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KENT AND MEDWAY HEALTH ECONOMY NATIONAL TARIFF EXCLUDED DRUGS

Summary of Current Arrangements 2017/18

Contents

NATIONAL TARIFF EXCLUDED DRUGS: SUMMARY OF CURRENT ARRANGEMENTS ...... 10

MANAGEMENT OF NATIONAL TARIFF EXCLUDED DRUGS ...... 11 Payment Arrangements ...... 12 Responsibilities ...... 12 Amendment Sheet ...... 13 3, 4 DIAMINOPYRIDINE ...... 15 ABACAVIR ...... 16 ABACAVIR with DOLUTEGRAVIR and LAMIVUDINE ...... 17 ABACAVIR with LAMIVUDINE ...... 18 ABALOPARATIDE ...... 19 ABATACEPT ...... 20 ABATACEPT (CCG) ...... 21 ABIRATERONE ...... 22 ADALIMUMAB ...... 23 ADALIMUMAB (CCG) ...... 24 ADEFOVIR ...... 25 AFAMELANOTIDE ...... 26 AFATINIB ...... 27 AFLIBERCEPT ...... 28 AFLIBERCEPT (CCG) ...... 29 AGALSIDASE ALFA ...... 30 AGALSIDASE BETA ...... 31 AGANIRSEN ...... 32 ALBUTREPENONACOG ALFA ...... 33 ALDESLEUKIN ...... 34 ALEMTUZUMAB ...... 35 ALGLUCOSIDASE ALFA ...... 36 ALIPOGENE TIPARVOVEC ...... 37 ALIROCUMAB ...... 38 ALITRETINOIN ...... 39 ALPHA-1 ANTITRYPSIN ...... 40 ALPHA MANNOSIDASE RECOMBINANT HUMAN ...... 41 AMBRISENTAN ...... 42 AMIFAMPRIDINE PHOSPHATE ...... 43 AMIKACIN INHALATION ...... 44 AMIKACIN LIPOSOMAL ...... 45 AMPHOTERICIN LIPOSOMAL ...... 46 ANAKINRA ...... 47 ANAKINRA (CCG) ...... 48 ANIDULAFUNGIN...... 49 ANTIHAEMOPHILIC FACTOR/VON WILLEBRAND FACTOR COMPLEX ...... 50 ANTILYMPHOCYTE GLOBULIN ...... 51 ANTITHROMBIN III ...... 52 ANTITHYMOCYTE IMMUNOGLOBULIN ...... 53 APREMILAST ...... 54 APREMILAST (CCG) ...... 55 ARAGAM® ...... 56

ASFOTASE ALPHA ...... 57 ASUNAPREVIR with DACLATASVIR ...... 58 ATACICEPT ...... 59 ATALUREN ...... 60 ATAZANAVIR ...... 61 ATAZANAVIR and COBICISTAT ...... 62 AVATROMBOPAG ...... 63 AXITINIB ...... 64 AZACITIDINE ...... 65 AZATHIOPRINE ...... 66 AZTREONAM LYSINE ...... 67 BARICITINIB ...... 68 BARICITINIB (CCG) ...... 69 BASILIXIMAB ...... 70 BECLABUVIR ...... 71 BEDAQUILINE FUMARATE ...... 72 BEGELOMAB ...... 73 BELATACEPT ...... 74 BELIMUMAB ...... 75 BENRALIZUMAB ...... 76 BENDAMUSTINE ...... 77 BERACTANT ...... 78 BETAINE ...... 79 BEVACIZUMAB ...... 80 BEVACIZUMAB (CCG) ...... 81 BIOTIN ...... 82 BLINATUMOMAB ...... 83 BLISIBIMOD ...... 84 BOCEPREVIR ...... 85 BORTEZOMIB ...... 86 BOSENTAN ...... 87 BOSUTINIB ...... 88 BOTULINUM TOXIN ...... 89 BOTULINUM TOXINS A & B (CCG) ...... 90 BOTULINUM TOXINS A & B (CCG) ...... 90 BRODALUMAB ...... 91 Brodalumab ...... 92 (Kyntheum®) ...... 92 BRENTUXIMAB ...... 93 C1 ESTERASE INHIBITOR ...... 94 CABAZITAXEL ...... 95 CABOZANTINIB ...... 96 CANAKINUMAB ...... 97 CARGLUMIC ACID ...... 98 CARNITINE ...... 99 CASPOFUNGIN ...... 100 CATRIDECACOG ...... 101 CERLIPONASE ALFA ...... 102 CERITINIB ...... 103 CERTOLIZUMAB PEGOL ...... 104 CERTOLIZUMAB PEGOL (CCG) ...... 105 CETUXIMAB ...... 106 CHEMOTHERAPY ...... 107 CHENODEOXYCHOLIC ACID ...... 108

CHOLIC ACID ...... 109 CICLOSPORIN ...... 110 CIDOFOVIR ...... 111 CINACALCET ...... 112 CIPROFLOXACIN INHALATION ...... 113 CIPROFLOXACIN LIPOSOMAL (INHALED) ...... 114 CLADRIBINE ...... 115 CLOFARABINE ...... 116 COBICISTAT ...... 117 COBITOLIMOD ...... 118 CO-CARELDOPA INTERNAL TUBE INTESTINAL GEL ...... 119 COLESTILAN ...... 120 COLISTIMETHATE SODIUM ...... 121 COLLAGENASE CLOSTRIDIUM HISTOLYTICUM ...... 122 CONESTAT ALFA ...... 123 CRIZOTINIB ...... 124 CX601 ...... 125 CYSTEAMINE BITARTRATE ...... 126 CYSTEAMINE HYDROCHLORIDE ...... 127 DABRAFENIB...... 128 DACLATASVIR ...... 129 DACLIZUMAB ...... 130 DAMOCTOCOG ALFA PEGOL ...... 131 DARBEPOETIN ...... 132 DARUNAVIR ...... 133 DARUNAVIR with COBICISTAT ...... 134 DASABUVIR ...... 135 DASATINIB ...... 136 DECITABINE ...... 137 DEFERASIROX ...... 138 DEFERIPRONE ...... 139 DEFIBROTIDE ...... 140 DELAMANID ...... 141 DESFERRIOXAMINE ...... 142 DEXAMETHASONE INTRAVITEAL IMPLANT ...... 143 DEXRAZOXANE ...... 144 DIBOTERMIN ALFA ...... 145 DIDANOSINE ...... 146 DIGOXIN IMMUNE FAB ...... 147 DIMETHYL FUMARATE ...... 148 DIMETHYL FUMARATE (CCG) ...... 149 DOLUTEGRAVIR ...... 150 DORNASE ALFA...... 151 Dupilumab ...... 152 DUPILUMAB ...... 153 ECULIZUMAB ...... 154 EFAVIRENZ...... 155 EFRALOCTOCOG ALPH / EFMOROCTOCOG ALFA / FACTOR VIII FC FUSION PROTEIN...... 156 EFTRENONACOG ALFA ...... 157 ELBASVIR + GRAZOPREVIR ...... 158 ELIGLUSTAT ...... 159 ELOSULFASE ALFA ...... 160 ELTROMBOPAG ...... 161 ELTROMBOPAG (CCG) ...... 162

ELVITEGRAVIR ...... 163 EMTRICITABINE ...... 164 EMTRICITABINE with TENOFOVIR ...... 165 EMTRICITABINE with TENOFOVIR ALAFENAMIDE ...... 166 ENFUVIRTIDE ...... 167 ENTECAVIR ...... 168 ENZALUTAMIDE ...... 169 EPOETIN (All variants) ...... 170 EPOPROSTENOL ...... 171 EPTOTERMIN ALFA ...... 172 ERIBULIN ...... 173 ERLOTINIB ...... 174 ETANERCEPT ...... 175 ETANERCEPT (CCG) ...... 176 ETELCALCETIDE ...... 177 ETEPLIRSEN ...... 178 ETRAVIRINE ...... 179 ETROLIZUMAB ...... 180 EVEROLIMUS (Afinitor®) ...... 181 EVEROLIMUS (Certican®) ...... 182 EVEROLIMUS (Votubia®) ...... 183 EVOLOCUMAB ...... 184 EVOLOCUMAB (CCG) ...... 185 EX-VIVO EXPANDED AUTOLOGOUS HUMAN CORNEAL EPITHELIAL CELLS CONTAINING STEM CELLS 1 ...... 186 FACTOR IX ...... 187 FACTOR VII ...... 188 FACTOR VIIa ...... 189 FACTOR VIII ...... 190 FACTOR VIII Fc FUSION PROTEIN ...... 191 FACTOR VIII Inhibitor Bypassing Factor (FEIBA) ...... 192 FACTOR XIII ...... 193 FACTOR X ...... 194 FAMPRIDINE ...... 195 FIBRINOGEN ...... 196 FIBROBLAST GROWTH FACTOR 1 GENE THERAPY ...... 197 FILGRASTIM ...... 198 FINGOLIMOD ...... 199 FLEBOGAMMA ...... 200 FLEBOGAMMA® DIF ...... 201 FLUOCINOLONE ACETONIDE ...... 202 FOMEPIZOLE ...... 203 FORIGERIMOD ACETATE ...... 204 FOSAMPRENAVIR ...... 205 FOSCARNET ...... 206 FOSTAMATINIB DISODIUM ...... 207 FOSTEMSAVIR ...... 208 GALCANEZUMAB ...... 209 GALSULFASE ...... 210 GAMMAGARD S/D® ...... 211 GAMMANORM® ...... 212 GAMMAPLEX® ...... 213 GAMUNEX® ...... 214 GANCICLOVIR ...... 215 GANTENERUMAB ...... 216

GEFITINIB ...... 217 GLATIRAMER ACETATE ...... 218 GLECAPREVIR + PIBRENTASVIR ...... 219 GLYCEROL PHENYLBUTYRATE ...... 220 GLYCOPEGYLATED FACTOR IX ...... 221 GOLIMUMAB ...... 222 GOLIMUMAB (CCG) ...... 223 GRANULOCYTE-MACROPHAGE COLONY-STIMULATING FACTOR ...... 224 GUSELKUMAB ...... 225 HIV VACCINE ...... 226 HIZENTRA® ...... 227 HUMAN (HAEM) ARGINATE ...... 228 HUMAN HETEROLOGOUS LIVER CELLS ...... 229 HUMAN PARATHYROID HORMONE-RELATED PROTEIN ANALOGUE ...... 230 HYQVIA® ...... 231 IBRUTINIB ...... 232 ICATIBANT ...... 233 IDELALISIB ...... 234 IDURSULFASE ...... 235 ILOPROST ...... 236 IMATINIB ...... 237 IMIGLUCERASE ...... 238 INDINAVIR ...... 239 INFLIXIMAB ...... 240 INFLIXIMAB (CCG) ...... 241 INTERFERON ALFA ...... 242 INTERFERON BETA ...... 243 INTRATECT® ...... 244 IPILIMUMAB ...... 245 ISAVUCONAZOLE ...... 246 IVACAFTOR ...... 247 IXAZOMIB ...... 248 IXEKIZUMAB ...... 249 KETOROLAC WITH PHENYLEPHRINE ...... 250 KIOVIG® ...... 251 LAMIVUDINE ...... 252 LAMPALIZUMAB ...... 253 LANREOTIDE ...... 254 LANTHANUM ...... 255 LAPATINIB ...... 256 LARONIDASE...... 257 LENALIDOMIDE ...... 258 LENOGRASTIM ...... 259 LETERMOVIR ...... 260 LEVODOPA + CARBIDOPA ...... 261 LEVOFLOXACIN (inhaled) ...... 262 LIPEGFILGRASTIM ...... 263 LIXIVAPTAN ...... 264 LOMITAPIDE ...... 265 LONAFARNIB ...... 266 LOPINAVIR + RITONAVIR ...... 267 LUMACAFTOR WITH IVACAFTOR ...... 268 LUSUTROMBOPAG ...... 269 MACITENTAN ...... 270

MANNITOL ...... 271 MARAVIROC ...... 272 MASITINIB ...... 273 MECASERMIN ...... 274 MEPOLIZUMAB ...... 275 MESENCHYMAL STEM CELLS ...... 276 METRELEPTIN ...... 277 MICAFUNGIN...... 278 MIGALASTAT ...... 279 MIGLUSTAT ...... 280 MYCOPHENOLATE MOFETIL...... 281 MYCOPHENOLIC ACID ...... 282 NATALIZUMAB ...... 283 NELARABINE ...... 284 NELFINAVIR ...... 285 NEVIRAPINE ...... 286 NILOTINIB ...... 287 NINTEDANIB ...... 288 NITISINONE ...... 289 NITRIC OXIDE ...... 290 NIVOLUMAB ...... 291 NONACOG ALPHA ...... 292 NONACOG BETA PEGOL ...... 293 NORMAL IMMUNOGLOBULIN ...... 294 OBETICHOLIC ACID ...... 295 OBINUTUZUMAB ...... 296 OCRELIZUMAB ...... 297 OCRIPLASMIN ...... 298 OCTAGAM® ...... 299 OCTOCOG ALFA ...... 300 OCTREOLIN ...... 301 OCTREOTIDE ...... 302 OFATUMUMAB ...... 303 OLAPARIB ...... 304 OLARATUMAB ...... 305 OMALIZUMAB ...... 306 OMALIZUMAB (CCG) ...... 307 OMBITASVIR/PARITAPREVIR/RITONAVIR WITH DASABUVIR +/- RIBAVIRIN ...... 308 OSIMERTINIB ...... 309 OZANIMOD ...... 310 PACLITAXEL (Albumin bound) ...... 311 PALIVIZUMAB ...... 312 PANITUMUMAB ...... 313 PANOBINOSTAT ...... 314 PARA-AMINOSALICYLIC ACID ...... 315 PARATHYROID HORMONE ...... 316 PARATHYROID HORMONE (CCG) ...... 317 PARENTERAL NUTRITION (Home use) ...... 318 PARENTERAL NUTRITION (Inpatient use) ...... 319 PARITAPREVIR ...... 320 PASIREOTIDE ...... 321 PAZOPANIB ...... 322 PEGAPTANIB ...... 323 PEGASPARGASE ...... 324

PEGFILGRASTIM ...... 325 PEGINTERFERON ALFA ...... 326 PEGINTERFERON BETA-1A ...... 327 PEGVISOMANT ...... 328 PEGYLATED LIPOSOMAL DOXORUBICIN ...... 329 PEMBROLIZUMAB ...... 330 PEMETREXED ...... 331 PEPTIDE RECEPTOR RADIONUCLEOTIDE THERAPY ...... 332 PERTUZUMAB ...... 333 PIRFENIDONE ...... 334 PIXANTRONE ...... 335 PLERIXAFOR ...... 336 POMALIDOMIDE ...... 337 PONATINIB ...... 338 PORACTANT ALFA ...... 339 PORCINE FACTOR ...... 340 POSACONAZOLE ...... 341 PRIVIGEN® ...... 342 PROTEIN C ...... 343 PROTEIN KINASE INHIBITORS ...... 344 PROTHROMBIN COMPLEX ...... 345 RADIUM-223 DICHLORIDE ...... 346 RALTEGRAVIR ...... 347 RAMUCIRUMAB ...... 348 RANIBIZUMAB ...... 349 RASBURICASE ...... 350 REGORAFENIB ...... 351 RESLIZUMAB...... 352 RIBAVIRIN ...... 353 RILONACEPT ...... 354 RILPIVIRINE ...... 355 RILUZOLE ...... 356 RIOCIGUAT ...... 357 RITONAVIR ...... 358 RITUXIMAB ...... 359 RITUXIMAB (iv and subcutaneous formulations) ...... 360 RITUXIMAB (CCG) ...... 361 ROMIPLOSTIM (CCG) ...... 362 RUXOLITINIB ...... 363 SANDOGLOBULIN ...... 364 SAPROPTERIN ...... 365 SAQUINAVIR ...... 366 SARILUMAB ...... 367 SEBELIPASE ALFA ...... 369 SECUKINUMAB ...... 370 SECUKINUMAB (CCG) ...... 371 SELEXIPAG ...... 372 SEVELAMER CARBONATE ...... 373 SEVELAMER HYDROCHLORIDE ...... 374 SIALIC ACID ...... 375 SILDENAFIL ...... 376 SILTUXIMAB ...... 377 SIMEPREVIR/PEGINTERFERON + RIBAVIRIN ...... 378 SIROLIMUS ...... 379

SODIUM OXYBATE ...... 380 SODIUM PHENYLBUTYRATE ...... 381 SOFOSBUVIR/DACLATASVIR + RIBAVIRIN ...... 382 SOFOSBUVIR/LEDIPASVIR +/- RIBAVIRIN ...... 383 SOFOSBUVIR/PEGINTERFERON + RIBAVIRIN ...... 384 SOFOSBUVIR / VELPATASVIR ...... 385 SOMATROPIN ...... 386 SOMATROPIN CCG ...... 387 SORAFENIB ...... 388 STAVUDINE ...... 389 SUBCUVIA® ...... 390 SUBGAM® ...... 391 SUCROFERRIC OXYHYDROXIDE ...... 392 SUNITINIB ...... 393 SUSOCTOCOG ALFA ...... 394 TACROLIMUS ...... 395 TADALAFIL ...... 396 TANEZUMAB ...... 397 TALIMOGENE LAHERPAREPVEC ...... 398 TEDUGLUTIDE ...... 399 TELAPREVIR ...... 400 TELBIVUDINE ...... 401 TEMOZOLOMIDE ...... 402 TEMSIROLIMUS ...... 403 TENOFOVIR ...... 404 TENOFOVIR ALAFENAMIDE ...... 405 TENOFOVIR ALAFENAMIDE + COBICISTAT + ELVITEGRAVIR + EMTRICITABINE ...... 406 TENOFOVIR DISOPROXIL + COBICISTAT + ELVITEGRAVIR + EMTRICITABINE ...... 407 TENOFOVIR with EMTRICITABINE and EFAVIRENZ ...... 408 TENOFOVIR with EMTRICITABINE and RILPIVIRINE ...... 409 TERIFLUNOMIDE ...... 410 TERIPARATIDE ...... 411 TERIPARATIDE (CCG) ...... 412 TETRAHYDROBIOPTERIN ...... 413 TEZACAFTOR ...... 414 THALIDOMIDE ...... 415 THROMBIN ...... 416 THROMBOMODULIN, RECOMBINANT HUMAN ...... 417 TILDRAKIZUMAB...... 418 TIPRANAVIR ...... 419 TOBRAMYCIN (for nebulisation) ...... 420 TOCILIZUMAB ...... 421 TOCILIZUMAB (CCG) ...... 422 TOFACITINIB (CCG) ...... 423 TOFACITINIB ...... 424 TOLVAPTAN ...... 425 TOLVAPTAN (CCG) ...... 426 TRABECTADIN ...... 427 TRAMETINIB ...... 428 TRASTUZUMAB ...... 429 TRASTUZUMAB EMTANSINE ...... 430 TRENONACOG ALFA ...... 431 TREPROSTINIL SODIUM ...... 432 TRIENTINE ...... 433

TRIFLURIDINE with TIPIRACIL ...... 434 TUROCTOCOG ALFA ...... 435 USTEKINUMAB ...... 436 USTEKINUMAB (CCG) ...... 437 VALGANCICLOVIR ...... 438 VANCOMYCIN (via unique delivery system) ...... 439 VANDETANIB ...... 440 VEDOLIZUMAB ...... 441 VEDOLIZUMAB (CCG) ...... 442 VELAGLUCERASE ALFA ...... 443 VEMURAFENIB ...... 444 VERTEPORFIN ...... 445 VIGAM® ...... 446 VISMODEGIB ...... 447 VIVAGLOBIN ...... 448 VON WILLEBRAND FACTOR, RECOMBINANT ...... 449 VORICONAZOLE ...... 450 ZICONOTIDE ...... 451 ZIDOVUDINE ...... 452 ZIDOVUDINE with LAMIVUDINE...... 453 ZIDOVUDINE with LAMIVUDINE and ABACAVIR ...... 454 APPENDIX 1 : Drugs that have been discontinued or have no UK development ...... 455 APPENDIX 2 : Clinical Commissioning Groups Organisational and Payables Details for CCGs within Kent and Medway 458 APPENDIX 3 : Invoice template ...... 459 ...... 459

National Tariff Excluded Drugs: Summary of Current Arrangements CONTACT DETAILS

Sachin Gohil – Pharmacist, Programme Lead Optum

Optum Commissioning Support Services Kent House, 81 Station Rd, Ashford TN23 1PJ, UK

Tel: 03000 424291 Email: [email protected] Email: [email protected]

Check IFR and blueteq links still apply Individual Funding Requests: Email: [email protected] https://www.blueteq-secure.co.uk/southeast-ifr [email protected]

Blueteq Hi-Cost Drugs Database Trust Edition: https://www.blueteq-secure.co.uk/trust/

This manual and associated guidelines can be accessed from:

Email: [email protected]

Manual for prescribed specialised services: https://www.england.nhs.uk/commissioning/wp- content/uploads/sites/12/2016/06/pss-manual-may16.pdf

NICE: www.nice.org.uk

Management of National Tariff Excluded Drugs The purpose of this manual is to describe the process for National Tariff Excluded Drugs (NTEs) these are the high cost drugs or devices excluded from the National Tariff payment system (National Tariff), previously known as National Tariff Exclusions (National Tariff). NHS England will commission and pay for a majority of these drugs under services described in the Manual for Prescribed Specialised Services. The remainder of the drugs or devices will require a decision on commissioning from individual Clinical Commissioning Groups (CCGs). There are currently approximately 330 of these drugs or devices and to aid use of the manual each page is colour coded to quickly identify the responsible commissioner.

Green page indicates drugs commissioned by NHS England (either Area Team or Central Team) please refer to the Commissioner box for further details Green page with a purple Commissioner box indicates that the drug is commissioned by the CDF. Green page with an amber indication box indicates that the drug is not routinely commissioned and must be requested via an IFR Green page with grey indication box indicates drug is only available from a Specialist Centre. Unless IFR required. Green page with an orange National Tariff Category box indicates this drug is included in the National Tariff but is listed as the commissioning responsibility of NHS England and/or the Cancer Drugs Fund.

Blue page indicates the drug is commissioned by the CCG(s). Please refer to the Commissioned By section for details of which CCG has commissioned the drug for each indication. Red page indicates that the drug should not be prescribed, this could be because it is not commissioned, the drug has not been launched in the UK yet or has been discontinued. Please see the Other Information section on the page for further details.

Drugs are only commissioned for those indications listed under the individual drug and with regard to locally commissioned (CCG) drugs may not be commissioned across every CCG. Information on whether a CCG has commissioned a drug can be found in the “Commissioned By” box. Invoices will be refused for indications not listed within this manual or for patients in a CCG where the drug is not commissioned.

Section 7(6) of the National Institute for Health and Care Excellence (Constitution and Functions) and the Health and Social Care Information Centre (Functions) Regulations 2013 requires clinical commissioning groups, NHS England and, with respect to their public health functions, local authorities to comply with the recommendations in NICE Technology Appraisals within 3 months of its date of publication.

If a drug is being requested to treat a patient for an indication/condition NOT listed in the manual then an Individual Funding Request (IFR) or Business Case must be made to either the CCG or NHS England depending on who currently commissions the drug for other uses. IFR requests may be made for rare diseases or exceptional circumstances. A business case would be required where it is expected or foreseeable that there is a cohort of patients affected. Please contact the named individual at the front of this manual for preliminary advice on whether an IFR or business case is required.

Payment Arrangements Drugs commissioned by NHS England.

Providers have an agreed contract value with NHS England of which 1/12 is paid each month. Providers are asked to submit back-up data and over or under performance is taken into account at certain fixed points throughout the year.

Invoices for drugs that were previously invoiced directly via homecare providers will not be accepted by NHS England after 1st April 2013. Homecare providers have been informed that invoices are to be returned to the Trust that referred the patient.

All queries regarding payments should be directed to NHS England directly. Contact details can be found on their web page; www.england.nhs.uk/contact-us/

Drugs Commissioned by CCGs

All invoices must be sent to the Shared Business Service Centre at Topcliffe Lane, Tingley but it is important to include the name of the organisation, the unique organisational ID and payables code that have been assigned to that organisation to ensure that invoices are accurately processed. A list of the CCGs within the Kent and Medway locality and an invoice template can be found at Appendices 1 and 2.

The CCGs have confirmed that they will continue to accept invoices from homecare providers for CCG commissioned drugs whilst referring Trusts work towards Hackett compliance.

Responsibilities Trust Responsibilities: 1. Agree internally how the notification process is managed e.g., whether requests go to the Chief Pharmacist or nominated Pharmacist(s) for review before being submitted. The Chief Pharmacist MUST be aware of all National Tariff Excluded drugs prescribed by Trust consultants that require an invoice to be raised. 2. Ensure that all notification documentation is completed and supplied within 2 weeks of patient’s initiation onto treatment using Blueteq (www.blueteq-secure.co.uk/trust). Notification of withdrawals should also be made within 2 weeks of discontinuation 3. Dispense drugs to individual patients to ensure use is invoiced correctly and an audit trail maintained. 4. Invoices for CCG commissioned treatment doses must be submitted within 60 days. 5. Invoices should reflect drug acquisition cost without any additional on cost payments, unless previously agreed with commissioners. 6. Any post-invoice or post-patient access scheme rebates should be returned to the payer. 7. Where there is a choice of brand, the most cost effective product should be used. 8. Carry out regular audits to ensure use is within agreed guidelines.

