support the GPs who were asked to continue to prescribe. In addition, it would remain with secondary care for mental health. PRODUCT DECISION COMMENTS 2. New requests Hydrocolloid Fibrous Dressings: KerraCel flat and rope Hydrating dressings: ActiveHeal Hydrogel KerraLite Cool Hydrocolloids: Comfeel Plus Transparent s Members considered a lengthy proposal document written by the Joint Wound Formulary Group. All recommendations for removals and new additions were approved with a review agreed after 6 months to consider financial impact and further product developments. 3

4 Antimicrobials - Manuka honey Medihoney antibacterial honey tulle Medihoney antibacterial wound gel*not just wound gel Medihoney HCS Antimicrobials Silver dressings Askina Calgitrol Paste KerraContact Ag Polyhexylmethylene biguanide (PHMB): Suprasorb X Dialkylcarbamoyl chloride (DACC): Cutimed Sorbact Swabs Cutimed Sorbact gel Both K-Two and K-Two reduced to remain as green K-Lite (standard) Island dressings / ancillary items: Melolin Softpore Clinipore s s s s s Adhesive Tape: Hypafix Ancillary Items K-Soft long green product 4

5 Protease modulating matrix: UrgoClean Protease modulating matrix: Urgostart contact Dimethyl fumarate (Skilarence ) Tofacitinib for moderate to severe rheumatoid arthritis (NICE TA 480) pyrimethamine sulfadiazine for toxoplasmosis Freestyle Libre sensors 3. Products considered by NICE Amber Approved Members approved the addition of dimethyl fumarate (Skilarence ) to the formulary as a red drug within the criteria for use of the NICE TA. It was noted that the guideline for the management of psoriasis does not reflect the biosimilar brands of some of the biologics. It was suggested that this information could be presented in a different way to remove the need for regular updates when a new brand is launched. MT to progress through the dermatology working group. A proposal to include tofacitinib on formulary as a in accordance with the NICE TA was approved. The group heard that to avoid a continual review by DMAG of the locally agreed pathway for the use of biologic and similar agents in rheumatoid arthritis this agent will be added to the pathway within its drug class. The DMAG noted the retrospective formulary applications for pyrimethamine as red on the pan- Dorset formulary. The DMAG noted the retrospective formulary applications for sulfadiazine for toxoplasmosis as red on the pan-dorset formulary. It was noted that the main discussion at the Diabetes Working Group meeting focused on the commissioning of the Freestyle Libre sensors which were included on the Drug Tariff from the 1st November The group decided to defer a recommendation until further information was made available from the DVLA about the use of these sensors and driving. DMAG members noted that the Northern Regional Medicines Optimisation Committee (RMOC) had made a decision to make them available despite the evidence-base being very weak. DMAG members were also asked for some feedback to pass on to the RMOCs regarding their recommendations for Freestyle Libre. 5

6 4. Miscellaneous recommendations by DMAG Position statement for the use of preservative free eye drops Oscillating positive expiratory pressure devices commissioning statement. Approved re-issue of the statement. Approved as not recommended for use The group heard that Dorset County Hospital appeared to be recommending the use of preservative free eye drops routinely. MT agreed to take this forward through a re-issue of the position statement for the use of preservative free eye drops and by putting this forward as an agenda item for the DCH medicines management committee. A commissioning statement had been produced to support recommendations that these items were not to be placed on the formulary until there had been a proper review, and as yet, there was no proposal for inclusion. Members were happy to approve this decision. Roflumilast Shared Care Guidance Alogliptin 5. Further Assessment / Evidence Required Approved Shared Care Guideline Cautionary warning to be added to the Formulary entry for alogliptin A proposed shared care guideline had been developed, following research into how an exacerbation may be defined and explicit exit criteria, which had been circulated to the Respiratory Working Group for consideration and approval. Members approved the shared care guideline pending clarification of the monitoring of LFTs, in line with the SPC and amendment for the generic term of depression screening system rather than specifying a particular tool. Members were asked to consider making alogliptin non-formulary in Dorset, following the working group s review of trial data on heart failure risk. It was considered that as alogliptin is currently the first line choice on the formulary and based on the significant use locally a prudent approach would be to add a caution on the formulary to avoid use in patients with ischemic heart disease (IHD) and recommend to GPs that they search for patients on alogliptin with IHD. This approach was thought to be proportionate to the risk. Compression Therapy products and garments Impact assessment of the Joint Wound Formulary Further discussions around the CBAP with Lewis Manning are required. JWFG to further measure the financial impact of the new formulary It was noted that there may be exceptions to go off formulary for the Lymphoedema Service, placed within DCH, PHFT and Lewis Manning. It was agreed to further discuss the CBAP with Lewis Manning. The Joint Wound Formulary Working Group were asked to further discuss and calculate the potential cost impact of the new formulary, the group hoped that there could be a reduction seen in the costs in this area by having this new formulary in place. 6

7 Breast Site Specific Group s business case for bisphosphonates 6. Expired Documents Reviewed Interim recommendations approved pending further discussions / developments It was noted that a large collaborative meta-analysis had been undertaken to clarify the risks and benefits of adjuvant bisphosphonate treatment in breast cancer. Nationally there is strong clinical support and is additionally supported by breast cancer charities. The group were in support of the interim recommendations pending a commissioning discussion and development of a shared care agreement which should be brought back to the March DMAG. MT will continue to link with the Cancer Partnership to consider the implementation of this proposal and ensure this is raised with the Operational and Finance Reference Group. The business case for bisphosphonates will remain an agenda item for future meetings. Medication which may contribute to falls For further development by the Polypharmacy Working Group It had been identified at the polypharmacy working group that it would be desirable to work to one list consistently across the county. This will be progressed by the working group. Classification of products: RED drugs for hospital use only AMBER with shared care drugs suitable for use with shared care arrangements AMBER drugs suitable for use without shared care arrangements GREEN drugs suitable for prescribing in primary and secondary care Not Recommended' drugs not recommended for use in Dorset The new traffic light system can be found on the Dorset CCG internet at: Dorset CCG - Traffic light scheme 7

HARROGATE & RURAL DISTRICT AREA PRESCRIBING COMMITTEE (HaRD APC) Application for a new product to be added to the formulary

HARROGATE & RURAL DISTRICT AREA PRESCRIBING COMMITTEE (HaRD APC) Application for a new product to be added to the formulary Guidance on completing the form Your submission should be comprehensive and indicate which, if any, information has been supplied by a pharmaceutical company. The application must be completed with the