Optum Responsibilities (on behalf of CCGs): 1. Support implementation of local guidelines, Blueteq forms. 2. Support the IFR process for CCG commissioned drugs as per agreement with NELCSU 3. Offer advice regarding IFR or Business Case applications 4. Ensure prompt payment of agreed invoices and clear communication in the event of payment queries. Letters confirming funding approval will not usually be sent if the patient meets NICE criteria or locally agreed guidance.

NEL CSU Responsibilities (on behalf of CCGs): 1. Manage IFRs for drugs that are responsibility of commissioning by CCGs as per the IFR policy, provide support for IFR documentation

This is a living document. Pages and content will be updated, added or deleted as appropriate. If you have any questions or queries please contact the Optum Medicines Management Team using the details at the front of this manual.

Amendment Sheet The table below lists recent amendments made to this manual, allowing users to see at a glance any recent changes that may have occurred.

Date Drug name Details of amendment Oct 18 Eltrombopag NICE TA updated Oct 18 Romiplosim NICE TA updated Oct 18 Tofacitinib NICE TA 543 Aug 18 Ixekizumab NICE TA 537 Aug 18 Dupilumab NICE TA 534 Jun 18 Guselkumab NICE TA 521 Mar 18 Brodalumab NICE TA 511 Feb 18 Sarilumab NICE TA485 added Dec 17 Various Red Page and discontinued drug page reviewed and updated. Dec 17 Various NICE TAs added Nov 17 Trastuzumab Changed commissioner from CDF to NHS England (effective from emantasine 17 October 2017 Nov 17 Sarilumab Now launched – page change to NHS England. Nov 17 Collagenase clostridium NICE TA459 added histolyticum Nov 17 Cladribine MS indication – no longer IFR. Prior approval pro-forma required. Specialist centre only. Nov 17 Dimethyl fumarate Added NICE TA475, local policy removed Nov 17 Baricitinib Page added for CCG commissioning in adults for rheumatoid arthritis Oct 17 Tocilizumab Now launched for Giant cell arteritis (NHS England commissioned) Oct 17 Ex-Vivo Expanded This drug is now launched. Page changed to green to indicate Autologous Human NHS England commissioned (IFR Only) Corneal Epithelial Cells Containing Stem Cells 1

Oct 17 Ustekinumab NICE TA456 added Aug 17 Afatinib NICE TA444 (Terminated Appraisal) added Aug 17 Bortezomib NICE TA453 (Terminated Appraisal) added Aug 17 Certolizumab NICE TA445 added Aug 17 Daclizumab NICE TA441 added Aug 17 Ibrutinib NICE TA452 (Terminated Appraisal) added Aug 17 Idelalisib NICE TA469 (Terminated Appraisal) added Aug 17 Obeticholic acid NICE TA443 added Aug 17 Ofatumab NICE TA470 (Terminated Appraisal) added Aug 17 Secukinumab NICE TA445 added July 17 Ixekizumab Changed to blue CCG Commissioned page and NICE TA reference added. June 17 Apremilast (CCG) NICE TA433 added (commissioned from 23 May 2017) June 17 Baricitinib This drug is now launched. Page changed to green to indicate NHS England commissioned. June 17 Botulinum toxins A & B Amendments to ensure all indications commissioned are (CCG) included. June 17 Daclizumab This drug is now launched. Page changed to green to indicate NHS England commissioned. June 17 Elbasvir (with Grazoprevir added for the combination product. Grazoprevir) June 17 Grazoprevir Page deleted, see above June 17 Glecaprevir (with Pibrentasvir added for the combination product. Pibrentasvir) June 17 Laquinimod This drug has been discontinued. Entry added to Appendix 1. June 17 Momelotinib This drug has been discontinued. Entry added to Appendix 1. June 17 Pacritinib Filing for this drug has been withdrawn. Entry added to Appendix 1.

Date Drug name Details of amendment June 17 Tenofovir Alafenamide This drug is now launched. Page changed to green to indicate NHS England commissioned.

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Drug 3, 4 DIAMINOPYRIDINE BNF Section National Tariff Category This drug is not National Tariff Excluded but is included as the commissioning responsibility of NHS England. Tariff Date N/A Commissioner NHS England Indication(s) Lambert Eaton Myasthenic Syndrome

Prescribed Services Manual (Section and title) Please note this link will take you to the front page of the Prescribed Services Manual. The manual can then be searched using the section number.

NICE Guidelines

Other Information NHS England recommends referring to Trust Guidelines. Specialist Centres Only.

Date Reviewed April 2017

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Drug ABACAVIR BNF Section 5.3.1 (Ziagen®) National Tariff Category AIDS/HIV Antiretroviral Tariff Date 2014/15 Commissioner NHS England Indication(s) HIV in combination with other anti-retroviral drugs

Prescribed Services 16 Adult specialist services for patients infected with HIV Manual (Section and title) 130. Specialist services for children and young people with infectious Please note this link will take diseases you to the front page of the Prescribed Services Manual. The manual can then be searched using the section number.

NICE Guidelines None issued

Other Information Patient to be treated in accordance with agreed Regional Guidelines.

Date Reviewed April 2017

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ABACAVIR with

Drug DOLUTEGRAVIR and BNF Section 5.3.1 LAMIVUDINE (Triumeq®) National Tariff Category AIDS/HIV Antiretroviral Tariff Date 2014/15 Commissioner NHS England Indication(s) HIV in combination with other anti-retroviral drugs

NICE Guidelines None issued

Other Information Patient to be treated in accordance with NHS England Policy B06/P/b and agreed Regional Guidelines.

Date Reviewed April 2017

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Drug ABACAVIR with LAMIVUDINE BNF Section 5.3.1 (Kivexa®) National Tariff Category AIDS/HIV antiretrovirals. Tariff Date 2015/16 Commissioner NHS England Indication(s) HIV in combination with other anti-retroviral drugs

NICE Guidelines None issued

Other Information Patient to be treated in accordance with agreed Regional Guidelines.

Date Reviewed April 2017

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Drug ABALOPARATIDE BNF Section 6.6.2 National Tariff Category Drugs affecting bone metabolism Tariff Date 2016/17 Commissioner NHS England - expected Indication(s) Male and juvenile osteoporosis

Prescribed Services Manual (Section and title) Please note this link will take you to the front page of the Prescribed Services Manual. The manual can then be searched using the section number.

NICE Guidelines

Other Information This drug has not yet been launched. Once launched it will not be routinely commissioned and should be requested from the commissioner via their IFR process. Specialist Centre only.

Date Reviewed December 2017

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Drug ABATACEPT BNF Section 10.1.3 (Orencia®) National Tariff Category Cytokine modulators Tariff Date 2014/15 Commissioner NHS England* 1 Paediatric indications (where adult TA available) Indication(s) 2 Juvenile arthritis

Prescribed Services 129. Specialist rheumatology services for children and young people Manual (Section and title) Please note this link will take you to the front page of the Prescribed Services Manual. The manual can then be searched using the section number.

NICE Guidelines TA375 – Adalimumab, etanercept, infliximab, certolizumab pegol golimumab, tocilizumab and abatacept for rheumatoid arthritis not previously treated with DMARDs or after conventional DMARDs only have failed.

TA373 – Abatacept, adalimumab, etanercept and tocilizumab for treating juvenile idiopathic arthritis

TA280 - Abatacept for treating rheumatoid arthritis after the failure of conventional disease-modifying anti-rheumatic drugs (rapid review of technology appraisal guidance 234)

TA234 Rheumatoid arthritis – abatacept (2nd line) (replaced by TA280 above)

TA195 - Rheumatoid arthritis - drugs for treatment after failure of a TNF inhibitor.

Other Information 2) Use in accordance with NHS England Clinical Commissioning Policy E03/P/d and NICE TA373. Prior approval pro-forma required.

* for use in children only, for use in adults please see CCG page Date Reviewed April 2017

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10.1.3 Drug ABATACEPT (CCG) BNF Section (Orencia®) National Tariff Category Cytokine modulators Tariff Date 2014/15 Commissioner CCG* Indication(s) Commissioned By Rheumatoid Arthritis Mandatory NICE TA’s – All CCGs

TA373 – Abatacept, adalimumab, etanercept and tocilizumab for treating juvenile idiopathic arthritis

TA280 - Abatacept for treating rheumatoid arthritis after the failure of conventional disease-modifying anti-rheumatic drugs (rapid review of technology appraisal guidance 234)

TA234 Rheumatoid arthritis – abatacept (2nd line) (replaced by TA280 above)

TA195 - Rheumatoid arthritis - drugs for treatment after failure of a TNF inhibitor.

Local Guidelines Kent and Medway guidelines for rheumatoid arthritis treatment pathways: (guideline 17)

Other Information * for use in adults only, for use in children please see previous page

Notification via Blueteq (please also use Blueteq to notify of withdrawals) Drug supplied via Homecare and billed directly to the Trust.

Date Reviewed September 2017

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Drug ABIRATERONE BNF Section 8.3.4 (Zytiga®) National Tariff Category Hormone antagonists Tariff Date 2014/15 Commissioner NHS England / CDF Indication(s) Cancer

Prescribed Services Manual (Section and title) Please note this link will take you to the front page of the Prescribed Services Manual. The manual can then be searched using the section number.

NICE Guidelines TA387 - Abiraterone for treating metastatic hormone-relapsed prostate cancer before chemotherapy is indicated

TA259 - Abiraterone for castration-resistant metastatic prostate cancer previously treated with a docetaxel-containing regimen

Other Information See also Specialised Services Circular 1438 and CDF Policy. Only in Enzalutamide naïve patients. Prior pro-forma required.

Date Reviewed April 2017

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BNF Drug ADALIMUMAB 1.5.3 / 10.1.3 (Humira®) Section National Tariff Category Cytokine modulators Tariff Date 2014/15 Commissioner NHS England 1 Paediatric indications (where adult TA available) 2 Juvenile arthritis - Paediatric Indication(s) 3 Uveitis – Paediatric 4 Uveitis - Adult 5 Hidradenitis Suppurativa 6 Bechet’s Syndrome

Prescribed Services 27. Behçet’s syndrome service (adults and adolescents) Manual (Section and title) 110. Specialist gastroenterology, hepatology and nutritional support (GHNS) services for Please note this link will take children and young people you to the front page of the Prescribed Services Manual. 129. Specialist rheumatology services for children and young people The manual can then be searched using the section number. NICE Guidelines TA455 - Adalimumab, etanercept and ustekinumab for treating plaque psoriasis in children and young people

TA392 – Adalimumab for treating moderate to severe hidradenitis suppurativa

TA383 – TNF-alpha inhibitors for ankylosing spondylitis and non-radiographic axial spondyloarthritis

TA375 – Adalimumab, etanercept, infliximab, certolizumab pegol golimumab, tocilizumab and abatacept for rheumatoid arthritis not previously treated with DMARDs or after conventional DMARDs only have failed.

TA373 – Abatacept, adalimumab, etanercept and tocilizumab for treating juvenile idiopathic arthritis

TA329 – Infliximab, adalimumab and golimumab for treating moderately to severely active ulcerative colitis after the failure of conventional therapy

TA199 - Psoriatic arthritis - etanercept, infliximab and adalimumab

TA195 - Rheumatoid arthritis - drugs for treatment after failure of a TNF inhibitor

TA187 - Crohn’s Disease - infliximab (review) and adalimumab (review of TA40)

TA146 – Psoriasis - adalimumab Other Information 1: Prior approval proforma required. 2: To be used in line with NHS England Interim Policy E03/P/d and NICE TA373. Prior approval proforma required. 3: Prior approval proforma required. To be used in line with NHS England Clinical Commissioning Policy D12X02. Specialist Centres only. 4: Uveitis – Adults: to be used in line with NHS England Clinical Commissioning Policy 16045/P. Prior Approval pro-forma required. Specialist Centres only. 5: Hidradenitis Suppurativa - Specialist Centres only. Prior approval proforma required. 6: Bechet’s Syndrome: Highly specialised criteria only. Specialist Centres only. Date Reviewed December 2017

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Drug ADALIMUMAB (CCG) BNF Section 1.5.3 / 10.1.3 (Humira®) National Tariff Category Cytokine modulators Tariff Date 2014/15 Commissioner CCG* Indication(s) Commissioned By Ankylosing spondylitis Crohn’s Disease Psoriasis Psoriatic Arthritis Mandatory NICE TA’s – All CCGs Rheumatoid Arthritis Ulcerative Colitis (moderate to severe)

NICE Guidelines TA460 - Adalimumab and dexamethasone for treating non-infectious uveitis

TA383 – TNF-alpha inhibitors for ankylosing spondylitis and non-radiographic axial spondyloarthritis

TA375 – Adalimumab, etanercept, infliximab, certolizumab pegol golimumab, tocilizumab and abatacept for rheumatoid arthritis not previously treated with DMARDs or after conventional

DMARDs only have failed.

TA373 – Abatacept, adalimumab, etanercept and tocilizumab for treating juvenile idiopathic arthritis

TA329 – Infliximab, adalimumab and golimumab for treating moderately to severely active ulcerative colitis after the failure of conventional therapy

TA199 - Psoriatic arthritis - etanercept, infliximab and adalimumab

TA195 - Rheumatoid arthritis - drugs for treatment after failure of a TNF inhibitor

TA187 - Crohn’s Disease - infliximab (review) and adalimumab (review of TA40)

TA146 – Psoriasis - adalimumab

Local Guidelines Kent and Medway Psoriatic Arthritis - Treatment Pathway: (guideline 17)

Kent and Medway guidelines for psoriasis and Biologic agents: (guideline 15)

Kent and Medway guidelines for rheumatoid arthritis treatment pathways: (guideline 19)

Other Information * for use in adults only, for use in children please see previous page

Rheumatoid arthritis Ankylosing spondylitis Blueteq notification* Psoriatic arthritis Crohn’s disease Ulcerative colitis

*incl. withdrawals

Drug supplied via Homecare and billed directly to the Trust. Date Reviewed December 2017

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Drug ADEFOVIR BNF Section 5.3.3 (Hepsera®) National Tariff Category Viral Hepatitis (B&C) & Respiratory Syncytial Virus Tariff Date 2014/15 Commissioner NHS England Indication(s) Hepatitis B

Prescribed Services Manual 16 Adult specialist services for patients infected with HIV (Section and title) Please note this link will take 130. Specialist services for children and young people with infectious you to the front page of the diseases Prescribed Services Manual. The manual can then be searched using the section number.

NICE Guidelines TA96 – Hepatitis B (Chronic) – adefovir dipivoxil and pegylated interferon alfa-2a

Other Information This drug is not routinely commissioned and should be requested from the commissioner via their IFR process. Specialist Centres only.

Date Reviewed April 2017

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BNF Drug AFAMELANOTIDE 13.1 (Scenesse®) Section National Tariff Category Skin Conditions Tariff Date 2014/15 Commissioner Not currently commissioned - Please do not prescribe Indication(s)

NICE Guidelines None Issued

Local Guidelines None issued

Other Information This drug is not currently commissioned and should not be prescribed.

Date Reviewed July 2017

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Drug AFATINIB BNF Section 8.1 (Giotrif®) National Tariff Category Cancer Exclusion Tariff Date 2016/17 Commissioner NHS England Indication(s) Cancer

Prescribed Services Manual (Section and title) Please note this link will take you to the front page of the Prescribed Services Manual. The manual can then be searched using the section number.

NICE Guidelines TA444 - Afatinib for treating advanced squamous non-small-cell lung cancer after platinum-based chemotherapy (terminated appraisal)

TA310 – Afatinib for treating epidermal growth factor receptor mutation- positive locally advanced or metastatic non-small-cell lung cancer.

Other Information

Date Reviewed August 2017

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Drug AFLIBERCEPT BNF Section 8.1 (Zaltrap®) National Tariff Category Cancer Exclusion Tariff Date 2016/17 Commissioner NHS England Indication(s) Cancer

Prescribed Services Manual (Section and title) Please note this link will take you to the front page of the Prescribed Services Manual. The manual can then be searched using the section number.

NICE Guidelines TA307 – Colorectal cancer (metastatic) - aflibercept (negative appraisal)

Other Information This drug is not routinely commissioned and should be requested from the commissioner via their CDIFR process.

Date Reviewed April 2017

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Drug AFLIBERCEPT (CCG) BNF Section 11.8.2 (Eylea®) National Tariff Category Subfoveal choroidal neovascularisation Tariff Date 2014/15 Commissioner CCG Indication(s) Commissioned By Macular degeneration (wet age-related) Diabetic macular oedema Choroidal Neovascularisation Mandatory – All CCGs Macular Oedema after BRVO (Branch Retinal Vein Occlusion) Macular Oedema NICE Guidelines TA346 – Aflibercept for treating diabetic macular oedema

TA486 – Aflibercept for treating Choroidal Neovascularisation

TA409 – Aflibercept for treating visual impairment caused by macular oedema after branch retinal vein occlusion

TA305 – Aflibercept for treating visual impairment caused by macular oedema secondary to central retinal vein occlusion

TA294 – Afliberecept solution for injection for treating wet age- related macular degeneration

Local Guidelines None issued

Other Information Notification via Blueteq. Indication of which eye is being treated must appear on notification form.

Date Reviewed March 2018

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Drug AGALSIDASE ALFA BNF Section 9.8.1 (Replagal®) National Tariff Category Lysosomal Storage Disorder Drugs Tariff Date 2014/15 Commissioner NHS England Indication(s) Fabry's disease

Prescribed Services 71. Lysosomal storage disorder service (adults and children) Manual (Section and title) Please note this link will take you to the front page of the Prescribed Services Manual. The manual can then be searched using the section number.

NICE Guidelines None issued

Other Information To be used in line with the NHS England Service Specification. Specialist Centres only.

Date Reviewed April 2017

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Drug AGALSIDASE BETA BNF Section 9.8.1 (Fabrazyme®) National Tariff Category Lysosomal Storage Disorder Drugs Tariff Date 2014/15 Commissioner NHS England Indication(s) Fabry's disease

NICE Guidelines None issued

Other Information To be used in line with the NHS England Service Specification. Specialist Centres only.

Date Reviewed April 2017

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BNF Drug AGANIRSEN Section National Tariff Category Subfoveal choroidal neovascularisation Tariff Date Commissioner Indication(s)

NICE Guidelines

Local Guidelines

Other Information This drug is currently in Phase III Clinical Trials and is expected to be launched in 2018.

Date Reviewed December 2017

Drug ALBUTREPENONACOG ALFA BNF Section (Idelvion®) National Tariff Category Blood related products Tariff Date 2016/17 Commissioner NHS England Indication(s) Haemophilia B

Prescribed Services Manual (Section and title) Please note this link will take you to the front page of the Prescribed Services Manual. The manual can then be searched using the section number.

NICE Guideline

Other Information To be used in line with NHS England Specialised Services Circular 1652

Date Reviewed June 2017

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Drug ALDESLEUKIN BNF Section 8.2.4 (Proleukin®) National Tariff Category Immunomodulating drugs Tariff Date 2014/15 Commissioner NHS England Indication(s) Cancer

Prescribed Services Manual (Section and title) Please note this link will take you to the front page of the Prescribed Services Manual. The manual can then be searched using the section number.

NICE Guidelines None issued

Other Information This is not routinely commissioned and should be requested from the commissioner via their IFR process. Specialist Centres only.

Date Reviewed April 2017

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Drug ALEMTUZUMAB BNF Section 8.2.3 (MabCampath®) National Tariff Category Drugs affecting the immune response Tariff Date 2014/15 Commissioner NHS England 1 Multiple Sclerosis 2 Pre-transplant immunosuppression; Islet transplantation Indication(s) 3 Chronic Lymphocytic Leukaemia 4 Bechet’s Syndrome

Prescribed Services Manual 27. Behçet’s syndrome service (adults and adolescents) (Section and title) Please note this link will take you to the front page of the Prescribed Services Manual. The manual can then be searched using the section number.

NICE Guidelines TA312 – Multiple sclerosis (relapsing-remitting) – alemtuzumab.

Other Information 1: Prior approval proforma required. Use as per NICE TA312.

2: This drug is only commissioned if it is provided at zero cost. NHS England recommends referring to Trust Guidelines. Specialist Centre only

3: This drug is only commissioned if it is provided at zero cost. NHS England recommends referring to Trust Guidelines.

4: This drug is only commissioned if it is provided at zero cost. Highly specialised criteria only. Specialist Centre only.

Date Reviewed April 2017

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Drug ALGLUCOSIDASE ALFA BNF Section 9.8.1 (Myozyme®) National Tariff Category Lysosomal Storage Disorder Drugs Tariff Date 2014/15 Commissioner NHS England Indication(s) Pompe disease

NICE Guidelines None issued

Other Information Specialist Centres Only. To be used in line with the NHS England Service Specification.

Date Reviewed April 2017

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Drug ALIPOGENE TIPARVOVEC BNF Section 9.8.1 (Glybera®) National Tariff Category Lysosomal Storage Disorder Drugs Tariff Date 2014/15 Commissioner NHS England Indication(s) Lipoprotein lipase deficiency

Prescribed Services Manual (Section and title) Please note this link will take you to the front page of the Prescribed Services Manual. The manual can then be searched using the section number.

NICE Guidelines None issued

Other Information This drug is not routinely commissioned and should be requested from the commissioner via their IFR process. Specialist Centres only.

Date Reviewed April 2017

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Drug ALIROCUMAB BNF Section 2.12 (Praluent®) National Tariff Category Lipid regulating drugs Tariff Date 2016/17 Commissioner Indication(s) Commissioned By: Primary hypercholesterolaemia or mixed Mandatory – All CCGs dyslipidaemia Primary heterozygous-familial Mandatory – All CCGs hypercholesterolaemia

NICE Guideline TA393 – Alirocumab for treating primary hypercholesterolaemia and mixed dyslipidaemia

Local Guidelines

Other Information Drug supplied via Homecare and billed directly to the Trust.

Date Reviewed September 2017

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Drug ALITRETINOIN BNF Section 13.5.1 (Toctino®) National Tariff Category Skin Conditions – Severe chronic hand eczema Tariff Date 2014/15 Commissioner CCG Indication(s) Commissioned By Eczema (chronic) Mandatory NICE TA’s – All CCGs

NICE Guidelines TA 177 - Eczema (chronic) - alitretinoin

Local Guidelines None issued

Commissioned By Mandatory – All CCGs

Other Information Notification via Blueteq (please also use Blueteq to notify of withdrawals)

Date Reviewed April 2017

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Drug ALPHA-1 ANTITRYPSIN BNF Section 3 (Respreeza®) National Tariff Category Drugs Used in Metabolic Disorders Tariff Date 2015/16 Commissioner Not Commissioned Indication(s) Alpha-1 Antitrypsin Deficiency (AATD)

Prescribed Services Manual (Section and title) Please note this link will take you to the front page of the Prescribed Services Manual. The manual can then be searched using the section number.

NICE Guidelines

Local Guidelines

Other Information This drug is not commissioned and should not be used.

Date Reviewed December 2017

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ALPHA MANNOSIDASE Drug RECOMBINANT HUMAN BNF Section 9.8.1 (Lamazym®) National Tariff Category Lysosomal Storage Disorder Drugs Tariff Date 2015/16 Commissioner NHS England Indication(s) Alpha Mannosidase Deficiency

Prescribed Services Manual (Section and title) Please note this link will take you to the front page of the Prescribed Services Manual. The manual can then be searched using the section number.

NICE Guidelines None issued

Other Information This drug is currently in Phase III Clinical Trials and is not expected to be launched until quarter 4 of 2017. Once launched it will not be routinely commissioned and should be requested from the commissioner via their IFR process. Specialist Centres only.

Date Reviewed December 2017

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Drug AMBRISENTAN BNF Section 2.5.1 (Volibris®) National Tariff Category Vasodilator antihypertensive drugs/Pulmonary Arterial Hypertension Tariff Date 2014/15 Commissioner NHS England Indication(s) Pulmonary Arterial Hypertension

Prescribed Services 92. Pulmonary hypertension service for children Manual (Section and title) Please note this link will take you to the front page of the Prescribed Services Manual. The manual can then be searched using the section number.

NICE Guidelines None Issued

Other Information To be used in line with NHS England Policies: A11/P/c

Date Reviewed April 2017

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Drug AMIFAMPRIDINE PHOSPHATE BNF Section 10.2.1 (Firdapse®) National Tariff Category Neuromuscular Disorders Tariff Date 2014/15 Commissioner NHS England Indication(s) Lambert-Easton Myasthenic Syndrome

Prescribed Services 11. Adult specialist neurosciences services Manual (Section and title) Please note this link will take you to the front page of the Prescribed Services Manual. The manual can then be searched using the section number.

NICE Guidelines None Issued

Other Information To be used in line with NHS England Policy: 16009/P. This drug should be requested from the commissioner via their IFR process.

Specialist Centres only.

Date Reviewed April 2017

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BNF Drug AMIKACIN INHALATION Section National Tariff Category Antibacterial Drugs Tariff Date 2016/17 Commissioner NHS England Indication(s) Fungal infection

Prescribed Services Manual (Section and title) Please note this link will take you to the front page of the Prescribed Services Manual. The manual can then be searched using the section number.

NICE Guidelines

Other Information This drug is currently in Phase III Clinical Trials and is not expected to be launched until 2018. NHS England recommends referring to Trust Guidelines.

Date Reviewed December 2017

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BNF Drug AMIKACIN LIPOSOMAL (Arikayce®) Section National Tariff Category Antibacterial Drugs Tariff Date 2016/17 Commissioner NHS England Indication(s) Cystic Fibrosis

Prescribed Services Manual (Section and title) Please note this link will take you to the front page of the Prescribed Services Manual. The manual can then be searched using the section number.

NICE Guidelines

Other Information This drug is currently in Phase III Clinical Trials and is not expected to be launched until 2018. Once launched it will not be routinely commissioned and should be requested from the commissioner via their IFR process.

Date Reviewed December 2017

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Drug AMPHOTERICIN LIPOSOMAL BNF Section 5.2.3 (Abelcet®, AmBisome®) National Tariff Category Antifungals Tariff Date 2014/15 Commissioner NHS England Indication(s) Fungal infection

Prescribed Services 65. Highly specialist services for adults with infectious diseases Manual (Section and title) Please note this link will take you to the front page of the Prescribed Services Manual. The manual can then be searched using the section number.

NICE Guidelines None issued

Other Information NHS England recommends referring to Trust Guidelines

Date Reviewed April 2017

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Drug ANAKINRA BNF Section 10.1.3 (Kineret®) National Tariff Category Cytokine modulators Tariff Date 2014/15 Commissioner NHS England 1 Cryopyrin Associated Periodic Syndrome 2 Juvenile arthritis Indication(s) 3 Paediatric indications 4 Specialist Auto-inflammatory Disease

Prescribed Services 44. Cryopyrin associated periodic disorder (adults) Manual (Section and title) Please note this link will take you to the front page of the Prescribed Services Manual. The manual can then be searched using the section number.

NICE Guidelines None Issued

Other Information 1: Treatment as per Cryopyrin Associated Periodic Syndrome Service Specification. Specialist Centres only.

2: Prior approval proforma required. NHS England Clinical Commissioning Policy: E03/P/d.

3 & 4: This drug, for this indication, is not routinely commissioned and should be requested from the commissioner via their IFR process. Specialist Centres only.

For Adult Onset Still’s Disease, please see next page. Date Reviewed April 2017

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Drug ANAKINRA (CCG) BNF Section 10.1.3 (Kineret®) National Tariff Category Cytokine modulators Tariff Date 2014/15 Commissioner CCG Indication(s) Commissioned By Adult Onset Still’s Disease NHS Ashford CCG NHS C4 CCG NHS Dartford, Gravesham and Swanley CCG NHS Medway CCG NHS South Kent Coast CCG NHS Swale CCG NHS Thanet CCG

NICE Guidelines

Local Guidelines Kent and Medway Adult Onset Still’s Disease: (guideline 3)

Other Information For other indications, please see previous page. Drug supplied via Homecare and billed directly to the Trust.

Date Reviewed September 2017

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Drug ANIDULAFUNGIN BNF Section 5.2.4 (Ecalta®) National Tariff Category Antifungals Tariff Date 2014/15 Commissioner NHS England Indication(s) Fungal infection

Prescribed Services Manual (Section and title) Please note this link will take you to the front page of the Prescribed Services Manual. The manual can then be searched using the section number.

NICE Guidelines None Issued

Other Information NHS England recommends referring to Trust Guidelines

Date Reviewed April 2017

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ANTIHAEMOPHILIC Drug FACTOR/VON WILLEBRAND BNF Section 2.11 FACTOR COMPLEX National Tariff Category Blood-related products Tariff Date 2014/15 Commissioner NHS England Indication(s) As per BCSH Guidelines for specialised indications

Prescribed Services 132. Specialist services for haemophilia and other related bleeding disorders Manual (all ages) (Section and title) Please note this link will take you to the front page of the Prescribed Services Manual. The manual can then be searched using the section number.

NICE Guidelines None issued

Other Information Treatment as per BCSH Guidelines.

Date Reviewed April 2017

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Drug ANTILYMPHOCYTE GLOBULIN BNF Section 9.1.3

National Tariff Category Drugs used in hypoplastic, haemolytic, and renal anaemias Tariff Date` 2014/15 Commissioner NHS England Indication(s) Aplastic Anaemia Organ Transplant

Prescribed Services Manual (Section and title) Please note this link will take you to the front page of the Prescribed Services Manual. The manual can then be searched using the section number.

NICE Guidelines None issued

Other Information Treatment as per BCSH Guidelines. Specialist Centres only.

Date Reviewed April 2017

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Drug ANTITHROMBIN III BNF Section 2.11 National Tariff Category Blood-related products Tariff Date 2014/15 Commissioner NHS England Indication(s) As per BCSH Guidelines for specialised indications

NICE Guidelines None issued

Other Information Treatment must be as per BCSH Guidelines.

Date Reviewed April 2017

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ANTITHYMOCYTE Drug BNF Section 8.2.2 IMMUNOGLOBULIN National Tariff Category Drugs used in hypoplastic, haemolytic, and renal anaemias Tariff Date 2014/15 Commissioner NHS England Indication(s) Aplastic Anaemia Organ Transplant

Prescribed Services 15. Adult specialist renal services Manual (Section and title) Please note this link will take you to the front page of the Prescribed Services Manual. The manual can then be searched using the section number.

NICE Guidelines None issued

Other Information Treatment must be as per BCSH Guidelines. Specialist Centres only.

Date Reviewed April 2017

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BNF See “Other Drug APREMILAST Information” (Otezla®) Section section National Tariff Category Cytokine modulators Tariff Date 2014/15 Commissioner NHS England 1 Ankylosing spondylitis (Paediatric use only) Indication(s) 2 Psoriasis (Paediatric use only) 3 Psoriatic arthritis (Paediatric use only)

Prescribed Services Manual (Section and title) Please note this link will take you to the front page of the Prescribed Services Manual. The manual can then be searched using the section number.

NICE Guidelines TA433 - Apremilast for treating active psoriatic arthritis

TA419 – Apremilast for treating moderate to severe plaque psoriasis

Other Information 1) This drug is in Phase III clinical trials and is not expected to be launched until 2019. Once launched it will not be routinely commissioned and should be requested from the commissioner via their IFR process. Specialist Centres only.

2) This drug for this indication is not routinely commissioned and should be requested from the commissioner via their IFR process. Specialist Centres only.

3) This drug for this indication is not routinely commissioned and should be requested from the commissioner via their IFR process. Specialist Centres only

For use in adults, please see next page. Date Reviewed October 2017

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Drug APREMILAST (CCG) BNF Section (Otezla®) National Tariff Category Cytokine modulators Tariff date 2014/15 Licensed Indication(s) Commissioned By Psoriatic Arthritis Please see Local Guidelines section Psoriasis

NICE Guidelines TA433 - Apremilast for treating active psoriatic arthritis

TA419 – Apremilast for treating moderate to severe plaque psoriasis

Local Guidelines

Other Information Drug supplied via Homecare and billed directly to the Trust. .

Date Reviewed September 2017

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Drug ARAGAM® BNF Section 14.5.1 National Tariff Category Intravenous/subcutaneous human normal immunoglobulins Tariff Date 2014/15 Commissioner NHS England Indication(s) As per National DMP

Prescribed Services Manual (Section and title) Please note this link will take you to the front page of the Prescribed Services Manual. The manual can then be searched using the section number.

NICE Guidelines

Other Information The Clinical Advisory Group (CAG) agreed that all immunoglobulins, regardless of the service in which they used and whether or not it was commissioned by the NHS CB, should be commissioned by the NHS CB. Usage can be identified through the National Clinical Database.

Please use in accordance with Clinical Guidelines for immunoglobulin use, second edition update (July 2011)

Date Reviewed April 2017

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Drug ASFOTASE ALPHA BNF Section 9.8.1 (Strensiq®) National Tariff Category Drugs used in Metabolic disorders Tariff Date 2014/15 Commissioner NHS England Indication(s) Hypophosphatasia

Prescribed Services Manual (Section and title) Please note this link will take you to the front page of the Prescribed Services Manual. The manual can then be searched using the section number.

NICE Guidelines

Other Information This drug is expected to be launched in Quarter 3 of 2015. Once launched it will not be routinely commissioned and should be requested from the commissioner via their IFR process. Specialist Centres only.

Date Reviewed April 2017

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ASUNAPREVIR with

Drug BNF Section DACLATASVIR

National Tariff Category Viral Hepatitis (B&C) & Respiratory Syncytial Virus Tariff Date 2016/17 Commissioner NHS England Indication(s) Hepatitis C

Prescribed Services Manual (Section and title) Please note this link will take you to the front page of the Prescribed Services Manual. The manual can then be searched using the section number.

NICE Guidelines

Other Information This drug combination is not routinely commissioned and should be requested from the commissioner via their IFR process. Specialist Centre only. Date Reviewed April 2017

BNF Drug ATACICEPT Section National Tariff Category Drugs affecting the immune reponse Tariff Date 2017/18 Commissioner NHS England Indication(s) Systemic lupus erythematosus (SLE)

Prescribed Services Manual (Section and title) Please note this link will take you to the front page of the Prescribed Services Manual. The manual can then be searched using the section number.

NICE Guidelines

Date Reviewed December 2017

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See “Other Drug ATALUREN BNF Section Information” (Translarna®) section National Tariff Category Neuromuscular Disorders Tariff Date 2014/15 Commissioner NHS England Indication(s) Duchenne muscular dystrophy

Prescribed Services Manual (Section and title) Please note this link will take you to the front page of the Prescribed Services Manual. The manual can then be searched using the section number.

NICE Guidelines

Other Information This drug is not routinely commissioned and should be requested from the commissioner via their IFR process. Specialist Centres only. Prior approval proforma required. NHS England Policy E09/P/a. Please also refer to NHS England circular 1633

Date Reviewed August 2017

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Drug ATAZANAVIR BNF Section 5.3.1 (Reyataz®) National Tariff Category AIDS/HIV antiretrovirals Tariff Date 2014/15 Commissioner NHS England Indication(s) HIV in combination with other anti-retroviral drugs

NICE Guidelines None issued

Other Information Patient to be treated in accordance with agreed Regional Guidelines.

Date Reviewed April 2017

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Drug ATAZANAVIR and COBICISTAT BNF Section 5.3.1 (Evotaz®) National Tariff Category AIDS/HIV antiretrovirals Tariff Date 2014/15 Commissioner NHS England Indication(s) HIV in combination with other anti-retroviral drugs

NICE Guidelines None issued

Other Information Patient to be treated in accordance with agreed Regional Guidelines.

Date Reviewed April 2017

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BNF Drug AVATROMBOPAG Section National Tariff Category Platelet disorder drugs Tariff Date 2016/17 Commissioner Indication(s) Idiopathic thrombocytopenic purpura (ITP)

NICE Guidelines

Local Guidelines

Other Information This drug is currently in Phase III Clinical Trials and is expected to be launched in 2019.

Date Reviewed December 2017

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Drug AXITINIB BNF Section 8.1.5 (Inlyta®) National Tariff Category Protein kinase inhibitors Tariff Date 2014/15 Commissioner NHS England Indication(s) Cancer – As per TA333 and Circular 1508

Prescribed Services Manual (Section and title) Please note this link will take you to the front page of the Prescribed Services Manual. The manual can then be searched using the section number.

NICE Guidelines TA333 – Axitinib for treating advanced renal cell carcinoma after failure of prior systemic treatment

Other Information Please also refer to NHS England circular 1508

Date Reviewed April 2017

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Drug AZACITIDINE BNF Section 8.1.3 (Vidaza®) National Tariff Category Myelodysplastic Syndrome Tariff Date 2014/15 Commissioner NHS England Indication(s) Cancer – as per NICE TA218

Prescribed Services Manual (Section and title) Please note this link will take you to the front page of the Prescribed Services Manual. The manual can then be searched using the section number.

NICE Guidelines TA399 – Azacitidine for treating acute myeloid leukaemia with more than 30% bone marrow blasts

TA218 – Myelodysplastic syndromes - azacitidine

Other Information To be used as described in NICE TA218

Date Reviewed April 2017

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Drug AZATHIOPRINE BNF Section 8.2.2 (Azapress®, Imuran®) This drug is NOT National Tariff Excluded but is listed as the commissioning National Tariff Category responsibility of NHS England. Tariff Date 2014/15 Commissioner NHS England Indication(s) Transplant immunosuppression only

Prescribed Services Manual (Section and title) Please note this link will take you to the front page of the Prescribed Services Manual. The manual can then be searched using the section number.

NICE Guidelines

Other Information New patients only until formal repatriation agreed. NHS England recommends referring to Trust Guidelines.

Date Reviewed April 2017

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Drug AZTREONAM LYSINE BNF Section 5.1.2.3 (Cayston®) National Tariff Category Antibacterial Drugs Tariff Date 2014/15 Commissioner NHS England 1. Cystic fibrosis Indication(s) 2. Cystic fibrosis – continuous use

Prescribed Services 45. Cystic fibrosis (all ages) Manual (Section and title) Please note this link will take you to the front page of the Prescribed Services Manual. The manual can then be searched using the section number.

NICE Guidelines

Other Information 1: To be used in line with NHS England Policy: A01/P/b 2: This drug for continuous use is not routinely funded and should be requested from the commissioner. Please refer to NHS England Clinical Commissioning Policy 16001/P

Date Reviewed April 2017

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Drug BARICITINIB BNF Section 10.1.3 (Olumiant®) National Tariff Category Immunomodulating Drugs Tariff Date 2015/16 Commissioner NHS England Indication(s) Paediatric indications (where adult TA available)

Prescribed Services Manual (Section and title) Please note this link will take you to the front page of the Prescribed Services Manual. The manual can then be searched using the section number.

NICE Guideline TA466 - Baricitinib for moderate to severe rheumatoid arthritis

Local Guidelines

Other Information This drug is not routinely commissioned and should be requested from the commissioner via their IFR process. Date Reviewed November 2017

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Drug BARICITINIB (CCG) BNF Section 10.1.3 (Olumiant®) National Tariff Category Immunomodulating Drugs Tariff Date 2015/16 Commissioner NHS England Indication(s) Commissioned By Rheumatoid Arthritis Mandatory – ALL CCGs

NICE Guideline TA466 - Baricitinib for moderate to severe rheumatoid arthritis

Local Guidelines

Other Information For adult patients only – for children please see previous page.

Date Reviewed November 2017

Drug BASILIXIMAB BNF Section 8.2.2 (Simulect®) National Tariff Category Corticosteroids and other immunosuppressants Tariff Date 2014/15 Commissioner NHS England Indication(s) Renal transplant

Prescribed Services 127. Specialist renal services for children and young people Manual (Section and title) Please note this link will take you to the front page of the Prescribed Services Manual. The manual can then be searched using the section number.

NICE Guidelines TA99 Renal transplantation - immunosuppressive regimens for children and adolescents: guidance

TA85 - Renal transplantation - immuno-suppressive regimens (adults) (review)

Other Information To be used as described in NICE TA’s above. Specialist Centres only.

Date Reviewed April 2017

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Drug BECLABUVIR BNF Section 5.3.3 National Tariff Category Viral Hepatitis (B&C) & Respiratory Syncytial Virus Tariff Date 2016/17 Commissioner NHS England Indication(s) Hepatitis C

NICE Guidelines

Other Information This drug is not routinely and should be requested from the commissioner via their IFR process. Specialist Centres only.

Date Reviewed April 2017

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Drug BEDAQUILINE FUMARATE BNF Section 5.1.9 (Sirturo®) National Tariff Category Antituberculosis Drugs Tariff Date 2015/16 Commissioner NHS England 1 Extensively Drug Resistant TB Indication(s) 2 Multi drug resistant TB

Prescribed Services Manual 65. Highly specialist services for adults with infectious diseases (Section and title) Please note this link will take 130. Specialist services for children and young people with infectious you to the front page of the diseases Prescribed Services Manual. The manual can then be searched using the section number.

NICE Guidelines

Other Information 1: Prior approval proforma required. To be used in line with NHS England Policy F04/P/a and SSC1645. Specialist Centre only.

2: Prior approval proforma required. To be used in line with NHS England Policy F04/P/a and SSC1645 Specialist Centre only.

Date Reviewed August 2017

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BNF Drug BEGELOMAB (Begedina®) Section National Tariff Category Malignant disease and immunosuppression Tariff Date 2017/18 Commissioner NHS England Indication(s) Graft Versus Host Disease

Prescribed Services Manual (Section and title) Please note this link will take you to the front page of the Prescribed Services Manual. The manual can then be searched using the section number.

NICE Guidelines

Other Information This drug is currently in Phase III Clinical Trials and is not expected to be launched until 2019. Once launched it will not be routinely commissioned and should be requested from the commissioner via their IFR process.

Date Reviewed December 2017

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Drug BELATACEPT BNF Section 8.2.2 (Nulojix®) National Tariff Category Drugs affecting the immune response Tariff Date 2014/15 Commissioner NHS England Indication(s) Renal transplant

Prescribed Services Manual (Section and title) Please note this link will take you to the front page of the Prescribed Services Manual. The manual can then be searched using the section number.

NICE Guidelines In Progress

Other Information This drug is not routinely commissioned.

Date Reviewed April 2017

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Drug BELIMUMAB BNF Section 10.1.3 (Benlysta®) National Tariff Category Drugs affecting the immune response Tariff Date 2014/15 Commissioner NHS England Indication(s) Systemic Lupus Erythematosus (SLE)

Prescribed Services Manual (Section and title) Please note this link will take you to the front page of the Prescribed Services Manual. The manual can then be searched using the section number.

NICE Guidelines TA397 – Belimumab for treating active autoantibody-positive systemic lupus erythematosus

Other Information Prior approval proforma required

Date Reviewed April 2017

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BNF Drug BENRALIZUMAB Section National Tariff Category Allergen Immunotherapy Tariff Date 2017/18 Commissioner NHS England Indication(s) Asthma

Prescribed Services Manual (Section and title) Please note this link will take you to the front page of the Prescribed Services Manual. The manual can then be searched using the section number.

NICE Guidelines

Other Information This drug is expected to be launched in quarter 1 of 2018. Once launched it will not be routinely commissioned and should be requested from the commissioner via their IFR process.

Date Reviewed December 2017

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Drug BENDAMUSTINE BNF Section 8.1.1 (Levact®) National Tariff Category Cancer exclusion – This drug is NOT National Tariff Excluded but is listed as the commissioning responsibility of NHS England and/or the Cancer Drugs Fund. Tariff Date 2014/15 Commissioner NHS England / CDF Indication(s) Cancer

Prescribed Services Manual (Section and title) Please note this link will take you to the front page of the Prescribed Services Manual. The manual can then be searched using the section number.

NICE Guidelines TA216 - Leukaemia (lymphocytic) - bendamustine

Other Information Patient to be treated in line with NICE TA216 and CDF Policy.

Date Reviewed April 2017

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Drug BERACTANT BNF Section 3.5.2 (Survanta®) National Tariff Category Pulmonary surfactants Tariff Date 2014/15 Commissioner NHS England Indication(s) Respiratory Distress Syndrome

Prescribed Services 128. Specialist respiratory services for children and young people Manual (Section and title) Please note this link will take you to the front page of the Prescribed Services Manual. The manual can then be searched using the section number.

NICE Guidelines None issued

Other Information NHS England recommends referring to Trust Guidelines

Date Reviewed April 2017

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9.8.1 Drug BETAINE BNF Section (Cystadane®) BNFc 9.8.1 National Tariff Category Drugs used in Metabolic disorders Tariff Date 2014/15 Commissioner NHS England Indication(s) Homocystinuria

Prescribed Services 62. Highly Specialist metabolic disorder services (all ages) for patients Manual registered IMD (Section and title) Please note this link will take you to the front page of the Prescribed Services Manual. The manual can then be searched using the section number.

NICE Guidelines None issued

Other Information Please refer to the NHS England Service Specification. Specialist Centres only.

Date Reviewed April 2017

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Drug BEVACIZUMAB BNF Section 8.1.5 (Avastin®) National Tariff Category Antineoplastic drugs Tariff Date 2014/15 Commissioner NHS England / CDF 1 Cancer (CDF) Indication(s) 2 Neurofibromatosis

Prescribed Services 76. Neurofibromatosis type 2 service (adults and children) Manual (Section and title) Please note this link will take you to the front page of the Prescribed Services Manual. The manual can then be searched using the section number.

NICE Guidelines TA353 – Bevacizumab for treating relapsed, platinum-resistant epithelial ovarian, fallopian tube or primary peritoneal cancer (terminated appraisal)

TA285 – Ovarian, fallopian tube and primary cancer (recurrent advanced, platinum-sensitive or partially platinum-sensitive) - bevacizumab (negative appraisal)

TA284 – Bevacizumab in combination with paclitaxel and carboplatin for first- line treatment of advanced ovarian cancer (negative appraisal)

TA242 Colorectal cancer (metastatic) 2nd line - cetuximab, bevacizumab and panitumumab (review) (negative appraisal)

TA214 - Bevacizumab in combination with a taxane for the first-line treatment of metastatic breast cancer (negative appraisal))

TA178 - Renal cell carcinoma (negative appraisal)

TA118 - Colorectal cancer (metastatic) - bevacizumab & cetuximab ((negative appraisal – replaced by TA242)

Other Information 1: Commissioned by the CDF. To be used in line with the CDF Policy.

2: As per National Protocol (see NF2 service spec). Specialist Centres only. Date Reviewed April 2017

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Drug BEVACIZUMAB (CCG) BNF Section 8.1.5 (Avastin®) National Tariff Category Cytokine modulators Tariff Date 2014/15 Commissioner CCG Indication(s) Commissioned By Choroidal neovascularisation (CNV) due to causes other than age-related macular All CCGs degeneration (AMD) or pathological myopia (PM)

NICE Guidelines

Local Guidelines Kent and Medway guidelines for choroidal neovascularisation (CNV) due to causes other than age- related macular degeneration (AMD) or pathological myopia (PM)

PR2014-01 – Bevacizumab (Avastin®) for choroidal neovascularisation (CNV) due to causes other than age- related macular degeneration (AMD) or pathological myopia (PM)

Other Information Notification via Blueteq. Indication of which eye is being treated must appear on notification form.

Date Reviewed April 2017

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Drug BIOTIN BNF Section 9.6 (Cerenday®) National Tariff Category Vitamins Tariff Date 2016/17 Commissioner NHS England Indication(s) Multiple Sclerosis

Prescribed Services Manual (Section and title) Please note this link will take you to the front page of the Prescribed Services Manual. The manual can then be searched using the section number.

NICE Guideline

Local Guidelines

Other Information This drug has not yet been launched, once launched it will not be routinely commissioned and should be requested from the commissioner via their IFR Process. Specialist Centre only.

Date Reviewed December 2017

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BNF Drug BLINATUMOMAB (Blincyto®) Section National Tariff Category Cancer exclusion - This drug is NOT National Tariff Excluded but is listed as the commissioning responsibility of the Cancer Drugs Fund and or NHS England. Tariff Date 2017/18 Commissioner NHS England Indication(s) Cancer

Prescribed Services Manual (Section and title) Please note this link will take you to the front page of the Prescribed Services Manual. The manual can then be searched using the section number.

NICE Guidelines TA450 - Blinatumomab for previously treated Philadelphia-chromosome- negative acute lymphoblastic leukaemia

Other Information

Date Reviewed December 2017

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BNF Drug BLISIBIMOD Section National Tariff Category Cytokine Modulators Tariff Date 2016/17 Commissioner NHS England Indication(s) Systemic lupus erythematosus (SLE)

Prescribed Services Manual (Section and title) Please note this link will take you to the front page of the Prescribed Services Manual. The manual can then be searched using the section number.

NICE Guidelines

Other Information This drug is currently in Phase II Clinical Trials and is not expected to be launched until 2020. Once launched it will not be routinely commissioned and should be requested from the commissioner via their IFR process.

Date Reviewed December 2017

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Drug BOCEPREVIR BNF Section 5.3.3 (Victrelis®) National Tariff Category Viral Hepatitis (B&C) & Respiratory Syncytial Virus Tariff Date 2014/15 Commissioner NHS England Indication(s) Hepatitis C

Prescribed Services Manual 16 Adult specialist services for patients infected with HIV (Section and title) Please note this link will take 65. Highly specialist services for adults with infectious diseases you to the front page of the Prescribed Services Manual. The manual can then be 130. Specialist services for children and young people with infectious searched using the section diseases number.

131. Specialist services for complex liver, biliary and pancreatic disease (adults)

NICE Guidelines TA253 Hepatitis C (genotype 1) - boceprevir: guidance

Other Information Prior approval proforma required. To be used in line with NICE TA253

Date Reviewed April 2017

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Drug BORTEZOMIB BNF Section 8.1.5 (Velcade®) National Tariff Category Antineoplastic drugs Tariff Date 2014/15 Commissioner NHS England / CDF Indication(s) 1 Cancer (NHS England or CDF) 2 Organ rejection post kidney transplant

Prescribed Services Manual (Section and title) Please note this link will take you to the front page of the Prescribed Services Manual. The manual can then be searched using the section number.

NICE Guidelines TA453 - Bortezomib for treating multiple myeloma after second or subsequent relapse (terminated appraisal)

TA370 – Bortezomib for previously untreated mantle cell lymphoma

TA311 – Bortezomib for induction therapy in multiple myeloma before high- dose chemotherapy and autologous stem cell transplantation

TA228 - Multiple myeloma (first line) bortezomib and thalidomide

TA129 - Multiple myeloma - bortezomib

Other Information 1: Patients to be treated in accordance with the NICE TAs above and the CDF Policy.

2: This drug is not routinely commissioned (NHS England Commissioning Policy: A07/P/c) and should be requested from the commissioner via their IFR process. Specialist Centres only.

Date Reviewed August 2017

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Drug BOSENTAN BNF Section 2.5.1 (Tracleer®) National Tariff Category Vasodilator antihypertensive drugs/Pulmonary Arterial Hypertension Commissioner NHS England 1 Digital ulcers Indication(s) 2 Pulmonary Arterial Hypertension (PAH)

Prescribed Services Manual 14. Adult specialist pulmonary hypertension services (Section and title) Please note this link will take 92. Pulmonary hypertension service to children you to the front page of the Prescribed Services Manual. The manual can then be searched using the section number.

NICE Guidelines None issued

Other Information 1: Prior approval proforma required. To be used in line with NHS England Policy: A13/P/b. Specialist Centre only.

2: To be used in line with NHS England Policy: A11/P/c. Specialist Centre only.

Date Reviewed April 2017

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Drug BOSUTINIB BNF Section 8.1.5 (Bosulif®) National Tariff Category Protein kinase inhibitors Tariff Date 2014/15 Commissioner NHS England Indication(s) Cancer

Prescribed Services Manual (Section and title) Please note this link will take you to the front page of the Prescribed Services Manual. The manual can then be searched using the section number.

NICE Guidelines TA401 – Bosutinib for previously treated chronic myeloid leukaemia

Other Information Prior approval pro-forma required. Please refer to Specialised Commissioning Services Circular 1661.

Date Reviewed August 2017

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Drug BOTULINUM TOXIN BNF Section 4.9.3 National Tariff Category Torsion Dystonias and other involuntary movements Tariff Date 2014/15 Commissioner NHS England 1 Focal spasticity in children Indication(s) 2 Intravesical use in spinal cord injury

Prescribed Services Manual (Section and title) Please note this link will take you to the front page of the Prescribed Services Manual. The manual can then be searched using the section number.

NICE Guidelines

Other Information 1&2: NHS England recommend referring to Trust Guidelines. Specialist Centres only

Date Reviewed April 2017

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BNF BNF DrugDrug 4.9.34.9.3 BOTULINUMBOTULINUM TOXINS TOXINS A A& & B B (CCG) (CCG) SectionSection

National TarifTarifff Category GlutamateGlutamate receptor receptor antagonist antagonist Tariff Date 2014/152014/15 Commissioner CCG Indication(s) Commissioned By

Achalasia

Axillary hyperhidrosis

Blepharospasm

Chronic anal fissure

Migraine All CCGs Spasticity in neurological disorders Overactive bladder with symptoms of urinary incontinence, urgency and frequency Sialorrhoea in adults

Spasticity for adults Urinary incontinence due to neurogenic detrusor over activity

NICE IPG80 - Selective peripheral denervation of cervical dystonia Guidance TA260 – Migraine (chronic) – botulinum toxin type A

NICE TA’s are mandatory for implementation. Please see page 9 for further information

Local Guidelines Botulinum Toxin Treatment for Spasticity in Neurological Disorders following cerebral vascular accident, traumatic brain injury or multiple sclerosis (or rare disorders similar to the above conditions e.g. cervical dystonia [spasmodic torticollis]). Kent and Medway Mental Health and Learning Disabilities 2012 Service specification no. 11.7

PR2016-18 – Botulinum toxin for achalasia PR2014-02 – Botulinum toxin type A for blepharospasm PR2014-06 – Hyperhidrosis PR2016-12 – Botulinum toxin for chronic anal fissures PR2016-09 – Botulinum toxin for spasticity in adults PR2014-09 – Botulinum toxin type A for urinary incontinence due to neurogenic detrusor overactivity PR2014-10 – Botulinum toxin type A for overactive bladder with symptoms of urinary incontinence, urgency and frequency PR2016-17 – Botulinum toxin for sialorrhoea in adults

Refer to NHS Kent and Medway Referral and Treatment Criteria. Other Notification via Blueteq. Information Date of June 2017 review Return to Contents page

BNF Drug 13.5.3 BRODALUMAB Section National Tariff Category Immunomodulating Drugs Tariff Date 2015/16 Commissioner NHS England Indication(s) 1 Psoriasis (paediatric patients, where adult TA is available) 2 Psoriatic Arthritis (paediatric patients, where adult TA is available)

Prescribed Services Manual (Section and title) Please note this link will take you to the front page of the Prescribed Services Manual. The manual can then be searched using the section number.

NICE Guideline

Local Guidelines

Other Information 1: This drug is not be routinely commissioned and should be requested from the commissioner via their IFR process.

2: This drug is not be routinely commissioned and should be requested from the commissioner via their IFR process.

Date Reviewed December 2017

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Drug Brodalumab BNF Section 13.5.3 (Kyntheum®) National Tariff Category Immunomodulating Drugs Tariff Date 2015/16 Indication(s) Commissioned By Plaque Psoriasis Mandatory – ALL CCGs

NICE Guideline TA511 – Brodalumab for treating moderate to severe plaque psoriasis

Local Guidelines

Other Information For adult patients only – for children please see previous page.

Notification, including withdrawals, should be made via Blueteq.

Date Reviewed June 2018

Drug BRENTUXIMAB BNF Section 8.1 (Adcetris®) Cancer exclusion - This drug is NOT National Tariff Excluded but is listed as National Tariff Category the commissioning responsibility of the Cancer Drugs Fund. Tariff Date 2014/15 Commissioner CDF / NHS England Indication(s) Cancer

Prescribed Services Manual (Section and title) Please note this link will take you to the front page of the Prescribed Services Manual. The manual can then be searched using the section number.

NICE Guidelines TA446 - Brentuximab vedotin for treating CD30-positive Hodgkin lymphoma

Other Information To be used in line with the CDF Policy and NICE TA(s) above

Date Reviewed December 2017

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Drug C1 ESTERASE INHIBITOR BNF Section 3.4.3 (Berinert®, Cinryze®) National Tariff Category Allergic emergencies Tariff Date 2014/15 Commissioner NHS England 1. Hereditary angioedema - acute treatment only Indication(s) 2. Hereditary angioedema – prophylactic treatment 3. Hereditary angioedema - prophylactic treatment in children (cinryze only)

Prescribed Services Manual 59. Highly specialised allergy services (all ages) (Section and title) Please note this link will take you to the front page of the Prescribed Services Manual. The manual can then be searched using the section number.

NICE Guidelines None issued

Other Information 1: To be used in line with NHS England Policy: B09/P/b 2: To be used in line with NHS England Clinical Policy 16045/P 3: Prior approval pro-forma required. To be used as per NHS England Clinical Commissioning Policy 16045/P. Specialist centre only. Date Reviewed April 2017

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Drug CABAZITAXEL BNF Section 8.1 (Jevtana®) Cancer exclusion – This drug is NOT National Tariff Excluded but is listed as National Tariff Category the commissioning responsibility of the Cancer Drugs Fund. Tariff Date 2014/15 Commissioner NHS England Indication(s) Cancer – metastatic hormone-relapsed prostate cancer (after docetaxel)

Prescribed Services Manual (Section and title) Please note this link will take you to the front page of the Prescribed Services Manual. The manual can then be searched using the section number.

NICE Guidelines TA391 - Cabazitaxel for hormone-relapsed metastatic prostate cancer treated with docetaxel

Other Information Prior approval proforma required.

Date Reviewed August 2017

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Drug CABOZANTINIB BNF Section 8.1 (Cometriq®) National Tariff Category Cancer exclusion – This drug is NOT National Tariff Excluded but is listed as the commissioning responsibility of the Cancer Drugs Fund. Tariff Date 2014/15 Commissioner CDF Indication(s) Cancer

Prescribed Services Manual (Section and title) Please note this link will take you to the front page of the Prescribed Services Manual. The manual can then be searched using the section number.

NICE Guidelines

Other Information To be used in line with the CDF Policy.

Date Reviewed April 2017

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Drug CANAKINUMAB BNF Section 8.2.4 (Ilaris®) National Tariff Category Immunomodulating Tariff Date 2014/15 Commissioner NHS England 1 Cryopyrin Associated Periodic Syndrome (CAPS) Indication(s) 2 Juvenile Arthritis (paediatric)

Prescribed Services Manual 44. Cryopyrin associated periodic disorder (adults) (Section and title) Please note this link will take you to the front page of the Prescribed Services Manual. The manual can then be searched using the section number.

NICE Guidelines TA302 – Juvenile idiopathic arthritis (systemic) – canakinumab (terminated appraisal)

TA281 - Canakinumab for treating gouty arthritis attacks and reducing the frequency of subsequent attacks (terminated appraisal)

Other Information 1: Highly specialised criteria only. Please refer to the Cryopyrin Associated Periodic Syndrome Service Specification. Specialist Centres only.

2: This is not routinely commissioned and should be requested from the commissioner via their IFR process. Specialist Centres only.

Date Reviewed April 2017

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Drug CARGLUMIC ACID BNF Section 9.8.1 (Carbaglu®) National Tariff Category Drugs used in Metabolic disorders Tariff Date 2014/15 Commissioner NHS England Indication(s) Urea cycle disorders

Prescribed Services Manual 62. Highly Specialist metabolic disorder services (all ages) for patients (Section and title) registered IMD Please note this link will take you to the front page of the Prescribed Services Manual. The manual can then be searched using the section number.

NICE Guidelines None issued

Other Information Highly specialised criteria only. To be used in line with the NHS England Service Specification. Specialist Centres only.

Date Reviewed April 2017

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Drug CARNITINE BNF Section 9.8.1 (Carnitor®) National Tariff Category Drugs used in Metabolic disorders Tariff Date 2014/15 Commissioner NHS England Indication(s) Carnitine deficiency

NICE Guidelines None issued

Other Information Highly specialised criteria only. To be used in line with the NHS England Service Specification.

Date Reviewed April 2017

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Drug CASPOFUNGIN BNF Section 5.2.4 (Cancidas®) National Tariff Category Antifungals Tariff Date 2014/15 Commissioner NHS England Indication(s) Fungal infection

Prescribed Services Manual (Section and title) Please note this link will take you to the front page of the Prescribed Services Manual. The manual can then be searched using the section number.

NICE Guidelines None issued

Other Information NHS England recommends referring to Trust Guidelines

Date Reviewed April 2017

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100

See “Other Drug CATRIDECACOG BNF Section Information” (NovoThirteen®) section National Tariff Category Blood Related Products Tariff Date 2014/15 Commissioner NHS England Indication(s) Congenital factor XIIIA-subunit deficiency

Prescribed Services Manual (Section and title) Please note this link will take you to the front page of the Prescribed Services Manual. The manual can then be searched using the section number.

NICE Guidelines

Other Information This drug has not yet been launched.

Once launched this drug will not be routinely commissioned and should be requested from the commissioner via their IFR process. Specialist Centres only.

Date Reviewed December 2017

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101

BNF Drug CERLIPONASE ALFA (Brineura®) Section National Tariff Category Central Nervous System Tariff Date 2017/18 Commissioner NHS England Indication(s) Neuronal ceroid lipofuscinosis

Prescribed Services Manual (Section and title) Please note this link will take you to the front page of the Prescribed Services Manual. The manual can then be searched using the section number.

NICE Guidelines

Other Information This drug has been licensed but has not yet been launched. Once launched it will not be routinely commissioned and should be requested from the commissioner using their IFR process.

Date Reviewed December 2017

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102

BNF Drug CERITINIB (Zykadia®) Section National Tariff Category Cancer exclusion – This drug is NOT National Tariff Excluded but is listed as the commissioning responsibility of NHS England Tariff Date 2016/17 Commissioner NHS England Indication(s) Cancer

Prescribed Services Manual (Section and title) Please note this link will take you to the front page of the Prescribed Services Manual. The manual can then be searched using the section number.

NICE Guidelines TA395 - Ceritinib for previously treated anaplastic lymphoma kinase positive non-small-cell lung cancer

Other Information Prior approval proforma required.

Date Reviewed April 2017

103

Drug CERTOLIZUMAB PEGOL BNF Section 10.1.3 (Cimzia®) National Tariff Category Cytokine modulators Tariff Date 2014/15 Commissioner NHS England Indication(s) Paediatric indications

Prescribed Services Manual (Section and title) Please note this link will take you to the front page of the Prescribed Services Manual. The manual can then be searched using the section number.

NICE Guidelines TA445 - Certolizumab pegol and secukinumab for treating active psoriatic arthritis after inadequate response to DMARDs

TA186 - Rheumatoid arthritis - certolizumab pegol

Other Information This is not routinely commissioned and should be requested from the commissioner via their IFR process. Specialist Centres only.

For use in adults please see next page Date Reviewed August 2017

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104

Drug CERTOLIZUMAB PEGOL (CCG) BNF Section 10.1.3 (Cimzia®) National Tariff Category Cytokine modulators Tariff Date 2014/15 Commissioner CCG Indication(s) Commissioned By Rheumatoid Arthritis* Mandatory – All CCGs

NICE Guidelines TA445 - Certolizumab pegol and secukinumab for treating active psoriatic arthritis after inadequate response to DMARDs

TA186 - Rheumatoid arthritis - certolizumab pegol

Local Guidelines Kent and Medway Certolizumab pegol for psoriatic arthritis (guideline 7)

Kent and Medway Psoriatic Arthritis - Treatment Pathway: (guideline 17)

Kent and Medway guidelines for rheumatoid arthritis treatment pathways: (guideline 19)

Other Information * for use in adults, for use in children please see previous page.

Notification using Blueteq. Patient Access Scheme. Drug supplied via Homecare and billed directly to the Trust.

Date Reviewed September 2017

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105

Drug CETUXIMAB BNF Section 8.1.5 (Erbitux®) National Tariff Category Antineoplastic drugs Tariff Date 2014/15 Commissioner NHS England / CDF Indication(s) Cancer

Prescribed Services Manual (Section and title) Please note this link will take you to the front page of the Prescribed Services Manual. The manual can then be searched using the section number.

NICE Guidelines TA439 - Cetuximab and panitumumab for previously untreated metastatic colorectal cancer

TA242 Colorectal cancer (metastatic) 2nd line - cetuximab, bevacizumab and panitumumab (review): (negative appraisal)

TA176 - Colorectal cancer (first line) - cetuximab

TA145 - Head and neck cancer - cetuximab

Other Information To be used in line with the CDF Policy and NICE TAs 145 and 176.

Date Reviewed December 2017

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106

Drug CHEMOTHERAPY BNF Section 8.1 & 8.2 Cancer - These drugs are NOT National Tariff Excluded but are listed as the National Tariff Category commissioning responsibility of NHS England and/or the Cancer Drugs Fund. Tariff Date 2014/15 Commissioner NHS England / CDF Indication(s) Cancer (not specifically listed)

Prescribed Services Manual (Section and title) Please note this link will take you to the front page of the Prescribed Services Manual. The manual can then be searched using the section number.

NICE Guidelines

Other Information Please refer to NICE TAs, CDF Policy or Trust Guidelines for use.

Date Reviewed April 2017

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107

BNF Drug CHENODEOXYCHOLIC ACID (Chenodeoxycholic acid sigma-tau®) Section National Tariff Category Drugs used in metabolic disorders Tariff Date 2017/18 Commissioner NHS England 1. Cerebrotendinous xanthomatosis (CTX) Indication(s) 2. Primary biliary cirrhosis

Prescribed Services Manual (Section and title) Please note this link will take you to the front page of the Prescribed Services Manual. The manual can then be searched using the section number.

NICE Guidelines

Other Information This drug has been licensed but has not yet been launched. Once launched it will not be routinely commissioned and should be requested from the commissioner using their IFR process.

Date Reviewed December 2017

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108

Drug CHOLIC ACID BNF Section 1.9.1 (Orphacol®) National Tariff Category Drugs used in metabolic disorders Tariff Date 2016/17 Commissioner NHS England Indication(s) Inborn Errors in Primary Bile Acid Synthesis

Prescribed Services Manual (Section and title) Please note this link will take you to the front page of the Prescribed Services Manual. The manual can then be searched using the section number.

NICE Guideline

Other Information This drug is not routinely commissioned and should be requested from the commissioner via their IFR process. Specialist Centres only.

Date Reviewed April 2017

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109

CICLOSPORIN Drug (Capimune®, Capsorin®, Deximune®, Neoral®, BNF Section 8.2.2 Sandimmun®) National Tariff Category Immunosuppressants - This drug is NOT National Tariff Excluded but is listed as the commissioning responsibility of NHS England. Tariff Date 2014/15 Commissioner NHS England Indication(s) Transplant immunosuppression only

Prescribed Services Manual 15. Adult specialist renal services (Section and title) Please note this link will take 57. Heart and lung transplantation service (including bridge to transplant you to the front page of the using mechanical circulatory support) (adults and children) Prescribed Services Manual. The manual can then be searched using the section 68. Islet transplantation service (adults) number. 69. Liver transplantation service (adults and children)

127. Specialist renal services for children and young people

NICE Guidelines TA99 Renal transplantation - immunosuppressive regimens for children and adolescents

TA85 - Renal transplantation - immuno-suppressive regimens (adults) (review)

Other Information New patients only until formal repatriation agreed.

Date Reviewed April 2017

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110

Drug CIDOFOVIR BNF Section 5.3.2.2 (Vistide®) National Tariff Category Cytomegalovirus infection Tariff Date 2014/15 Commissioner NHS England Indication(s) Cytomegalovirus

NICE Guidelines None Issued

Other Information NHS England recommends referring to Trust Guidelines

Date Reviewed April 2017

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111

Drug CINACALCET BNF Section 9.5.1.2 (Mimpara®) National Tariff Category Drugs for mineral bone disorders - This drug is NOT National Tariff Excluded but is listed as the commissioning responsibility of NHS England. Tariff Date 2014/15 Commissioner NHS England Indications(s) Hyperparathyroidism – dialysis patients only

Prescribed Services Manual 15. Adult specialist renal services (Section and title) Please note this link will take you to the front page of the Prescribed Services Manual. The manual can then be searched using the section number.

NICE Guidelines TA117 - Hyperparathyroidism - cinacalcet (negative appraisal)

Other Information

Date Reviewed April 2017

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112

Drug CIPROFLOXACIN INHALATION BNF Section 5.1.12 (Otiprio®) National Tariff Category Antibacterial drugs Tariff Date 2016/17 Commissioner NHS England 1 Cystic Fibrosis Indication(s) 2 Paediatric Indications

Prescribed Services Manual (Section and title) Please note this link will take you to the front page of the Prescribed Services Manual. The manual can then be searched using the section number.

NICE Guideline

Other Information UK development of this drug appears to have been stopped however the launch dated is still showing as 2017. If launched it will not be routinely commissioned and should be requested from the commissioner via their IFR process. Specialist Centres only.

Date Reviewed December 2017

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113

CIPROFLOXACIN LIPOSOMAL Drug (INHALED) BNF Section 5.1.12 (Pulmaquin®) National Tariff Category Antibacterial drugs Tariff Date 2016/17 Commissioner NHS England Indication(s) Cystic Fibrosis

Prescribed Services Manual (Section and title) Please note this link will take you to the front page of the Prescribed Services Manual. The manual can then be searched using the section number.

NICE Guideline

Date Reviewed December 2017

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114

Drug CLADRIBINE BNF Section 8.1.3 (Leustat®, Litak®) National Tariff Category Immunomodulating Drugs Tariff Date 2014/15 Commissioner NHS England 1 Multiple sclerosis Indication(s) 2 Pulmonary Langerhans Histiocytosis

Prescribed Services Manual (Section and title) Please note this link will take you to the front page of the Prescribed Services Manual. The manual can then be searched using the section number.

NICE Guidelines None Issued

Other Information 1: Prior approval pro-forma required. Specialist centres only.

2: This drug is not routinely commissioned and should be requested from the commissioner via their IFR process. Specialist Centres only.

Date Reviewed November 2017

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115

Drug CLOFARABINE BNF Section 8.1 (Evoltra®) Cancer exclusion - This drug is NOT National Tariff Excluded but is listed as National Tariff Category the commissioning responsibility of the Cancer Drugs Fund. Tariff Date 2014/15 Commissioner CDF Indication(s) Cancer

Prescribed Services Manual (Section and title) Please note this link will take you to the front page of the Prescribed Services Manual. The manual can then be searched using the section number.

NICE Guidelines

Other Information To be used in line with the CDF Policy

Date Reviewed November 2017

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116

Drug COBICISTAT BNF Section Not yet listed. (Tybost®) National Tariff Category AIDS/HIV antiretrovirals Tariff Date 2014/15 Commissioner NHS England Indication(s) HIV in combination with other anti-retroviral drugs

Prescribed Services Manual (Section and title) Please note this link will take you to the front page of the Prescribed Services Manual. The manual can then be searched using the section number.

NICE Guidelines None issued

Other Information Use in line with NHS England Policy F03/P/b and agreed regional guidelines

Date Reviewed April 2017

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117

BNF Drug COBITOLIMOD (Kappaproct®) Section National Tariff Category Drugs affecting the immune response Tariff Date 2017/18 Commissioner NHS England Indication(s) Paediatric Indications (where adult TA available)

Prescribed Services Manual (Section and title) Please note this link will take you to the front page of the Prescribed Services Manual. The manual can then be searched using the section number.

NICE Guidelines

Date Reviewed December 2017

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118

CO-CARELDOPA INTERNAL Drug TUBE INTESTINAL GEL BNF Section 4.9.1 (Duodopa®) National Tariff Category Neurodegenerative Conditions Tariff Date 2014/15 Commissioner NHS England Indication(s) Parkinson’s disease

NICE Guidelines None issued

Local Guidelines

Other Information Use in line with NHS England Policy D04/P/e. Prior approval pro-forma required. Specialist Centres only.

Date Reviewed April 2017

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119

Drug COLESTILAN BNF Section 9.5.2.2 (BindRen®) National Tariff Category Drugs for mineral bone disorders - This drug is NOT National Tariff Excluded but is listed as the commissioning responsibility of NHS England. Tariff Date 2014/15 Commissioner NHS England Indication(s) Adult renal dialysis only

NICE Guidelines

Other Information NHS England recommends referring to Trust Guidelines.

Date Reviewed April 2017

120

Drug COLISTIMETHATE SODIUM BNF Section 5.1.7 (Colomycin®, Promixin®, Colobreathe®) National Tariff Category Antibacterial Drugs Tariff Date 2014/15 Commissioner NHS England Indication(s) Cystic Fibrosis

Prescribed Services Manual 45. Cystic Fibrosis (all ages) (Section and title) Please note this link will take you to the front page of the Prescribed Services Manual. The manual can then be searched using the section number.

NICE Guidelines TA276 – Cystic Fibrosis (pseudomonas lung infection) – Colistimethate sodium and tobramycin

Other Information To be used in line with NHS England Policy: A01/P/b and NICE TA276

Date Reviewed April 2017

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121

COLLAGENASE CLOSTRIDIUM BNF Drug 10.3.1 HISTOLYTICUM Section (Xiapex®) National Tariff Category Antibacterial drugs Tariff Date 2014/15 Commissioner Indication(s) Commissioned By Dupuytren’s contracture in patients with Mandatory – All CCGs a palpable cord

NICE Guidelines TA459 - Collagenase clostridium histolyticum for treating Dupuytren's contracture

Local Guidelines

Other Information

Date Reviewed November 2017

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122

Drug CONESTAT ALFA BNF Section 3.4.3 (Ruconest®) National Tariff Category Allergic emergencies Tariff Date 2014/15 Commissioner NHS England Indication(s) Hereditary angioedema - acute treatment only

NICE Guidelines None issued

Other Information To be used in line with NHS England Policy: B09/P/b

Date Reviewed April 2017

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123

Drug CRIZOTINIB BNF Section 8.1.5 (Xalkori®) National Tariff Category Protein Kinase Inhibitors Tariff Date 2014/15 Commissioner NHS England Indication(s) Cancer

Prescribed Services Manual 105. Specialist cancer services (adults) (Section and title) Please note this link will take you to the front page of the Prescribed Services Manual. The manual can then be searched using the section number.

NICE Guidelines TA422 - Crizotinib for previously treated anaplastic lymphoma kinase- positive advanced non-small-cell lung cancer

TA406 - Crizotinib for untreated anaplastic lymphoma kinase-positive advanced non-small-cell lung cancer

TA296 - Lung cancer (non-small-cell, anaplastic lymphoma kinase fusion gene, previously treated) - crizotinib (negative appraisal)

Other Information Prior approval pro-forma required. Please refer to Specialised Commissioning Services circular 1726.

Date Reviewed August 2017

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124

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BNF Drug CX601 Section National Tariff Category Drugs affecting the immune response Tariff Date 2016/17 Commissioner NHS England Area Team Indication(s)

Prescribed Services Manual (Section and title) Please note this link will take you to the front page of the Prescribed Services Manual. The manual can then be searched using the section number.

NICE Guidelines

Local Guidelines

Other Information This drug is not expected to be launched until 2018.

Date Reviewed December 2017

125

CYSTEAMINE BITARTRATE Drug (MERCAPTAMINE) BNF Section 9.8.1

National Tariff Category Drugs used in metabolic disorders Tariff Date 2014/15 Commissioner NHS England Indication(s) Nephropathic Cystinosis

Prescribed Services Manual (Section and title) Please note this link will take you to the front page of the Prescribed Services Manual. The manual can then be searched using the section number.

NICE Guideline

Local Guidelines

Other Information Highly specialised criteria only. To be used in line with the NHS England Service Specification. Specialist Centre only.

Date Reviewed April 2017

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126

CYSTEAMINE HYDROCHLORIDE Drug BNF Section 11.01 (MERCAPTAMINE) National Tariff Category Drugs used in metabolic disorders Tariff Date 2015/16 Commissioner Indication(s)

Prescribed Services Manual (Section and title) Please note this link will take you to the front page of the Prescribed Services Manual. The manual can then be searched using the section number.

NICE Guideline

Local Guidelines

Other Information This drug has not been commissioned and should not be prescribed

Date Reviewed December 2017

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127

Drug DABRAFENIB BNF Section 8.1.5 (Tafinlar®) National Tariff Category Cancer exclusion. Tariff Date 2016/17 Commissioner NHS England Indication(s) Cancer

Prescribed Services Manual (Section and title) Please note this link will take you to the front page of the Prescribed Services Manual. The manual can then be searched using the section number.

NICE Guidelines TA396 - Trametinib in combination with dabrafenib for treating unresectable or metastatic melanoma

TA321 – Dabrafenib for treating unresectable or metastatic BRAF V600 mutation-positive melanoma

Other Information To be used in line with the NICE TAs above. Prior approval proforma is required for use in accordance with NICE TA396. Specialist Centre only.

Date Reviewed April 2017

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128

Drug DACLATASVIR BNF Section 5.3.3 (Daklinza®) National Tariff Category Viral Hepatitis (B&C) & Respiratory Syncytial Virus Tariff Date 2015/16 Commissioner NHS England Indication(s) Hepatitis C

Prescribed Services 65. Highly specialist services for adults with infectious diseases Manual (Section and title) 131. Specialist services for complex liver, biliary and pancreatic diseases in Please note this link will take adults you to the front page of the Prescribed Services Manual. The manual can then be searched using the section number.

NICE Guidelines TA364 - Daclatasvir for treating chronic hepatitis C

Other Information Prior approval proforma required. Specialist Centres only.

Date Reviewed April 2017

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129

BNF Drug DACLIZUMAB (Zinbryta®) Section National Tariff Category Immunomodulating Drugs Tariff Date 2017/18 Commissioner NHS England Indication(s) Multiple sclerosis

Prescribed Services Manual (Section and title) Please note this link will take you to the front page of the Prescribed Services Manual. The manual can then be searched using the section number.

NICE Guidelines TA441 - Daclizumab for treating relapsing–remitting multiple sclerosis

Other Information Specialist Centres only. Prior approval pro-forma required. Please refer to Specialised Commissioning Circular 1745.

Date Reviewed August 2017

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130

Drug DAMOCTOCOG ALFA PEGOL BNF Section 2.11 National Tariff Category Fibrinolytics Tariff Date 2016/17 Commissioner Indication(s) Haemophilia A

Prescribed Services Manual (Section and title) Please note this link will take you to the front page of the Prescribed Services Manual. The manual can then be searched using the section number.

NICE Guideline

Local Guidelines

Other Information This drug not expected to be launched until 2018.

Date Reviewed December 2017

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131

Drug DARBEPOETIN BNF Section 9.1.3 (Aranesp®) National Tariff Category Erythropoetins - This drug is NOT National Tariff Excluded but is listed as the commissioning responsibility of NHS England. Tariff Date 2014/15 Commissioner NHS England Indication(s) Dialysis-induced anaemia

Prescribed Services Manual 127. Specialist renal services for children and young people (Section and title) Please note this link will take you to the front page of the Prescribed Services Manual. The manual can then be searched using the section number.

NICE Guidelines TA323 – Erythropoiesis – stimulating agents (epoetin and darbepoetin) for treating anaemia in people with cancer having chemotherapy (including review of TA142)

CG114 – Anaemia management in people with chronic kidney disease.

TA142 - Anaemia (cancer-treatment induced) - erythropoietin (alpha and beta) and darbepoetin

Other Information Renal dialysis only, including via outpatients, and only as per NICE CG114.

Date Reviewed April 2017

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132

Drug DARUNAVIR BNF Section 5.3.1 (Prezista®) National Tariff Category AIDS/HIV antiretrovirals Tariff Date 2014/15 Commissioner NHS England Indication(s) HIV in combination with other anti-retroviral drugs

Prescribed Services Manual 16. Adult specialist services for patients infected with HIV (Section and title) Please note this link will take 130. Specialist services for children and young people with infectious you to the front page of the diseases Prescribed Services Manual. The manual can then be searched using the section number.

NICE Guidelines None Issued

Other Information Patient to be treated in accordance with agreed Regional Guidelines.

Date Reviewed April 2017

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133

Drug DARUNAVIR with COBICISTAT BNF Section 5.3.1 (Rezolsta®) National Tariff Category AIDS/HIV antiretrovirals Tariff Date 2014/15 Commissioner NHS England Indication(s) HIV in combination with other anti-retroviral drugs

NICE Guidelines None Issued

Other Information Patient to be treated in accordance with agreed Regional Guidelines

Date Reviewed April 2017

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134

Drug DASABUVIR BNF Section 5.3.3 (Exviera®) National Tariff Category Viral hepatitis (B&C) & Respiratory Syncytial Virus Tariff Date 2016/17 Commissioner NHS England Indication(s) Hepatitis C

Prescribed Services Manual (Section and title) Please note this link will take you to the front page of the Prescribed Services Manual. The manual can then be searched using the section number.

NICE Guideline

Other Information This drug is not routinely commissioned and should be requested from the commissioner via their IFR process. Specialist Centres only. Date Reviewed April 2017

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135

Drug DASATINIB BNF Section 8.1.5 (Sprycel®) National Tariff Category Protein kinase inhibitors Tariff Date 2014/15 Commissioner NHS England / CDF Indication(s) Cancer

Prescribed Services Manual (Section and title) Please note this link will take you to the front page of the Prescribed Services Manual. The manual can then be searched using the section number.

NICE Guidelines TA426 - Dasatinib, nilotinib and imatinib for untreated chronic myeloid leukaemia

TA425 - Dasatinib, nilotinib and high-dose imatinib for treating imatinib- resistant or intolerant chronic myeloid leukaemia

Other Information To be used in line with the CDF Policy and NICE TAs listed above.

Date Reviewed April 2017

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136

Drug DECITABINE BNF Section 8.1.3 (Dacogen®) National Tariff Category Myelodysplastic Syndrome Tariff Date 2014/15 Commissioner NHS England Indication(s) Cancer

Prescribed Services Manual (Section and title) Please note this link will take you to the front page of the Prescribed Services Manual. The manual can then be searched using the section number.

NICE Guidelines TA270: Decitabine for the treatment of acute myeloid leukaemia (terminated appraisal)

Other Information This drug is not routinely commissioned and should be requested from the commissioner via their IFR process. Specialist Centres only.

Date Reviewed April 2017

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137

Drug DEFERASIROX BNF Section 9.1.3 (Exjade®) National Tariff Category Drugs used in hypoplastic, haemolytic, and renal anaemias - Iron overload Tariff Date 2014/15 Commissioner NHS England Indication(s) Iron chelation in thalassaemia and sickle cell

Prescribed Services Manual (Section and title) Please note this link will take you to the front page of the Prescribed Services Manual. The manual can then be searched using the section number.

NICE Guidelines In progress

Other Information NHS England recommends referring to Trust Guidelines. NHS England Clinical Commissioning Policy 16070/P. Specialist Centres Only.

Date Reviewed April 2017

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138

Drug DEFERIPRONE BNF Section 9.1.3 (Ferriprox®) National Tariff Category Drugs used in hypoplastic, haemolytic, and renal anaemias - Iron overload Tariff Date 2014/15 Commissioner NHS England Indication(s) Iron chelation in thalassaemia and sickle cell

Prescribed Services Manual (Section and title) Please note this link will take you to the front page of the Prescribed Services Manual. The manual can then be searched using the section number.

NICE Guidelines In progress

Other Information NHS England recommends referring to Trust Guidelines. NHS England Clinical Commissioning Policy 16070/P. Specialist Centres Only.

Date Reviewed April 2017

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139

Please see Drug DEFIBROTIDE BNF Section “Other

(Defitelio®) Information” National Tariff Category Blood-related products Tariff Date 2014/15 Commissioner NHS England Indication(s) Hepatic veno-occlusive disease

Prescribed Services Manual (Section and title) Please note this link will take you to the front page of the Prescribed Services Manual. The manual can then be searched using the section number.

NICE Guidelines None issued

Other Information Treatment should be in accordance with the NHS England Policy B04/P/c. Prior approval pro-forma required. Specialist Centres only.

Date Reviewed April 2017

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140

Drug DELAMANID BNF Section 5.1.9 (Deltyba®) National Tariff Category Antituberculosis Drugs Tariff Date 2015/16 Commissioner NHS England 1 Extensively drug resistant TB Indication(s) 2 Multi drug resistant TB

Prescribed Services 65. Highly specialist services for adults with infectious diseases Manual (Section and title) 130. Specialist services for children and young people with infectious Please note this link will take diseases you to the front page of the Prescribed Services Manual. The manual can then be searched using the section number.

NICE Guidelines

Other Information 1 & 2: Prior approval proforma required. Use in line with NHS England Policy F04/P/a and Specialised Commissioning Circular 1645 Specialist Centres only.

Date Reviewed August 2017

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141

Drug DESFERRIOXAMINE BNF Section 9.1.3 (Desferal®) National Tariff Category Drugs used in hypoplastic, haemolytic, and renal anaemias - Iron overload Tariff Date 2014/15 Commissioner NHS England Indication(s) Iron chelation in thalassaemia and sickle cell

Prescribed Services Manual 113. Specialist haematology services for children and young people (Section and title) Please note this link will take you to the front page of the Prescribed Services Manual. The manual can then be searched using the section number.

NICE Guidelines In progress

Other Information NHS England recommends referring to Trust Guidelines. NHS England Clinical Commissioning Policy 16070/P. Specialist Centres Only.

Date Reviewed April 2017

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142

DEXAMETHASONE Drug INTRAVITEAL IMPLANT BNF Section 11.4.1 (Ozurdex®) National Tariff Category Macular oedema Tariff Date 2014/15 Commissioner CCGs Indication(s) Commissioned By Macular oedema Mandatory – All CCGs

NICE Guidelines TA460 - Adalimumab and dexamethasone for treating non-infectious uveitis

TA349 – Dexamethasone intravitreal implant for treating diabetic macular oedema

TA229 - Macular oedema (retinal vein occlusion) - dexamethasone

Local Guidelines None issued

Other Information Monthly invoicing to CCG Notification using Blueteq.

Date Reviewed December 2017

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143

Drug DEXRAZOXANE BNF Section 8.1 (Savene®1,Cardioxane®2) National Tariff Category Immunomodulating Tariff Date 2014/15 Commissioner NHS England Indication(s) 1 Anthracycline extravasation (Savene®) 2 Anthracycline cardiotoxicity (Cardioxane®)

Prescribed Services Manual (Section and title) Please note this link will take you to the front page of the Prescribed Services Manual. The manual can then be searched using the section number.

NICE Guidelines

Other Information 1: NHS England recommends referring to Trust Guidelines

2: This is not routinely commissioned and should be requested from the commissioner via their IFR process. Specialist Centres only.

Date Reviewed April 2017

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144

Not currently Drug DIBOTERMIN ALFA BNF Section (InductOs®) included National Tariff Category Bone Morphogenetic Protein Tariff Date 2014/15 Commissioner NHS England Indication(s) Complex spinal surgery

Prescribed Services Manual 40. Complex spinal surgery services (all ages) (Section and title) Please note this link will take you to the front page of the Prescribed Services Manual. The manual can then be searched using the section number.

NICE Guidelines None issued.

Local Guidelines None Issued

Other Information To be used in line with NHS England Clinical Commissioning Policy 16063/P. Specialist Centres only.

Date Reviewed April 2017

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145

Drug DIDANOSINE BNF Section 5.3.1 (Videx®) National Tariff Category AIDS/HIV antiretrovirals Tariff Date 2014/15 Commissioner NHS England Indication(s) HIV in combination with other anti-retroviral drugs

NICE Guidelines None Issued

Other Information Patient to be treated in accordance with agreed Regional Guidelines.

Date Reviewed April 2017

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146

Drug DIGOXIN IMMUNE FAB BNF Section 2.1.1 (DigiFab®) National Tariff Category Poisoning Tariff Date 2014/15 Commissioner This drug has not been formally commissioned, however due the nature of the indication it is considered that all CCGs would fund. Indication(s) Digoxin toxicity

NICE Guideline

Local Guidelines

Other Information This drug is available on a named patient basis.

Date Reviewed April 2017

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147

Drug DIMETHYL FUMARATE BNF Section 8.2.4 (Tecfidera®) National Tariff Category Immunomodulating Drugs Tariff Date 2014/15 Commissioner NHS England Indication(s) Multiple sclerosis

Prescribed Services Manual (Section and title) Please note this link will take you to the front page of the Prescribed Services Manual. The manual can then be searched using the section number.

NICE Guidelines TA320 – Dimethyl fumarate for treating relapsing – remitting multiple sclerosis

Other Information Prior approval pro-forma required.

Date Reviewed April 2017

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148

Drug DIMETHYL FUMARATE (CCG) BNF Section (Fumaderm®) National Tariff Category Local National Tariff exclusion Tariff Date 2014/15 Commissioner CCGs Indication(s) Commissioned By NHS Ashford CCG Moderate to severe NHS Canterbury CCG plaque psoriasis NHS South Kent Coast CCG NHS Thanet CCG

NICE Guidelines TA475 - Dimethyl fumarate for treating moderate to severe plaque psoriasis

Local Guidelines

Other Information

Date Reviewed November 2017

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149

Drug DOLUTEGRAVIR BNF Section 5.3.1 (Tivicay®) National Tariff Category AIDS/HIV antiretrovirals Tariff Date 2014/15 Commissioner NHS England Indication(s) HIV in combination with other anti-retroviral drugs

Prescribed Services Manual 16. Adult specialist services for patients infected with HIV (Section and title) Please note this link will take 130. Specialist services for children and young people with infectious you to the front page of the Prescribed Services Manual. diseases The manual can then be searched using the section number.

NICE Guidelines None issued

Other Information Patient to be treated in accordance with NHS England Policy: B06/P/b and agreed regional guidelines.

Date Reviewed April 2017

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150

Drug DORNASE ALFA BNF Section 3.7 (Pulmozyme®) National Tariff Category Mucolytics Tariff Date 2014/15 Commissioner NHS England 1 Cystic Fibrosis Indication(s) 2 Primary Ciliary Dyskinesia

Prescribed Services Manual 45. Cystic fibrosis (all ages) (Section and title) Please note this link will take you to the front page of the Prescribed Services Manual. The manual can then be searched using the section number.

NICE Guidelines TA276 – Cystic Fibrosis (pseudomonas lung infection) – Colistimethate sodium and tobramycin

Other Information 1: To be used in line with NHS England Policy: A01/P/b 2: This drug, for this indication, is not routinely commissioned and should be requested from the commissioner via their IFR process. Specialist Centre only.

Date Reviewed April 2017

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151

BNF Drug Dupilumab 10.1.3 (Dupixent®) Section National Tariff Drugs affecting the immune response Category Tariff Date 2017/2018 Commissioner CCG Indication(s) Commissioned By Moderate to severe atopic dermatitis after topical treatments All CCGs

NICE Guidelines NICE TA534

Local Guidelines

Other Information Notification, including withdrawals, should be made via Blueteq.

Date Reviewed August 2018

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152

BNF Drug DUPILUMAB (Dupixent®) Section National Tariff Category Drugs affecting the immune response Tariff Date 2017/18 Commissioner NHS England Indication(s) Asthma

Prescribed Services Manual (Section and title) Please note this link will take you to the front page of the Prescribed Services Manual. The manual can then be searched using the section number.

NICE Guidelines

Other Information This drug is currently in Phase III clinical trials and is not expected to be launched until 2019. Once launched it will not be routinely commissioned and should be requested from the commissioner via their IFR process. Specialist Centres only.

Date Reviewed December 2017

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153

Drug ECULIZUMAB BNF Section 9.1.3 (Soliris®) National Tariff Category Paroxysmal nocturnal haemoglobinuria Tariff Date 2014/15 Commissioner NHS England Central Team 1 Atypical Haemolytic Uraemic Syndrome (aHUS) 2 Paroxysmal Nocturnal Haemoglobinuria Indication(s) 3 Organ rejection post kidney transplant 4 C3 Glomerulopathy (post transplant)

Prescribed Services Manual 86. Paroxysmal nocturnal haemoglobinuria service (adults and adolescents) (Section and title) Please note this link will take you to the front page of the Prescribed Services Manual. The manual can then be searched using the section number.

NICE Guidelines None issued

Other Information 1: To be used in line with the NHS England Policy: E03/PS(HSS)/A and NICE HST1. Specialist Centres only.

2: Treatment as per NHS National Specialised Commissioning Team Service Specification. Specialist Centres only.

3:This drug is not routinely commissioned for this indication and should be requested from the commissioner via their IFR process. To be used in line with NHS England Policy A07/P/b. Specialist Centres only.

4: To be used in line with NHS England Policy 16054/P. Specialist Centres only.

Date Reviewed April 2017

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154

Drug EFAVIRENZ BNF Section 5.3.1 (Sustiva®) National Tariff Category AIDS/HIV antiretrovirals Tariff Date 2014/15 Commissioner NHS England Indication(s) HIV in combination with other anti-retroviral drugs

NICE Guidelines None issued

Other Information Patient to be treated in accordance with agreed Regional Guidelines.

Date Reviewed April 2017

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155

EFRALOCTOCOG ALPH / EFMOROCTOCOG ALFA / Drug FACTOR VIII FC FUSION BNF Section 9.1 PROTEIN (Elocta®) National Tariff Category Blood-related products Tariff Date 2015/16 Commissioner NHS England Indication(s) Haemophilia A

Prescribed Services Manual (Section and title) Please note this link will take you to the front page of the Prescribed Services Manual. The manual can then be searched using the section number.

NICE Guideline

Other Information Use in accordance with Specialised Commissioning Circular 1652. Specialist Centres only.

Date Reviewed April 2017

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156

Drug EFTRENONACOG ALFA BNF Section 2.11 (Alprolix®) National Tariff Category Blood-related products Tariff Date 2015/16 Commissioner NHS England Indication(s) Haemophilia B

Prescribed Services Manual (Section and title) Please note this link will take you to the front page of the Prescribed Services Manual. The manual can then be searched using the section number.

NICE Guideline

Other Information Use in accordance with Specialised Commissioning Circular 1652. Specialist Centres only.

Date Reviewed April 2017

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157

Drug ELBASVIR + GRAZOPREVIR BNF Section 6.2b (Zepatier®) National Tariff Category Viral Hepatitis (B&C) & Respiratory Syncytial Virus Tariff Date 2016/17 Commissioner NHS England Indication(s) Hepatitis C

Prescribed Services Manual (Section and title) Please note this link will take you to the front page of the Prescribed Services Manual. The manual can then be searched using the section number.

NICE Guideline TA413 - Elbasvir–grazoprevir for treating chronic hepatitis C

Other Information Prior approval pro-forma required. Specialist Centres only.

Date Reviewed June 2017

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158

Please see “Other Drug ELIGLUSTAT BNF Section (Cerdelga®) Information” section National Tariff Category Lysosomal Storage Disorder Drugs Tariff Date 2015/16 Commissioner NHS England Indication(s) Gaucher's disease

Prescribed Services Manual (Section and title) Please note this link will take you to the front page of the Prescribed Services Manual. The manual can then be searched using the section number.

NICE Guidelines None issued

Other Information This drug is not be routinely commissioned and should be requested from the commissioner via their IFR process. Specialist Centres only.

Date Reviewed September 2017

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159

See “Other Drug ELOSULFASE ALFA BNF Section Information” (Vimizim®) section National Tariff Category Lysosomal Storage Disorder Drugs Tariff Date 2014/15 Commissioner NHS England Indication(s) Mucopolysaccharidosis IV Type A

Prescribed Services Manual HST2 - Elosulfase alfa for treating Mucopolysaccharidosis type IVa (Section and title) Please note this link will take you to the front page of the Prescribed Services Manual. The manual can then be searched using the section number.

NICE Guidelines

Other Information Prior approval proforma required. To be used in accordance with NICE HST2 Specialist Centres only.

Date Reviewed April 2017

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160

Drug ELTROMBOPAG BNF Section 9.1.4 (Revolade®) National Tariff Category Platelet Disorder Drugs Tariff Date 2014/15 Commissioner NHS England Indication(s) ITP in Children

Prescribed Services Manual (Section and title) Please note this link will take you to the front page of the Prescribed Services Manual. The manual can then be searched using the section number.

NICE Guidelines TA293 - Thrombocytopenic purpura - eltrombopag

Other Information Prior approval proforma required. Specialist Centres only.

For adults please see the next page. Date Reviewed April 2017

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161

BNF Drug ELTROMBOPAG (CCG) 9.1.4 (Revolade®) Section National Tariff Category Platelet Disorder Drugs Tariff Date 2014/15 Commissioner CCGs Indication(s) Commissioned By 1 Thrombocytopenia purpura Mandatory – All CCGs

2 Severe aplastic anaemia in All CCGS (Please see Other Information box) adults

NICE Guidelines TA293 - Thrombocytopenic purpura - eltrombopag

TA205 - Thrombocytopenic purpura - eltrombopag – Superseded by NICE TA293

Local Guidelines PR2016-07 – Eltrombopag for severe aplastic anaemia in adults

Other Information 1: Notification, including withdrawals, should be made via Blueteq.

2: Commissioned by all CCGs in Kent and Medway but use not expected to be seen from local Trusts. Blueteq form not available.

Date Reviewed April 2017

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162

Drug ELVITEGRAVIR BNF Section 5.3.1 (Vitekta®) National Tariff Category AIDS/HIV antiretrovirals Tariff Date 2014/15 Commissioner NHS England Indication(s) HIV in combination with other anti-retroviral drugs

Prescribed Services Manual (Section and title) Please note this link will take you to the front page of the Prescribed Services Manual. The manual can then be searched using the section number.

NICE Guidelines None issued

Other Information Patient to be treated in accordance with agreed Regional Guidelines

Date Reviewed April 2017

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163

Drug EMTRICITABINE BNF Section 5.3.1 (Emtriva®) National Tariff Category AIDS/HIV antiretrovirals Tariff Date 2014/15 Commissioner NHS England Indication(s) HIV in combination with other anti-retroviral drugs

NICE Guidelines None issued

Other Information Patient to be treated in accordance with agreed Regional Guidelines.

Date Reviewed April 2017

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164

EMTRICITABINE with Drug TENOFOVIR BNF Section 5.3.1 (Truvada®) National Tariff Category AIDS/HIV antiretrovirals Tariff Date 2014/15 Commissioner NHS England Indication(s) HIV in combination with other anti-retroviral drugs

NICE Guidelines None issued

Other Information Patient to be treated in accordance with agreed Regional Guidelines

Date Reviewed April 2017

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165

EMTRICITABINE with Drug TENOFOVIR ALAFENAMIDE BNF Section 5.3.1 (Descovy®) National Tariff Category AIDS/HIV antiretrovirals Tariff Date 2017/18 Commissioner NHS England Indication(s) HIV in combination with other anti-retroviral drugs

NICE Guidelines None issued

Other Information Patient to be treated in accordance with NHS England Clinical Commissioning Policy 16043/P

Date Reviewed April 2017

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166

Drug ENFUVIRTIDE BNF Section 5.3.1 (Fuzeon®) National Tariff Category AIDS/HIV antiretrovirals Tariff Date 2014/15 Commissioner NHS England Indication(s) HIV in combination with other anti-retroviral drugs

NICE Guidelines None issued

Other Information Patient to be treated in accordance with agreed Regional Guidelines

Date Reviewed April 2017

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167

Drug ENTECAVIR BNF Section 5.3.3 (Baraclude®) National Tariff Category Viral Hepatitis (B&C) & Respiratory Syncytial Virus Tariff Date 2014/15 Commissioner NHS England Indication(s) Hepatitis B

Prescribed Services Manual 16. Adult specialist services for patients infected with HIV (Section and title) Please note this link will take you to the front page of the Prescribed Services Manual. The manual can then be searched using the section number.

NICE Guidelines TA153 - Hepatitis B - entecavir

Further guidance is in progress.

Other Information

Date Reviewed April 2017

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168

Drug ENZALUTAMIDE BNF Section 8.3.4.2 (Xtandi®) National Tariff Category Hormone Antagonists Tariff Date 2014/15 Commissioner NHS England Indication(s) Cancer

Prescribed Services Manual (Section and title) Please note this link will take you to the front page of the Prescribed Services Manual. The manual can then be searched using the section number.

NICE Guidelines TA377 – Enzalutamide for treating metastatic hormone-relapsed prostate cancer before chemotherapy is indicated

TA316 - Enzalutamide for metastatic hormone-relapsed prostate cancer previously treated with a docetaxel-containing regimen.

Other Information As per NICE TA’s 77 and 316 and SSC1439 - only in abiraterone naïve patients.

Date Reviewed April 2017

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169

EPOETIN (All variants) Drug (Binocrit®, Eporatio®, Eprex®, NeoRecormon®, BNF Section 9.1.3 Retacrit®, Mircera®) National Tariff Category Erythropoetins - These drugs are NOT National Tariff excluded but are listed as the commissioning responsibility of NHS England. Tariff Date 2014/15 Commissioner NHS England Indication(s) Dialysis-induced anaemia

NICE Guidelines TA323 – Erythropoiesis-stimulating agents (epoetin and darbepoetin) for treating anaemia in people with cancer having chemotherapy (including review of TA142)

CG114 – Anaemia management in people with chronic kidney disease.

TA142 Anaemia (cancer-treatment induced) - erythropoietin (alpha and beta) and darbepoetin

Other Information Renal dialysis only, including via outpatients, and only as per NICE CG114.

Date Reviewed April 2017

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170

Drug EPOPROSTENOL BNF Section 2.8.1 (Flolan®) National Tariff Category Vasodilator antihypertensive drugs/Pulmonary Arterial Hypertension Tariff Date 2014/15 Commissioner NHS England Indication(s) Pulmonary Arterial Hypertension

NICE Guidelines None issued

Other Information To be used in line with the NHS England Policy: A11/P/c

Date Reviewed April 2017

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171

Drug EPTOTERMIN ALFA BNF Section (Opgenra®) National Tariff Category Bone Morphogenetic Protein Tariff Date 2014/15 Commissioner NHS England Indication(s) Complex spinal surgery

NICE Guidelines None issued.

Local Guidelines None Issued

Other Information This is not routinely commissioned and should be requested from the commissioner via their IFR process. Specialist Centres only.

Date Reviewed April 2017

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172

Drug ERIBULIN BNF Section 8.1.5 (Halaven®) Cancer exclusion – This drug is NOT National Tariff Excluded but is listed as National Tariff Category the commissioning responsibility of the Cancer Drugs Fund. Tariff Date 2014/15 Commissioner NHS England / CDF Indication(s) Cancer

Prescribed Services Manual (Section and title) Please note this link will take you to the front page of the Prescribed Services Manual. The manual can then be searched using the section number.

NICE Guidelines TA423 - Eribulin for treating locally advanced or metastatic breast cancer after 2 or more chemotherapy regimens

Other Information To be used in line with NICE TA423 and the CDF Policy

Date Reviewed April 2017

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173

Drug ERLOTINIB BNF Section 8.1.5 (Tarceva®) National Tariff Category Protein kinase inhibitors Tariff Date 2014/15 Commissioner NHS England Indication(s) Cancer

Prescribed Services Manual 18. Adult thoracic surgery services (Section and title) Please note this link will take 105. Specialist cancer services (adults) you to the front page of the Prescribed Services Manual. The manual can then be 106. Specialist cancer services for children and young people searched using the section number.

NICE Guidelines TA374 – Erlotinib and gefitinib for treating non-small-cell lung cancer that has progressed after prior chemotherapy

TA227 - Lung cancer (non-small-cell, advanced or metastatic maintenance treatment) - erlotinib (monotherapy) (negative appraisal)

TA162 - Lung cancer (non-small-cell) - erlotinib (Please see “Other Information” section below)

Other Information To be used in line with NICE TA’s above and NHS England letter.

NICE TA162 - Erlotinib is not recommended for the second-line treatment of locally advanced or metastatic NSCLC in patients for whom docetaxel is unsuitable (that is, where there is intolerance of or contraindications to docetaxel) or for third-line treatment after docetaxel therapy.

Date Reviewed April 2017

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174

Drug ETANERCEPT BNF Section 10.1.3 (Enbrel®) National Tariff Category Cytokine modulators Tariff Date 2014/15 Commissioner NHS England Indication(s) 1 Paediatric indications (where adult TA available) 2 Juvenile arthritis

Prescribed Services Manual 27. Behçet’s syndrome service (adults and adolescents) (Section and title) Please note this link will take 129. Specialist rheumatology services for children and young people you to the front page of the Prescribed Services Manual. The manual can then be searched using the section number.

NICE Guidelines TA455 - Adalimumab, etanercept and ustekinumab for treating plaque psoriasis in children and young people

TA383 – TNF-alpha inhibitors for ankylosing spondylitis and non- radiographic axial spondyloarthritis

TA373 – Abatacept, adalimumab, etanercept and tocilizumab for treating juvenile idiopathic arthritis

TA199 – Psoriatic arthritis - etanercept, infliximab and adalimumab

TA103 – Psoriasis - efalizumab and etanercept

Other Information 1: Treatment as per Adult TAs listed above. Prior approval proforma required.

2: Prior approval proforma required. Treatment as per NHS Clinical Commissioning Policy E03/P/d and NICE TA373.

Date Reviewed December 2017

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175

BNF Drug ETANERCEPT (CCG) 10.1.3 (Enbrel®) Section National Tariff Category Cytokine modulators Tariff Date 2014/15 Commissioner CCGs Indications(s) Commissioned By Adult Onset Still’s Disease All CCGs Ankylosing spondylitis Psoriasis Mandatory – All CCGs Psoriatic arthritis Rheumatoid arthritis

NICE Guidelines TA383 – TNF-alpha inhibitors for ankylosing spondylitis and non-radiographic axial spondyloarthritis

TA373 – Abatacept, adalimumab, etanercept and tocilizumab for treating juvenile idiopathic arthritis

TA199 – Psoriatic arthritis - etanercept, infliximab and adalimumab

TA195 – Rheumatoid arthritis - drugs for treatment after failure of a TNF inhibitor

TA103 – Psoriasis - efalizumab and etanercept

Local Guidelines Kent and Medway Guidelines for Adult Onset Still’s Disease (guideline 3)

Kent and Medway guidelines for psoriasis and Biologic agents: (guideline 15)

Kent and Medway Psoriatic Arthritis - Treatment Pathway: (guideline 17)

Kent and Medway guidelines for rheumatoid arthritis treatment pathways: (guideline 19)

Other Information For use in adults only, for use in children please see previous page.

Patients must be treated by a consultant dermatologist.

Notification (including withdrawals) via Blueteq

Drug supplied via Homecare and billed directly to the Trust.

Date Reviewed September 2017

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176

Drug ETELCALCETIDE BNF Section 9.5.1.2 (Parsabiv®) National Tariff Category Drugs for mineral bone disorders - This drug is NOT National Tariff Excluded but is listed as the commissioning responsibility of NHS England. Tariff Date 2017/18 Commissioner NHS England Indications(s) Hyperparathyroidism – dialysis patients only

NICE Guidelines TA448 - Etelcalcetide for treating secondary hyperparathyroidism

Other Information Prior approval pro-forma required. Specialist Centres only. Please refer to Specialised Services Commissioning circular 1763.

Date Reviewed August 2017

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177

BNF Drug ETEPLIRSEN (Exondys®) Section National Tariff Category Neuromuscular Disorders Tariff Date 2017/18 Commissioner NHS England Indication(s) Duchenne Muscular Dystrophy

Prescribed Services Manual (Section and title) Please note this link will take you to the front page of the Prescribed Services Manual. The manual can then be searched using the section number.

NICE Guidelines

Other Information This drug has not yet been launched. Once it has been launched it will not be routinely commissioned and should be requested from the commissioner via their IFR process.

Date Reviewed December 2017

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178

Drug ETRAVIRINE BNF Section 5.3.1 (Intelence®) National Tariff Category AIDS/HIV antiretrovirals Tariff Date 2014/15 Commissioner NHS England Indication(s) HIV in combination with other anti-retroviral drugs

NICE Guidelines None issued

Other Information Patient to be treated in accordance with agreed Regional Guidelines.

Date Reviewed April 2017

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179

BNF Drug ETROLIZUMAB Section National Tariff Category Drugs affecting the immune response Tariff Date 2017/18 Commissioner NHS England Indication(s) Paediatric indications (where adult TA available)

Prescribed Services Manual (Section and title) Please note this link will take you to the front page of the Prescribed Services Manual. The manual can then be searched using the section number.

NICE Guidelines

Date Reviewed December 2017

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180

Drug EVEROLIMUS (Afinitor®) BNF Section 8.1.5 National Tariff Category Protein kinase inhibitors Tariff Date 2014/15 Commissioner NHS England / CDF Indication(s) Cancer

Prescribed Services Manual (Section and title) Please note this link will take you to the front page of the Prescribed Services Manual. The manual can then be searched using the section number.

NICE Guidelines TA449 - Everolimus and sunitinib for treating unresectable or metastatic neuroendocrine tumours in people with progressive disease

TA432 - Everolimus for advanced renal cell carcinoma after previous treatment

TA421 - Everolimus with exemestane for treating advanced breast cancer after endocrine therapy

TA295 Breast cancer (HER2 negative, oestrogen receptor positive, locally advanced or metastatic) - everolimus (with an aromatase inhibitor) (negative appraisal)

TA219 - Everolimus for the second-line treatment of advanced renal cell carcinoma (negative appraisal)

Other Information Prior approval proforma required. To be used in line with NICE TA’s and the CDF Policy.

Date Reviewed December 2017

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181

Drug EVEROLIMUS (Certican®) BNF Section 8.1.5 National Tariff Category Protein kinase inhibitors Tariff Date 2014/15 Commissioner NHS England Indication(s) 1 Preventing organ rejection in liver transplantation 2 Preventing organ rejection in heart transplantation

Prescribed Services Manual (Section and title) Please note this link will take you to the front page of the Prescribed Services Manual. The manual can then be searched using the section number.

NICE Guidelines TA348 – Everolimus for preventing organ rejection in liver transplantation.

Other Information 1: This drug is not routinely commissioned and should be requested from the commissioner via their IFR process. Specialist Centres only

2: This drug is not routinely commissioned and should be requested from the commissioner via their IFR process. NHS England clinical commissioning policy 16016/P

Date Reviewed April 2017

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182

Drug EVEROLIMUS (Votubia®) BNF Section 8.1.5 National Tariff Category Protein kinase inhibitors Tariff Date 2014/15 Commissioner NHS England Indication(s) 1 Renal angiomyolipoma associated with Tubular sclerosis 2 Subependymal giant cell astrocytoma (SEGA) associated with Tubular sclerosis

Prescribed Services Manual (Section and title) Please note this link will take you to the front page of the Prescribed Services Manual. The manual can then be searched using the section number.

NICE Guidelines

Other Information 1: Prior approval proforma required. NHS England clinical commissioning policy statement 16066/P. Specialist Centre use only. 2:Prior approval proforma required. NHS England clinical commissioning policy 16066/P. Specialist Centre only.

Date Reviewed August 2017

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183

Drug EVOLOCUMAB BNF Section 2.12 (Repatha SureClick®) National Tariff Category Lipid Regulating Drugs Tariff Date 2016/17 Commissioner NHS England Indication(s) Homozygous familial hypercholesterolemia

Prescribed Services Manual (Section and title) Please note this link will take you to the front page of the Prescribed Services Manual. The manual can then be searched using the section number.

NICE Guidelines TA394 - Evolocumab for treating primary hypercholesterolaemia and mixed dyslipidaemia

Other Information Specialist Centres only. Follow NICE TA394 guidance for heterozygous FH)

Date Reviewed April 2017

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184

Drug EVOLOCUMAB (CCG) BNF Section 2.12 (Repatha SureClick®) National Tariff Category Lipid regulating drugs Tariff Date 2016/17 Commissioner Indication(s) Commissioned By: Primary hypercholesterolaemia or mixed Mandatory – All CCGs dyslipidaemia Primary heterozygous-familial Mandatory – All CCGs hypercholesterolaemia

NICE Guideline TA3943 – Evolocumab for treating primary hypercholesterolaemia and mixed dyslipidaemia

Local Guidelines Drug supplied via Homecare and billed directly to the Trust.

Other Information

Date Reviewed September 2017

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185

EX-VIVO EXPANDED AUTOLOGOUS Drug HUMAN CORNEAL EPITHELIAL BNF Section 11.08 CELLS CONTAINING STEM CELLS 1 (Holoclar®) National Tariff Category ATMP Tariff Date 2016/17 Commissioner TBC Indication(s) Treatment of adult patients with moderate to severe limbal stem-cell deficiency (LSCD), unilateral or bilateral, due to physical or chemical ocular burns.

Prescribed Services Manual (Section and title) Please note this link will take you to the front page of the Prescribed Services Manual. The manual can then be searched using the section number.

NICE Guidelines TA467 - Holoclar for treating limbal stem cell deficiency after eye burns

Other Information Prior approval pro-forma required. Specialist Centres only.

Date Reviewed December 2017

186

Drug FACTOR IX BNF Section 2.11 National Tariff Category Blood-related products Tariff Date 2014/15 Commissioner NHS England Indication(s) As per BCSH Guidelines

Prescribed Services Manual 132. Specialist services for haemophilia and other related bleeding disorders (Section and title) (all ages) Please note this link will take you to the front page of the Prescribed Services Manual. The manual can then be searched using the section number.

NICE Guidelines None issued

Other Information Treatment must be as per BCSH Guidelines.

Date Reviewed April 2017

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187

Drug FACTOR VII BNF Section 2.11 National Tariff Category Blood-related products Tariff Date 2014/15 Commissioner NHS England Indication(s) As per BCSH Guidelines

NICE Guidelines None issued

Other Information Treatment must be as per BCSH Guidelines.

Date Reviewed April 2017

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188

Drug FACTOR VIIa BNF Section 2.11 (Eptacog Alfa) National Tariff Category Blood-related products Tariff Date 2014/15 Commissioner NHS England Indication(s) As per BCSH Guidelines

NICE Guidelines None issued

Other Information Treatment must be as per BCSH Guidelines.

Date Reviewed April 2017

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189

FACTOR VIII Drug BNF Section 2.11

National Tariff Category Blood-related products Tariff Date 2014/15 Commissioner NHS England Indication(s) As per BCSH Guidelines

NICE Guidelines None issued

Other Information Treatment must be as per BCSH Guidelines.

Date Reviewed April 2017

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190

FACTOR VIII Fc FUSION Please see “Other Drug BNF Section PROTEIN Information” (Efmoroctocog alfa) (Elocta®) section National Tariff Category Blood-related products Tariff Date 2014/15 Commissioner NHS England Indication(s) As per BSCH Guidelines

Prescribed Services Manual (Section and title) Please note this link will take you to the front page of the Prescribed Services Manual. The manual can then be searched using the section number.

NICE Guidelines None issued

Other Information To be used in accordance with BSCH Guidelines.

Date Reviewed April 2017

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191

FACTOR VIII Inhibitor Bypassing Drug BNF Section 2.11 Factor (FEIBA) National Tariff Category Blood-related products Tariff Date 2014/15 Commissioner NHS England Indication(s) As per BCSH Guidelines

NICE Guidelines None issued

Other Information Treatment must be as per BCSH Guidelines.

Date Reviewed April 2017

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192

FACTOR XIII Drug BNF Section 2.11

National Tariff Category Blood-related products Tariff Date 2014/15 Commissioner NHS England Indication(s) As per BCSH Guidelines

NICE Guidelines None issued

Other Information Treatment must be as per BCSH Guidelines.

Date Reviewed April 2017

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193

FACTOR X Drug BNF Section 2.11

National Tariff Category Blood-related products Tariff Date 2017/18 Commissioner NHS England Indication(s) Hereditary Factor X Deficiency

NICE Guidelines None issued

Other Information This drug is not routinely commissioned and should be requested from the commissioner via their IFR process. Specialist Centre only.

Date Reviewed April 2017

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194

Drug FAMPRIDINE BNF Section 10.2.1 (Fampyra®) National Tariff Category Neuromuscular Disorders Tariff Date 2014/15 Commissioner NHS England Indication(s) Multiple Sclerosis

Prescribed Services Manual 11. Adult specialist neurosciences services (Section and title) Please note this link will take you to the front page of the Prescribed Services Manual. The manual can then be searched using the section number.

NICE Guidelines None issued

Other Information This drug is not routinely commissioned and should be requested from the commissioner via their IFR process.

NHS England Policy:1601/P

Date Reviewed April 2017

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195

FIBRINOGEN Drug BNF Section 2.11

National Tariff Category Blood-related products Tariff Date 2014/15 Commissioner NHS England Indication(s) As per BCSH Guidelines for specialised indications

NICE Guidelines None issued

Other Information Patient to be treated in line with BCSH Guidelines

Date Reviewed April 2017

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196

FIBROBLAST GROWTH Drug BNF Section FACTOR 1 GENE THERAPY National Tariff Category Somatostatin Analogues Tariff Date 2014/15 Commissioner NHS England Indication(s) Somatostatin analogue

Prescribed Services Manual 9. Adult specialist endocrinology services (Section and title) Please note this link will take 109. Specialist endocrinology and diabetes services for children and young you to the front page of the people Prescribed Services Manual. The manual can then be searched using the section number.

NICE Guidelines None issued

Other Information This is not routinely commissioned and should be requested from the commissioner via their IFR process. Specialist Centres only.

Date Reviewed April 2017

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197

FILGRASTIM Drug (Neupogen®, Nivestim®, Ratiograstim®, BNF Section 9.1.6 Tevagrastim®, Zarzio®) National Tariff Category Drugs used in neutropenia Tariff Date 2014/15 Commissioner NHS England Indication(s) 1 Neutropenia 2 Barth Syndrome (see “Other Information” section)

Prescribed Services Manual 25. Barth syndrome service (male adults and children) (Section and title) Please note this link will take you to the front page of the Prescribed Services Manual. The manual can then be searched using the section number.

NICE Guidelines None issued

Other Information 1: Please refer to the SPC. Specialist Centres only. 2: Highly specialised criteria only. Specialist Centres only. Date Reviewed April 2017

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198

Drug FINGOLIMOD BNF Section 8.2.4 (Gilenya®) National Tariff Category Immunomodulating drugs Tariff Date 2014/15 Commissioner NHS England Indication(s) Multiple sclerosis

Prescribed Services Manual (Section and title) Please note this link will take you to the front page of the Prescribed Services Manual. The manual can then be searched using the section number.

NICE Guidelines TA254 - Multiple sclerosis (relapsing-remitting) - fingolimod

Other Information To be used in line with NICE TA254 (above) and NHS England Policy: D04/P/b. Prior approval pro-forma required.

Date Reviewed April 2017

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199

FLEBOGAMMA Drug BNF Section 14.5.1

National Tariff Category Intravenous/subcutaneous human normal immunoglobulins Tariff Date 2014/15 Commissioner NHS England Indication(s) As per National DMP

Prescribed Services Manual 5. Adult highly specialist rheumatology services (Section and title) Please note this link will take 11. Adult specialist neurosciences services you to the front page of the Prescribed Services Manual. The manual can then be 54. Fetal medicine services (adults and adolescents) searched using the section number. 119. Specialist neuroscience services for children and young people

128. Specialist respiratory services for children and young people

129. Specialist rheumatology services for children and young people

NICE Guidelines None issued

Please use in accordance with Clinical Guidelines for immunoglobulin use, second edition update (July 2011)

Date Reviewed April 2017

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200

FLEBOGAMMA® DIF Drug BNF Section 14.5.1

National Tariff Category Intravenous/subcutaneous human normal immunoglobulins Tariff Date 2014/15 Commissioner NHS England Indication(s) As per National DMP

128. Specialist respiratory services for children and young people

129. Specialist rheumatology services for children and young people

NICE Guidelines None issued

Please use in accordance with Clinical Guidelines for immunoglobulin use, second edition update (July 2011)

Date Reviewed April 2017

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201

Drug FLUOCINOLONE ACETONIDE BNF Section 11.4.2 (Iluvien®) National Tariff Category Macular Oedema Tariff Date 2014/15 Commissioner CCG Indication(s) Commissioned By Diabetic Macular Oedema Mandatory – All CCGs

NICE Guidelines TA301 – Diabetic Macular Oedema – Fluocinolone acetonide intravitreal implant (rapid review of TA271)*

Local Guidelines

Other Information

Date Reviewed April 2017

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202

Emergency treatment of Drug BNF Section FOMEPIZOLE poisoning Pg41 National Tariff Category Poisoning Tariff Date 2014/15 Commissioner This drug has not been formally commissioned, however due the nature of the indication it is considered that all CCGs would fund. Indication(s) Commissioned By Ethylene glycol poisoning All CCGS – please see other information section below Methanol poisoning All CCGS – please see other information section below

NICE Guidelines None issued

Local Guidelines

Other Information Available from “Special-order” manufacturers or specialist importing companies (see BNF) for treatment of ethylene glycol and methanol (methyl alcohol) poisoning. Advice should be sought from the National Poisons Information Service (0844 8920111) Date Reviewed April 2017

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203

BNF Drug FORIGERIMOD ACETATE (Lupuzor®) Section National Tariff Category Cytokine Modulators Tariff Date 2016/17 Commissioner NHS England Indication(s) SLE

Prescribed Services Manual (Section and title) Please note this link will take you to the front page of the Prescribed Services Manual. The manual can then be searched using the section number.

NICE Guidelines

Date Reviewed December 2017

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204

Drug FOSAMPRENAVIR BNF Section 5.3.1 (Telzir®) National Tariff Category AIDS/HIV antiretrovirals Tariff Date 2014/15 Commissioner NHS England Indication(s) HIV in combination with other anti-retroviral drugs

NICE Guidelines None issued

Other Information Patient to be treated in accordance with agreed Regional Guidelines

Date Reviewed April 2017

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205

Drug FOSCARNET BNF Section 5.3.2.2 (Foscavir®) National Tariff Category Antiviral drugs - Cytomegalovirus infection Tariff Date 2014/15 Commissioner NHS England Indication(s) Cytomegalovirus

NICE Guidelines None issued

Other Information NHS England recommends referring to Trust Guidelines

Date Reviewed April 2017

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206

See “other Drug FOSTAMATINIB DISODIUM BNF Section Information” (Tavalisse®) section National Tariff Category Protein Kinase Inhibitors Tariff Date 2014/15 Commissioner Indication(s) Commissioned By

NICE Guideline

Local Guidelines

Other Information This drug is currently in Phase III Clinical Trials and is not expected to be launched until 2019.

Date Reviewed December 2017

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207

BNF Drug FOSTEMSAVIR Section National Tariff Category AIDS/HIV antiretrovirals Tariff Date 2017/18 Commissioner NHS England Indication(s) HIV in combination with other antiretroviral drugs

Prescribed Services Manual (Section and title) Please note this link will take you to the front page of the Prescribed Services Manual. The manual can then be searched using the section number.

NICE Guidelines

Other Information This drug is currently in Phase III Clinical Trials and is not expected to be launched until 2021. Once launched it will not be routinely commissioned and should be requested from the commissioner via their IFR process.

Date Reviewed December 2017

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208

BNF Drug GALCANEZUMAB Section National Tariff Category Cytokine modulators Tariff Date 2017/18 Commissioner Indication(s)

NICE Guidelines

Local Guidelines

Other Information This drug is not expected to be launched until 2019.

Date Reviewed December 2017

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209

Drug GALSULFASE BNF Section 9.8.1 (Naglazyme®) National Tariff Category Lysosomal Storage Disorder Drugs Tariff Date 2014/15 Commissioner NHS England Indication(s) Mucopolysaccharidosis

NICE Guidelines None issued

Other Information To be used in line with the NHS England Service Specification. Highly specialised criteria only. Specialist centre only.

Date Reviewed April 2017

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210

GAMMAGARD S/D® Drug BNF Section 14.5.2

National Tariff Category Intravenous/subcutaneous human normal immunoglobulins Tariff Date 2014/15 Commissioner NHS England Indication(s) As per National DMP

128. Specialist respiratory services for children and young people

129. Specialist rheumatology services for children and young people

NICE Guidelines None issued

Please use in accordance with Clinical Guidelines for immunoglobulin use, second edition update (July 2011)

Date Reviewed April 2017

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211

GAMMANORM® Drug BNF Section 14.5.1

National Tariff Category Intravenous/subcutaneous human normal immunoglobulins Tariff Date 2014/15 Commissioner NHS England Indication(s) As per National DMP

128. Specialist respiratory services for children and young people

129. Specialist rheumatology services for children and young people

NICE Guidelines None issued

Please use in accordance with Clinical Guidelines for immunoglobulin use, second edition update (July 2011)

Date Reviewed April 2017

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212

GAMMAPLEX® Drug BNF Section 14.5.1

National Tariff Category Intravenous/subcutaneous human normal immunoglobulins Tariff Date 2014/15 Commissioner NHS England Indication(s) As per National DMP

128. Specialist respiratory services for children and young people

129. Specialist rheumatology services for children and young people

NICE Guidelines None issued

Please use in accordance with Clinical Guidelines for immunoglobulin use, second edition update (July 2011)

Date Reviewed April 2017

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213

Drug GAMUNEX® BNF Section 14.1.5 National Tariff Category Intravenous/subcutaneous human normal immunoglobulins Tariff Date 2014/15 Commissioner NHS England Indication(s) As per National DMP

Prescribed Services Manual (Section and title) Please note this link will take you to the front page of the Prescribed Services Manual. The manual can then be searched using the section number.

NICE Guidelines

Please use in accordance with Clinical Guidelines for immunoglobulin use, second edition update (July 2011).

Date Reviewed April 2017

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214

Drug GANCICLOVIR BNF Section 5.3.2.2 (Cymevene®) National Tariff Category Cytomegalovirus infection Tariff Date 2014/15 Commissioner NHS England Indication(s) Cytomegalovirus

NICE Guidelines None issued

Other Information NHS England recommends referring to Trust Guidelines

Date Reviewed April 2017

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215

BNF Drug 4.1.1 GANTENERUMAB Section National Tariff Category Hypnotics and anxiolytics Tariff Date 2017/18 Commissioner Indication(s) Alzheimer’s Disease

NICE Guidelines

Local Guidelines

Other Information This drug is currently in Phase III Clinical Trials and is not expected to be launched until 2020.

Date Reviewed December 2017

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216

Drug GEFITINIB BNF Section 8.1.5 (Iressa®) National Tariff Category Protein kinase inhibitors Tariff Date 2014/15 Commissioner NHS England Indication(s) Cancer

Prescribed Services Manual (Section and title) Please note this link will take you to the front page of the Prescribed Services Manual. The manual can then be searched using the section number.

NICE Guidelines TA192 - Lung cancer (non-small-cell, first line) - gefitinib

TA175 - Lung cancer (non-small-cell, second line) - gefitinib (terminated appraisal)

Other Information

Date Reviewed April 2017

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217

Drug GLATIRAMER ACETATE BNF Section 8.2.4 (Copaxone®) National Tariff Category Immunomodulating drugs Tariff Date 2014/15 Commissioner NHS England Indication(s) Multiple Sclerosis

Prescribed Services Manual (Section and title) Please note this link will take you to the front page of the Prescribed Services Manual. The manual can then be searched using the section number.

NICE Guidelines TA32 - Multiple sclerosis - beta interferon and glatiramer acetate (negative appraisal – see “Other Information” section below)

Other Information To be used in line with NICE TA32 and NHS England Policy: D04/P/b. Prior approval pro-forma required

Not approved by NICE, however, risk sharing scheme agreed between manufacturers and DoH allows use.

Date Reviewed April 2017

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218

GLECAPREVIR + BNF Drug 6.2b PIBRENTASVIR Section National Tariff Category Viral Hepatitis (B&C) & Respiratory Syncytial Virus Tariff Date 2017/18 Commissioner NHS England Indication(s) Hepatitis C

Prescribed Services Manual (Section and title) Please note this link will take you to the front page of the Prescribed Services Manual. The manual can then be searched using the section number.

NICE Guidelines

Other Information This drug is not routinely commissioned and should be requested from the commissioner via their IFR process. Specialist Centres only.

Date Reviewed September 2017

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219

Drug GLYCEROL PHENYLBUTYRATE BNF Section 9.8.1 (Ravicti®) National Tariff Category Drugs used in metabolic disorders Traiff Date 2016/17 Commissioner NHS England Indication(s) Urea Cycle Disorders

Prescribed Services Manual (Section and title) Please note this link will take you to the front page of the Prescribed Services Manual. The manual can then be searched using the section number.

NICE Guidelines

Other Information This drug has been licensed but is expected to be launched in 2017. Once launched it will not be routinely commissioned and should be requested from the commissioner via their IFR process. Specialist Centre only.

Date Reviewed December 2017

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220

Drug GLYCOPEGYLATED FACTOR IX BNF Section 2.11 National Tariff Category Blood Related Products Except Fibrin Sealants Traiff Date 2014/15 Commissioner NHS England Indication(s) Haemophilia A

Prescribed Services Manual (Section and title) Please note this link will take you to the front page of the Prescribed Services Manual. The manual can then be searched using the section number.

NICE Guidelines

Other Information This drug is not routinely commissioned and should be requested from the commissioner via their IFR process. Specialist Centre only.

Date Reviewed September 2017

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221

Drug GOLIMUMAB BNF Section 10.1.3 (Simponi®) National Tariff Category Cytokine modulators Tariff Date 2014/15 Commissioner NHS England Indication(s) Paediatric Indications

Prescribed Services Manual 129. Specialist rheumatology services for children and young people (Section and title) Please note this link will take you to the front page of the Prescribed Services Manual. The manual can then be searched using the section number.

NICE Guidelines TA233 - Ankylosing spondylitis - golimumab

TA220 – Psoriatic arthritis - golimumab

Other Information Treatment as per Adult TAs listed above.

For adult patients please see the next page.

Date Reviewed April 2017

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222

Drug GOLIMUMAB (CCG) BNF Section 10.1.3 (Simponi®) National Tariff Category Cytokine modulators Tariff Date 2014/15 Commissioner CCGs Indication(s) Commissioned By Ankylosing spondylitis* Psoriatic arthritis* Rheumatoid arthritis* Mandatory – All CCGs Ulcerative Colitis (moderate to severe)

TA329 – Infliximab, adalimumab and golimumab for treating moderately to severely active ulcerative colitis after the failure of conventional therapy

TA233 - Ankylosing spondylitis - golimumab

TA225 – Rheumatoid arthritis (after the failure of previous anti-rheumatic drugs) - golimumab

TA220 – Psoriatic arthritis - golimumab

TA497 – For treating non-radiographic axial spondyloarthritis

Local Guidelines Kent and Medway Psoriatic Arthritis - Treatment Pathway: (guideline 17)

Kent and Medway guidelines for rheumatoid arthritis treatment pathways: (guideline 19) . Other Information *for use in adults only, for use in children please see previous page.

Ankylosing spondylitis Psoriatic arthritis Blueteq notification** Rheumatoid arthritis Ulcerative colitis

**Consultant teams in Kent & Medway must also notify withdrawals using Blueteq Drug supplied via Homecare and billed directly to the Trust.

Date Reviewed May 2018

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GRANULOCYTE-MACROPHAGE

Drug COLONY-STIMULATING BNF Section 9.1.6 FACTOR (Leukine® - Import) National Tariff Category Drugs used in neutropenia Tariff Date 2014/15 Commissioner NHS England Indication(s) Antibody-positive pulmonary alveolar proteinosis

Prescribed Services Manual (Section and title) Please note this link will take you to the front page of the Prescribed Services Manual. The manual can then be searched using the section number.

NICE Guidelines None issued

Other Information This drug is not routinely commissioned and should be requested from the commissioner via their IFR process. Specialist centre only.

Date Reviewed April 2017

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224

BNF Drug GUSELKUMAB 10.1.3 (Tremfya ®) Section National Tariff Drugs affecting the immune response Category Tariff Date 2016/2017 Commissioner CCG Indication(s) Commissioned By Moderate to severe plaque psoriasis in adults. All CCGs

NICE Guidelines TA521-Guselkumab for treating moderate to severe plaque psoriasis

Local Guidelines

Other Information Notification, including withdrawals, should be made via Blueteq.

Date Reviewed July 2018

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225

Drug HIV VACCINE BNF Section 14.4 (Remune®) National Tariff Category Vaccines and Antisera Tariff Date 2016/17 Commissioner NHS England Indication(s) HIV Infection prophylaxis

Prescribed Services Manual (Section and title) Please note this link will take you to the front page of the Prescribed Services Manual. The manual can then be searched using the section number.

NICE Guidelines

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226

HIZENTRA® Drug BNF Section 14.5.1

National Tariff Category Intravenous/subcutaneous human normal immunoglobulins Tariff Date 2014/15 Commissioner NHS England Indication(s) As per National DMP

128. Specialist respiratory services for children and young people

129. Specialist rheumatology services for children and young people

NICE Guidelines None issued

Other Information Clinical Advisory Group (CAG) agreed that all immunoglobulins, regardless of the service in which they used and whether or not it was commissioned by the NHS CB, should be commissioned by the NHS CB. Usage can be identified through the National Clinical Database.

Please use in accordance with Clinical Guidelines for immunoglobulin use, second edition update (July 2011)

Date Reviewed April 2017

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227

Drug HUMAN (HAEM) ARGINATE BNF Section 9.8.2 (Normosang®) National Tariff Category Drugs used in Metabolic disorders Tariff Date 2014/15 Commissioner NHS England Indication(s) Hepatic porphyria

NICE Guidelines None issued

Other Information To be used in line with the NHS England Service Specification. Highly specialised criteria only. Specialist Centre only.

Date Reviewed April 2017

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228

HUMAN HETEROLOGOUS Drug LIVER CELLS BNF Section 9.8.1 (Heparesc) National Tariff Category Drugs Used in Metabolic Disorders Tariff Date 2015/16 Commissioner NHS England Indication(s) Urea Cycle Disorders

Prescribed Services Manual (Section and title) Please note this link will take you to the front page of the Prescribed Services Manual. The manual can then be searched using the section number.

NICE Guideline

Other Information This drug is not currently available. Once available it will not be routinely commissioned and should be requested from the commissioner via their IFR process. Specialist centre only. Date Reviewed December 2017

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229

HUMAN PARATHYROID

Drug HORMONE-RELATED PROTEIN BNF Section 6.6.2 ANALOGUE (Abaloparatide analogue) National Tariff Category Drugs Affecting Bone Metabolism Tariff Date Commissioner TBC Indication(s) Male and Juvenile Osteoporosis

Prescribed Services Manual (Section and title) Please note this link will take you to the front page of the Prescribed Services Manual. The manual can then be searched using the section number.

NICE Guideline

Local Guidelines

Other Information This drug has not yet been launched.

Once launched it will not be routinely commissioned and should be requested from the commissioner via their IFR process. Specialist Centres only.

Date Reviewed December 2017

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230

Drug HYQVIA® BNF Section 14.5 National Tariff Category Intravenous/Subcutaneous Human Normal Immunoglobulins Tariff Date 2015/16 Commissioner NHS England Indication(s) As per National DMP

Prescribed Services 5. Adult highly specialist rheumatology services Manual (Section and title) 11. Adult specialist neurosciences services Please note this link will take you to the front page of the 54. Fetal medicine services (adults and adolescents) Prescribed Services Manual. The manual can then be searched using the section 119. Specialist neuroscience services for children and young people number. 128. Specialist respiratory services for children and young people

129. Specialist rheumatology services for children and young people

NICE Guideline

Other Information This drug is not routinely commissioned and should be requested from the commissioner via their IFR process. Specialist centre only.

Date Reviewed April 2017

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231

Drug IBRUTINIB BNF Section 8.1.5 (Imbruvica®) National Tariff Category Cancer exclusion - This drug is NOT National Tariff Excluded but is listed as the commissioning responsibility of the Cancer Drugs Fund. Tariff Date 2015/16 Commissioner NHS England / CDF Indication(s) Cancer

Prescribed Services Manual (Section and title) Please note this link will take you to the front page of the Prescribed Services Manual. The manual can then be searched using the section number.

NICE Guidelines TA452 - Ibrutinib for untreated chronic lymphocytic leukaemia without a 17p deletion or TP53 mutation (terminated appraisal)

TA429 - Ibrutinib for previously treated chronic lymphocytic leukaemia and untreated chronic lymphocytic leukaemia with 17p deletion or TP53 mutation

Other Information Prior approval proforma required. To be used in line with the CDF Policy and NICE TA and Specialised Services Commissioning circular 1735. Date Reviewed August 2017

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232

Drug ICATIBANT BNF Section 3.4.3 (Firazyr®) National Tariff Category Allergic emergencies Tariff Date 2015/16 Commissioner NHS England 1 Hereditary angioedema - acute treatment only Indication(s) 2 Hereditary angioedema – prophylactic treatment

NICE Guidelines None issued

Other Information 1: To be used in line with NHS England Policy B09/P/b 2: To be used in line with NHS England Policy 16045/P. Prior approval proforma required. Specialist centre only

Date Reviewed April 2017

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233

Drug IDELALISIB BNF Section 10.2 (Zydelig®) National Tariff Category Cancer exclusion - This drug is NOT National Tariff Excluded but is listed as the commissioning responsibility of the Cancer Drugs Fund. Tariff Date 2015/16 Commissioner NHS England Indication(s) Cancer

Prescribed Services Manual (Section and title) Please note this link will take you to the front page of the Prescribed Services Manual. The manual can then be searched using the section number.

NICE Guideline TA469 - Idelalisib with ofatumumab for treating chronic lymphocytic leukaemia (terminated appraisal)

TA359 – Idelalisib for treating chronic lymphocytic leukaemia

Other Information

Date Reviewed August 2017

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234

Drug IDURSULFASE BNF Section 9.8.1 (Elaprase®) National Tariff Category Lysosomal Storage Disorder Drugs Tariff Date 2014/15 Commissioner NHS England Indication(s) Mucopolysaccharidosis

NICE Guidelines None issued

Other Information Highly specialised criteria only. To be used in line with the NHS England Service Specification. Specialist centre only

Date Reviewed April 2017

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235

Drug ILOPROST BNF Section 2.5.1 (Ventavis®) National Tariff Category Vasodilator antihypertensive drugs/Pulmonary Arterial Hypertension Tariff Date 2014/15 Commissioner NHS England Indication(s) Pulmonary Arterial Hypertension

NICE Guidelines None issued

Other Information To be used in line with NHS England Policy: A11/P/c

Date Reviewed April 2017

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236

Drug IMATINIB BNF Section 8.1.5 (Glivec®) National Tariff Category Protein kinase inhibitors Tariff Date 2014/15 Commissioner NHS England Indication(s) 1 Cancer 2 Graft versus host disease

Prescribed Services Manual 29. Blood and marrow transplantation services (all ages) (Section and title) Please note this link will take you to the front page of the Prescribed Services Manual. The manual can then be searched using the section number.

NICE Guidelines TA326 – Imatinib for the adjuvant treatment of gastrointestinal stromal tumours (review of NICE technology appraisal guidance 196)

TA251 – Leukaemia (chronic myeloid, first line) – dasatinib, nilotinib and standard-dose imatinib)

TA241 – Leukaemia (chronic myeloid) – dasatinib, nilotinib, imatinib (intolerant, resistant) (negative appraisal)

TA209 – Gastrointestinal stromal tumours (unresectable/metastatic) - imatinib (negative appraisal)

TA86 – Gastrointestinal stromal tumours - imatinib

TA70 – Leukaemia (chronic myeloid) - imatinib

Other Information 1: To be used in line with NICE TAs above and the CDF Policy.

2: This drug is not routinely commissioned and should be requested from the commissioner via their IFR process. Specialist centre only.

Date Reviewed April 2017

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237

Drug IMIGLUCERASE BNF Section 9.8.1 (Cerezyme®) National Tariff Category Lysosomal Storage Disorder Drugs Tariff Date 2014/15 Commissioner NHS England Indication(s) Gaucher's disease

Prescribed Services Manual 71. Lysosomal storage disorder service (adults and children) (Section and title) Please note this link will take you to the front page of the Prescribed Services Manual. The manual can then be searched using the section number.

NICE Guidelines None issued

Other Information To be used in line with the NHS England Service Specification. Specialist centre only

Date Reviewed April 2017

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238

Drug INDINAVIR BNF Section 5.3.1 (Crixivan®) National Tariff Category AIDS/HIV antiretrovirals Tariff Date 2014/15 Commissioner NHS England Indication(s) HIV in combination with other anti-retroviral drugs

NICE Guidelines None issued

Other Information Patient to be treated in accordance with agreed Regional Guidelines

Date Reviewed April 2017

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239

BNF Drug INFLIXIMAB 1.5.4 and 10.1.3 (Remicade®) Section National Tariff Category Cytokine modulators Tariff Date 2014/15 Commissioner NHS England 1 Bechet’s Syndrome 2 Paediatric indications (where adult TA available) 3 Connective tissue disease - interstitial lung disease 4 Crohn's disease in children Indication(s) 5 Graft versus host disease

6 Hidradenitis Suppurativa

7 Juvenile arthritis 8 Renal 9 Sarcoidosis 10 Uveitis Prescribed Services 27. Behçet’s syndrome service (adults and adolescents) Manual (Section and title) 29. Blood and marrow transplantation services (all ages) Please note this link will take you to the front page of the 110. Specialist gastroenterology, hepatology and nutritional support (GHNS) services for children and Prescribed Services Manual. The manual can then be young people searched using the section number. 129. Specialist rheumatology services for children and young people

NICE Guidelines TA383 – TNF-alpha inhibitors for ankylosing spondylitis and non-radiographic axial spondyloarthritis

TA329 – Infliximab, adalimumab and golimumab for treating moderately to severely active ulcerative colitis after the failure of conventional therapy

TA199 – Psoriatic arthritis - etanercept, infliximab and adalimumab

TA187 – Crohn's disease - infliximab (review) and adalimumab (review of TA40)

TA163 – Ulcerative colitis (acute exacerbations) - infliximab

TA134 – Psoriasis - infliximab

Other Information 1: Highly specialised criteria only. Specialist centre only.

2: Prior approval proforma required.

3: This is not routinely commissioned and should be requested from the commissioner via an IFR. Specialist centre only. Policy in Progress.

5, 8 and 9: This is not routinely commissioned and should be requested from the commissioner via an IFR. Specialist centre only

6: This is not routinely commissioned and should be requested from the commissioner via an IFR. NHS England Policy 16018/P Specialist centre only

7: As per NHS England Clinical Commissioning Policy E03/P/d. Prior approval proforma required

10: This is not routinely commissioned and should be requested from the commissioner via an IFR. As per NHS England Clinical Commissioning Policy D12/P/a and D12/P/b. Specialist centre only.

Date Reviewed April 2017

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240

Drug INFLIXIMAB (CCG) BNF Section 1.5.4 and 10.1.3 (Inflectra®, Remsima® Remicade®) National Tariff Category Cytokine modulators Tariff Date 2014/15 Indication(s) Commissioned By Adult Onset Still’s Disease All CCGs Ankylosing spondylitis Crohn’s disease Psoriasis Mandatory – All CCGs Psoriatic arthritis Rheumatoid arthritis Ulcerative colitis

NICE Guidelines TA383 – TNF-alpha inhibitors for ankylosing spondylitis and non-radiographic axial spondyloarthritis

TA375 – Adalimumab, etanercept, infliximab, certolizumab pegol golimumab, tocilizumab and abatacept for rheumatoid arthritis not previously treated with DMARDs or after conventional

DMARDs only have failed.

TA329 – Infliximab, adalimumab and golimumab for treating moderately to severely active ulcerative colitis after the failure of conventional therapy

TA199 – Psoriatic arthritis - etanercept, infliximab and adalimumab

TA187 – Crohn's disease - infliximab (review) and adalimumab (review of TA40)

TA163 – Ulcerative colitis (acute exacerbations) - infliximab

TA134 – Psoriasis - infliximab

Local Guidelines Kent and Medway Guidelines for Adult Onset Still’s Disease (guideline 3)

Kent and Medway Psoriatic Arthritis - Treatment Pathway: (guideline 17)

Kent and Medway guidelines for psoriasis and Biologic agents: (guideline 15)

Kent and Medway guidelines for rheumatoid arthritis treatment pathways: (guideline 19)

Other Information *for use in adults only, for use in children please see previous page

Inflectra and Remsima are bio-smiliars. Inflectra should be used in patients who have not previously been treated with infliximab.

Notification via Blueteq (please also use Blueteq to notify of withdrawals)

Trust to send invoices for payment on monthly basis to relevant CCG. Automatic approval if guidelines are met. Date Reviewed April 2017

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241

Drug INTERFERON ALFA BNF Section 8.2.4 (IntronA®, Roferon-A®) National Tariff Category Immunomodulating drugs Tariff Date 2014/15 Commissioner NHS England Indication(s) Hepatitis B and C

Prescribed Services Manual (Section and title) Please note this link will take you to the front page of the Prescribed Services Manual. The manual can then be searched using the section number.

NICE Guidelines TA75 - Hepatitis C - pegylated interferons, ribavirin and alfa interferon

Other Information

Date Reviewed April 2017

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242

INTERFERON BETA Drug (Avonex®, Rebif®, (beta-1a) Betaferon®, Extavia® BNF Section 8.2.4 (beta-1b) National Tariff Category Immunomodulating Tariff Date 2014/15 Commissioner NHS England Indication(s) Multiple Sclerosis

Prescribed Services Manual (Section and title) Please note this link will take you to the front page of the Prescribed Services Manual. The manual can then be searched using the section number.

NICE Guidelines TA32 - Multiple sclerosis - beta interferon and glatiramer acetate

Other Information Prior approval proforma required. To be used in line with NICA TA32 and NHS England Policy: D04/P/b

Date Reviewed April 2017

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243

INTRATECT® Drug BNF Section 14.5

National Tariff Category Intravenous/subcutaneous human normal immunoglobulins Tariff Date 2014/15 Commissioner NHS England Indication(s) As per National DMP

128. Specialist respiratory services for children and young people

129. Specialist rheumatology services for children and young people

NICE Guidelines None issued

Please use in accordance with Clinical Guidelines for immunoglobulin use, second edition update (July 2011). Date Reviewed April 2017

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244

Drug IPILIMUMAB BNF Section 8.1 (Yervoy®) National Tariff Category Cancer exclusion – This drug is NOT National Tariff Excluded but is listed as the commissioning responsibility of NHS England. Tariff Date 2014/15 Commissioner NHS England Indication(s) Cancer

Prescribed Services Manual (Section and title) Please note this link will take you to the front page of the Prescribed Services Manual. The manual can then be searched using the section number.

NICE Guidelines TA400 - Nivolumab in combination with ipilimumab for treating advanced melanoma

TA319 - Ipilimumab for previously untreated advanced (unresectable or metastatic) melanoma

TA268 - Ipilimumab for previously treated advanced (unresectable or metastatic) melanoma

Other Information

Date Reviewed April 2017

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245

Drug ISAVUCONAZOLE BNF Section 5.2 (Cresemba®) National Tariff Category Antifungals Tariff Date 2014/15 Commissioner NHS England Indication(s) Fungal infection (licensed indications)

Prescribed Services Manual (Section and title) Please note this link will take you to the front page of the Prescribed Services Manual. The manual can then be searched using the section number.

NICE Guidelines

Other Information Use in accordance with Trust Guidelines

Date Reviewed April 2017

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246

Drug IVACAFTOR BNF Section 3.7 (Kalydeco®) National Tariff Category Mucolytics Tariff Date 2014/15 Commissioner NHS England Indication(s) Cystic fibrosis

NICE Guidelines None issued

Other Information To be used in line with the NHS England Policies: A01/P/c and 16049/P. Specialist centre only

Date Reviewed April 2017

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247

BNF Drug IXAZOMIB 8.6 (Ninlaro®) Section National Tariff Category Drugs used in hypoplastic, haemolytic and renal anaemias Tariff Date 2016/17 Commissioner NHS England Indication(s) Amyloidosis/Multiple Myeloma

Prescribed Services Manual (Section and title) Please note this link will take you to the front page of the Prescribed Services Manual. The manual can then be searched using the section number.

NICE Guidelines

Other Information This drug is not routinely commissioned and should be requested from the commissioner via their IFR process. Specialist centres only.

Date Reviewed September 2017

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248

Drug Ixekizumab BNF Section 10.1.3 (Taltz®) National Tariff Category Drugs affecting the immune response Tariff Date Commissioner CCG. Indication(s) Commissioned By 1.Moderate to severe All CCGS plaque psoriasis 2.Psoriatic arthritis All CCGS

NICE Guidelines TA442 - Ixekizumab for treating moderate to severe plaque psoriasis

TA537 - Ixekizumab for treating active psoriatic arthritis after inadequate response to DMARDs

Local Guidelines

Other Information Approval via Blueteq. Available via homecare. Date Reviewed October 2018

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249

KETOROLAC WITH See “other Drug BNF Section Information” PHENYLEPHRINE section (Omidria®) National Tariff Category Retinal disorders/intraocular lens replacement surgery Tariff Date 2014/15 Commissioner Indication(s) Intraocular lens replacement surgery

Prescribed Services Manual (Section and title) Please note this link will take you to the front page of the Prescribed Services Manual. The manual can then be searched using the section number.

NICE Guideline

Local Guidelines

Other Information This drug is not commissioned, please do not prescribe.

Date Reviewed December 2017

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250

KIOVIG® Drug BNF Section 14.5.1

National Tariff Category Intravenous/subcutaneous human normal immunoglobulins Tariff Date 2014/15 Commissioner NHS England Indication(s) As per National DMP

128. Specialist respiratory services for children and young people

129. Specialist rheumatology services for children and young people

NICE Guidelines None issued

Please use in accordance with Clinical Guidelines for immunoglobulin use, second edition update (July 2011). Date Reviewed April 2017

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251

Drug LAMIVUDINE BNF Section 5.3.1 (Epivir®1, Zeffix®2) National Tariff Category AIDS/HIV antiretrovirals Tariff Date 2014/15 Commissioner NHS England 1 HIV in combination with other anti-retroviral drugs Indication(s) 2 Hepatitis B

NICE Guidelines CG165 – Hepatitis B (chronic)

Other Information 1: Patient to be treated in accordance with agreed Regional Guidelines

Date Reviewed April 2017

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252

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BNF Drug 11.8 LAMPALIZUMAB Section National Tariff Category Subfoveal choroidal neovascularisation Tariff Date 2017/18 Commissioner Indication(s)

NICE Guidelines

Local Guidelines

Other Information This drug is currently in Phase III Clinical Trials. It is not expected to be launched until 2019.

Date Reviewed December 2017

253

Drug LANREOTIDE BNF Section 8.3.4.3 (Somatuline® LA, Somatuline Autogel®) National Tariff Category Somatostatin Analogues Tariff Date 2014/15 Commissioner NHS England 1 Cancer Indication(s) 2 Acromegaly 3 Congenital hyperinsulinism – highly specialised criteria only

Prescribed Services Manual 9. Adult specialist endocrinology services (Section and title) Please note this link will take you to the front page of the Prescribed Services Manual. The manual can then be searched using the section number.

NICE Guidelines None issued

Other Information 1: NHS England recommends referring to Trust Guidelines. 2: Only when prescribed in a specialist centre. NHS England recommends referring to Trust Guidelines. Specialist centre only. 3: Highly specialised criteria only. Specialist centre only.

Date Reviewed April 2017

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254

Drug LANTHANUM BNF Section 9.5.2.2 (Fosrenol®) National Tariff Category Drugs for mineral bone disorders - This drug is NOT National Tariff Excluded but is listed as the commissioning responsibility of NHS England. Tariff Date 2014/15 Commissioner NHS England Indication(s) Adult renal dialysis only

Prescribed Services Manual 15. Adult specialist renal services (Section and title) Please note this link will take 127. Specialist renal services for children and young people. you to the front page of the Prescribed Services Manual. The manual can then be searched using the section number.

NICE Guidelines None issued

Other Information NHS England recommends referring to Trust Guidelines

Date Reviewed April 2017

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255

Drug LAPATINIB BNF Section 8.1.5 (Tyverb®) National Tariff Category Protein kinase inhibitors Tariff Date 2014/15 Commissioner CDF Indication(s) Cancer

Prescribed Services Manual (Section and title) Please note this link will take you to the front page of the Prescribed Services Manual. The manual can then be searched using the section number.

NICE Guidelines

Other Information This drug is not routinely commissioned and should be requested from the commissioner via their IFR process.

Date Reviewed April 2017

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256

Drug LARONIDASE BNF Section 9.8.1 (Aldurazyme®) National Tariff Category Lysosomal Storage Disorder Drugs Tariff Date 2014/15 Commissioner NHS England Indication(s) Mucopolysaccharidosis

Prescribed Services Manual 62. Highly Specialist metabolic disorder services (all ages) for patients (Section and title) registered IMD Please note this link will take you to the front page of the 71. Lysosomal storage disorder service (adults and children) Prescribed Services Manual. The manual can then be searched using the section number.

NICE Guidelines None issued

Other Information To be used in line with the NHS England Service Specification. Specialist centre only.

Date Reviewed April 2017

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257

Drug LENALIDOMIDE BNF Section 8.2.4 (Revlimid®) National Tariff Category Immunomodulating drugs Tariff Date 2014/15 Commissioner NHS England Indication(s) Cancer

Prescribed Services Manual (Section and title) Please note this link will take you to the front page of the Prescribed Services Manual. The manual can then be searched using the section number.

NICE Guidelines TA427 - Pomalidomide for multiple myeloma previously treated with lenalidomide and bortezomib

TA322 – Lenalidomide for treating myelodysplastic syndromes associated with an isolated deletion 5q cytogenetic abnormality.

TA171 - Multiple myeloma - lenalidomide

Other Information To be used in line with NICE TA’s above

Date Reviewed April 2017

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258

Drug LENOGRASTIM BNF Section 9.1.7 (Granocyte®) National Tariff Category Drugs used in neutropenia Tariff Date 2014/15 Commissioner NHS England Indication(s) 1 Neutropenia 2 Barth Syndrome (See “Other Information” section)

NICE Guidelines None issued

Other Information 1: Please refer to the SPC. 2: Highly specialised criteria only. Specialist centre only

Date Reviewed April 2017

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259

BNF Drug LETERMOVIR Section National Tariff Category Cytomegalovirus infection Tariff Date 2017/18 Commissioner NHS England Indication(s) Cytomegalovirus

Prescribed Services Manual (Section and title) Please note this link will take you to the front page of the Prescribed Services Manual. The manual can then be searched using the section number.

NICE Guidelines

Other Information This drug is not expected to be launched until 2018. Once launched it will not be routinely commissioned and should be requested from the commissioner via their IFR process.

Date Reviewed December 2017

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260

Return to Contents page BNF Drug LEVODOPA + CARBIDOPA Section National Tariff Category Neurodegenerative conditions Tariff Date 2017/18 Commissioner TBC Indication(s) Parkinson’s Disease

Prescribed Services Manual (Section and title) Please note this link will take you to the front page of the Prescribed Services Manual. The manual can then be searched using the section number.

NICE Guidelines

Local Guidelines

Other Information This drug is currently in Phase I Clinical Trials and is not expected to be launched until 2019.

Date Reviewed December 2017

261

Drug LEVOFLOXACIN (inhaled) BNF Section 5.1.12 (Aeroquin® / Quinsair®) National Tariff Category Antibacterial Drugs Tariff Date 2014/15 Commissioner NHS England Indication(s) Cystic Fibrosis

Prescribed Services Manual (Section and title) Please note this link will take you to the front page of the Prescribed Services Manual. The manual can then be searched using the section number.

NICE Guidelines

Other Information This drug is not routinely commissioned and should be requested from the commissioner via their IFR process. Specialist centre only.

Date Reviewed April 2017

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262

See “Other Drug LIPEGFILGRASTIM BNF Section Information” (Lonquex®) section National Tariff Category Drugs used in neutropenia Tariff Date 2014/15 Commissioner NHS England Indication(s) Neutropenia

Prescribed Services Manual (Section and title) Please note this link will take you to the front page of the Prescribed Services Manual. The manual can then be searched using the section number.

NICE Guidelines

Other Information This drug is not routinely commissioned and should be requested from the commissioner via their IFR process. Specialist centre only.

Date Reviewed April 2017

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263

Drug LIXIVAPTAN BNF Section 6.5.2 (Lixar®) National Tariff Category Posterior pituitary hormones and antagonists Tariff Date 2014/15 Commissioner NHS England Indication(s) Hyponatraemia and other endocrine uses.

Prescribed Services Manual (Section and title) Please note this link will take you to the front page of the Prescribed Services Manual. The manual can then be searched using the section number.

NICE Guidelines None issued

Other Information This drug is not routinely commissioned and should be requested from the commissioner via their IFR process. Specialist centre only.

Date Reviewed April 2017

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264

Drug LOMITAPIDE BNF Section 2.12 (Lojuxta®) National Tariff Category Lipid-regulating drugs Tariff Date 2014/15 Commissioner NHS England Indication(s) Homozygous familial hypercholesterolemia

NICE Guidelines

Local Guidelines

Other Information This drug is not routinely commissioned and should be requested from the commissioner via their IFR process. Specialist centre only.

Date Reviewed April 2017

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265

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BNF Drug LONAFARNIB Section National Tariff Category Protein kinase inhibitors Tariff Date 2017/18 Commissioner NHS England Indication(s) Cancer

Prescribed Services Manual (Section and title) Please note this link will take you to the front page of the Prescribed Services Manual. The manual can then be searched using the section number.

NICE Guidelines

Other Information This drug is not routinely commissioned and should be requested from the commissioner via their IFR process. Specialist centres only.

Date Reviewed April 2017

266

Drug LOPINAVIR + RITONAVIR BNF Section 5.3.1 (Kaletra®) National Tariff Category AIDS/HIV antiretrovirals Tariff Date 2014/15 Commissioner NHS England Indication(s) HIV in combination with other anti-retroviral drugs

NICE Guidelines None issued

Other Information Patient to be treated in accordance with agreed Regional Guidelines

Date Reviewed April 2017

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267

LUMACAFTOR WITH Drug IVACAFTOR BNF Section 3.7 (Orkambi®) National Tariff Category Mucolytics Tariff Date 2015/16 Commissioner NHS England Indication(s) Cystic Fibrosis

Prescribed Services Manual (Section and title) Please note this link will take you to the front page of the Prescribed Services Manual. The manual can then be searched using the section number.

NICE Guideline TA398 – Lumacaftor – ivacaftor for treating cystic fibrosis homozygous for the F508del mutation (Negative appraisal)

Other Information This drug is not routinely commissioned and should be requested from the commissioner via their IFR process. Specialist centre only. Date Reviewed April 2017

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268

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BNF Drug LUSUTROMBOPAG (Mulpleta®) Section National Tariff Category Platelet disorder drugs Tariff Date 2017/18 Commissioner Indication(s)

Prescribed Services Manual (Section and title) Please note this link will take you to the front page of the Prescribed Services Manual. The manual can then be searched using the section number.

NICE Guidelines

Other Information This drug is currently in Phase III Clinical Trials and is not expected to be launched until 2018.

Date Reviewed December 2017

269

Drug MACITENTAN BNF Section 2.5.1 (Opsumit®) National Tariff Category Vasodilator antihypertensive drugs/Pulmonary Arterial Hypertension Tariff Date 2014/15 Commissioner NHS England Indication(s) Pulmonary Arterial Hypertension

Prescribed Services Manual (Section and title) Please note this link will take you to the front page of the Prescribed Services Manual. The manual can then be searched using the section number.

NICE Guidelines None issued

Other Information This drug is not routinely commissioned and should be requested from the commissioner via their IFR process. To be used in line with the NHS England Policy: A11/P/c. Specialist Centre only.

Date Reviewed April 2017

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270

Drug MANNITOL BNF Section 3.7 (Bronchitol®) National Tariff Category Mucolytics Tariff Date 2014/15 Commissioner NHS England Indication(s) Cystic fibrosis

NICE Guidelines TA266 - Cystic Fibrosis – mannitol dry powder for inhalation

Other Information To be used in line with the NHS England Policy: A01/P/b

Date Reviewed April 2017

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271

Drug MARAVIROC BNF Section 5.3.1 (Celsentri®) National Tariff Category AIDS/HIV antiretrovirals Tariff Date 2014/15 Commissioner NHS England Indication(s) HIV in combination with other anti-retroviral drugs

NICE Guidelines None issued

Other Information Patient to be treated in accordance with agreed Regional Guidelines

Date Reviewed April 2017

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272

Drug MASITINIB BNF Section 8.1.5 (Masican®, Masiviera®) National Tariff Category Protein Kinase Inhibitors Tariff Date 2014/15 Commissioner NHS England Indication(s) Pancreatic cancer / GIST

Prescribed Services Manual (Section and title) Please note this link will take you to the front page of the Prescribed Services Manual. The manual can then be searched using the section number.

NICE Guideline

Other Information This drug is not routinely commissioned and should be requested from the commissioner via their IFR process. Specialist centre only.

Date Reviewed April 2017

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273

Drug MECASERMIN BNF Section 6.7.4 (Increlex®) National Tariff Category Growth Hormone & Growth Hormone Receptor Antagonist Tariff Date 2014/15 Commissioner NHS England Indication(s) Growth Failure

Prescribed Services Manual 109. Specialist endocrinology and diabetes services for children and young (Section and title) people Please note this link will take you to the front page of the Prescribed Services Manual. The manual can then be searched using the section number.

NICE Guidelines None issued

Other Information To be used in line with the NHS England Policy: E03/P/a. Specialist centre only.

Date Reviewed April 2017

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274

Drug MEPOLIZUMAB BNF Section 3.4.2 (Nucala®) National Tariff Category Allergen Immunotherapy Tariff Date 2015/16 Commissioner NHS England Indication(s) Asthma

Prescribed Services Manual (Section and title) Please note this link will take you to the front page of the Prescribed Services Manual. The manual can then be searched using the section number.

NICE Guidelines TA431 - Mepolizumab for treating severe refractory eosinophilic asthma

Other Information Prior approval proforma required. Specialist centre only.

Date Reviewed April 2017

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275

Drug MESENCHYMAL STEM CELLS BNF Section (e.g. Prochymal®) National Tariff Category This drug is NOT National Tariff Excluded but is listed as the commissioning responsibility of NHS England. Tariff Date 2014/15 Commissioner NHS England Indication(s) Acute Graft versus Host Disease (GvHD) and other indications (BCSH)

Prescribed Services Manual (Section and title) Please note this link will take you to the front page of the Prescribed Services Manual. The manual can then be searched using the section number.

NICE Guidelines None issued

Other Information This is not routinely commissioned and should be requested via an IFR. Specialist centre only.

Date Reviewed April 2017

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276

Drug METRELEPTIN BNF Section 6.7 (Myalept®) National Tariff Category Other Endocrine Drugs Tariff Date 2016/17 Commissioner NHS England Indication(s) Dyslipidaemia

Prescribed Services Manual (Section and title) Please note this link will take you to the front page of the Prescribed Services Manual. The manual can then be searched using the section number.

NICE Guideline

Other Information This drug is expected to be launched in 2018. Once launched it will not be routinely commissioned and should be requested from the commissioner via their IFR process. Specialist centre only. Date Reviewed December 2017

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277

Drug MICAFUNGIN BNF Section 5.2.4 (Mycamine®) National Tariff Category Antifungals Tariff Date 2014/15 Commissioner NHS England Indication(s) Fungal infection

Prescribed Services Manual 34. Chronic pulmonary aspergillosis service (adults) (Section and title) Please note this link will take you to the front page of the Prescribed Services Manual. The manual can then be searched using the section number.

NICE Guidelines None issued

Other Information NHS England recommends referring to Trust Guidelines.

Date Reviewed April 2017

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278

New drug not Drug MIGALASTAT BNF Section (Galafold®) yet in BNF National Tariff Category Lysosomal Storage Disorder Drugs Tariff Date 2014/15 Commissioner NHS England Indication(s) Fabry's Disease

Prescribed Services Manual (Section and title) Please note this link will take you to the front page of the Prescribed Services Manual. The manual can then be searched using the section number.

NICE Guidelines HST4 - Migalastat for treating Fabry disease

Other Information Use in line with the NHS England Service Specification. Highly specialised criteria only. Specialist centre only.

Date Reviewed June 2017

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279

Drug MIGLUSTAT BNF Section 9.8.1 (Zavesca®) National Tariff Category Lysosomal Storage Disorder Drugs Tariff Date 2014/15 Commissioner NHS England Indication(s) Gaucher's disease/ Niemann-Pick

NICE Guidelines None issued

Other Information Highly specialised criteria only. To be used in line with the NHS England Service Specification. Specialist centre only.

Date Reviewed April 2017

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280

Drug MYCOPHENOLATE MOFETIL BNF Section 8.2.1 (CellCept®) National Tariff Category Immunosuppressants – This drug is NOT National Tariff Excluded but is listed as the commissioning responsibility of NHS England. Tariff Date 2014/15 Commissioner NHS England Indication(s) Transplant immunosuppression only

127. Specialist renal services for children and young people

128. Specialist respiratory services for children and young people

NICE Guidelines

Other Information New patients only until formal repatriation agreed. NHS England recommends referring to Trust Guidelines.

Date Reviewed April 2017

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281

Drug MYCOPHENOLIC ACID BNF Section 8.2.1 (Myfortic®) National Tariff Category Immunosuppressants – This drug is NOT National Tariff Excluded but is listed as the commissioning responsibility of NHS England. Tariff Date 2014/15 Commissioner NHS England Indication(s) Transplant immunosuppression only

127. Specialist renal services for children and young people

128. Specialist respiratory services for children and young people

NICE Guidelines TA99 Renal transplantation - immunosuppressive regimens for children and adolescents

TA85 - Renal transplantation - immuno-suppressive regimens (adults) (review)

Other Information New patients only until formal repatriation agreed. NHS England recommends referring to Trust Guidelines.

Date Reviewed April 2016

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282

Drug NATALIZUMAB BNF Section 8.2.4 (Tysabri®) National Tariff Category Immunomodulating drugs Tariff Date 2014/15 Commissioner NHS England Indication(s) Multiple sclerosis

Prescribed Services Manual (Section and title) Please note this link will take you to the front page of the Prescribed Services Manual. The manual can then be searched using the section number.

NICE Guidelines TA127 - Multiple sclerosis - natalizumab

Other Information To be used in line with NICE TA127 and NHS England Policy: D04/P/b Prior approval proforma required.

Date Reviewed April 2017

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283

Drug NELARABINE BNF Section 8.1.3 (Atriance®) National Tariff Category Cancer exclusion - This drug is NOT National Tariff Excluded but is listed as the commissioning responsibility of the Cancer Drugs Fund. Tariff Date 2014/15 Commissioner CDF Indication(s) Cancer

Prescribed Services Manual (Section and title) Please note this link will take you to the front page of the Prescribed Services Manual. The manual can then be searched using the section number.

NICE Guidelines

Other Information To be used in line with CDF Policy.

Date Reviewed April 2017

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284

Drug NELFINAVIR BNF Section 5.3.1 (Viracept®) National Tariff Category AIDS/HIV antiretrovirals Tariff Date 2014/15 Commissioner NHS England Indication(s) HIV in combination with other anti-retroviral drugs

NICE Guidelines None issued

Other Information Patient to be treated in accordance with agreed Regional Guidelines.

Date Reviewed April 2017

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285

Drug NEVIRAPINE BNF Section 8.3.1 (Viramune®) National Tariff Category AIDS/HIV antiretrovirals Tariff Date 2014/15 Commissioner NHS England Indication(s) HIV in combination with other anti-retroviral drugs

NICE Guidelines None issued

Other Information Patient to be treated in accordance with agreed Regional Guidelines

Date Reviewed April 2017

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286

Drug NILOTINIB BNF Section 8.1.5 (Tasigna®) National Tariff Category Protein kinase inhibitors Tariff Date 2014/15 Commissioner NHS England Indication(s) Cancer

Prescribed Services Manual (Section and title) Please note this link will take you to the front page of the Prescribed Services Manual. The manual can then be searched using the section number.

NICE Guidelines TA251 Dasatinib, nilotinib and standard-dose imatinib for the first-line treatment of chronic myeloid leukaemia (part review of technology appraisal guidance 70)

TA241 Leukaemia (chronic myeloid) - dasatinib, nilotinib, imatinib (intolerant, resistant)

Other Information

Date Reviewed April 2017

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287

See “Other Drug NINTEDANIB BNF Section Information” (Vargatef®, Ofev®) section National Tariff Category Immunomodulating drugs Tariff Date 2014/15 Commissioner NHS England 1 Non-small cell lung cancer (NSCLC) (Vargatef®) Indication(s) 2 Idiopathic pulmonary fibrosis (Ovef®) 3 Ovarian cancer (Vargatef®)

Prescribed Services Manual (Section and title) Please note this link will take you to the front page of the Prescribed Services Manual. The manual can then be searched using the section number.

NICE Guidelines TA379 – Nintedanib for treating idiopathic pulmonary fibrosis

TA347 – Nintedanib for previously treated locally advanced, metastatic, or locally recurrent non-small-cell lung cancer

Other Information 2: Prior approval proforma reuired. Specialist Centre only.

3: This drug (Vargate®) is in Phase III Clinical Trials and is not expected to be launched until 2018. Once launched this drug will not be routinely commissioned and should be requested from the commissioner via their IFR process. Specialist centre only.

Date Reviewed December 2017

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288

Drug NITISINONE BNF Section 9.8.1 (Orfadin®) National Tariff Category Drugs used in Metabolic disorders Tariff Date 2014/15 Commissioner NHS England Indication(s) 1 Alkaptonuria – Highly specialised criteria only 2 Tyrosinaemia – Highly specialised criteria only

Prescribed Services Manual 19. Alkaptonuria service (adults) (Section and title) Please note this link will take you to the front page of the Prescribed Services Manual. The manual can then be searched using the section number.

NICE Guidelines None issued

Other Information 1&2: To be used in line with the NHS England Service Specification. Specialist centre only.

Date Reviewed April 2017

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289

NITRIC OXIDE Drug BNF Section 15.1.2

National Tariff Category Vasodilator antihypertensive drugs/Pulmonary Arterial Hypertension Tariff Date 2014/15 Commissioner NHS England Indication(s) Pulmonary Arterial Hypertension

Prescribed Services Manual 118. Specialist neonatal care services (Section and title) Please note this link will take 128. Specialist respiratory services for children and young people you to the front page of the Prescribed Services Manual. The manual can then be searched using the section number.

NICE Guidelines None issued

Other Information NHS England recommends referring to Trust Guidelines

Date Reviewed April 2017

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290

Drug NIVOLUMAB BNF Section (Opvido®) National Tariff Category Cancer exclusion - This drug is NOT National Tariff Excluded but is listed as the commissioning responsibility of the Cancer Drugs Fund and or NHS England. Tariff Date 2016/17 Commissioner NHS England Indication(s) Cancer

Prescribed Services Manual (Section and title) Please note this link will take you to the front page of the Prescribed Services Manual. The manual can then be searched using the section number.

NICE Guidelines TA462 - Nivolumab for treating relapsed or refractory classical Hodgkin lymphoma

TA417 - Nivolumab for previously treated advanced renal cell carcinoma

TA400 - Nivolumab in combination with ipilimumab for treating advanced melanoma

TA384 - Nivolumab for treating advanced (unresectable or metastatic) melanoma

Other Information Prior approval pro-forma required.

Date Reviewed August 2017

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291

Drug NONACOG ALPHA BNF Section 2.11 (BeneFIX®) National Tariff Category Blood-related products except Fibrin Sealants Tariff Date 2016/17 Commissioner NHS England Indication(s) Haemophilia B

Prescribed Services Manual (Section and title) Please note this link will take you to the front page of the Prescribed Services Manual. The manual can then be searched using the section number.

NICE Guidelines

Other Information To be used according to BSCH Guidelines

Date Reviewed April 2017

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292

Drug NONACOG BETA PEGOL BNF Section

National Tariff Category Blood-related products except Fibrin Sealants Tariff Date 2016/17 Commissioner NHS England Indication(s) Haemophilia B

Prescribed Services Manual (Section and title) Please note this link will take you to the front page of the Prescribed Services Manual. The manual can then be searched using the section number.

NICE Guidelines

Other Information This drug is not expected to be launched until 2018. Once launched this drug will not be routinely commissioned and should be requested from the commissioner via their IFR process. Specialist Centre only.

Date Reviewed December 2017

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293

NORMAL IMMUNOGLOBULIN Drug BNF Section 14.5.1

National Tariff Category Intravenous/subcutaneous human normal immunoglobulins Tariff Date 2014/15 Commissioner NHS England Indication(s) As per National DMP

Prescribed Services Manual (Section and title) 5. Adult highly specialist rheumatology services Please note this link will take you to the front page of the Prescribed 11. Adult specialist neurosciences services Services Manual. The manual can then be searched using the section number. 54. Fetal medicine services (adults and adolescents)

119. Specialist neuroscience services for children and young people

128. Specialist respiratory services for children and young people

129. Specialist rheumatology services for children and young people

NICE Guidelines None issued

Please use in accordance with Clinical Guidelines for immunoglobulin use, second edition update (July 2011).

Date Reviewed April 2017

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294

BNF Drug OBETICHOLIC ACID (Ocaliva®) Section National Tariff Category Drugs used in metabolic disoreders Tariff Date 2017/18 Commissioner NHS England Indication(s) Primary biliary cirrhosis

Prescribed Services Manual (Section and title) Please note this link will take you to the front page of the Prescribed Services Manual. The manual can then be searched using the section number.

NICE Guidelines TA443 - Obeticholic acid for treating primary biliary cholangitis

Other Information Specialist centre only. Prior approval pro-forma required. Please refer to Specialised Commissioning Circular 1746.

Date Reviewed August 2017

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295

Drug OBINUTUZUMAB BNF Section 8.2.4 (Gazyvaro®) National Tariff Category Cancer exclusion - This drug is NOT National Tariff Excluded but is listed as the commissioning responsibility of the Cancer Drugs Fund and or NHS England. Tariff Date 2015/16 Commissioner NHS England Indication(s) Cancer

Prescribed Services Manual (Section and title) Please note this link will take you to the front page of the Prescribed Services Manual. The manual can then be searched using the section number.

NICE Guideline TA343 – Obinttuzumab in combination with chlorambucil for untreated chronic lymphocytic leukaemia

Other Information

Date Reviewed April 2017

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296

Drug OCRELIZUMAB BNF Section 8.2.4 (Ocrevus®) National Tariff Category Immunomodulating Drugs Tariff Date 2015/16 Commissioner NHS England Indication(s) Multiple sclerosis

Prescribed Services Manual (Section and title) Please note this link will take you to the front page of the Prescribed Services Manual. The manual can then be searched using the section number.

NICE Guideline

Local Guidelines

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297

Drug OCRIPLASMIN BNF Section 11 (Jetrea®) National Tariff Category Retinal disorders Tariff Date 2014/15 Commissioner CCGs Indication(s) Commissioned By Retinal disorders – Vitreomacular traction All Kent and Medway CCGs

NICE Guidelines TA297 – Vitreomacular traction - ocriplasmin

Local Guidelines None issued

Other Information Notifications via Blueteq, including withdrawals.

Date Reviewed April 2017

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298

OCTAGAM® Drug BNF Section 14.5.1

National Tariff Category Intravenous/subcutaneous human normal immunoglobulins Tariff Date 2014/15 Commissioner NHS England Indication(s) As per National DMP

119. Specialist neuroscience services for children and young people

128. Specialist respiratory services for children and young people

129. Specialist rheumatology services for children and young people

NICE Guidelines None issued

Please use in accordance with Clinical Guidelines for immunoglobulin use, second edition update (July 2011).

Date Reviewed April 2017

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299

Drug OCTOCOG ALFA BNF Section 2.11 (NovoEight®) National Tariff Category Platelet Disorder Drugs Tariff Date 2015/16 Commissioner NHS England Indication(s) Haemophilia A

NICE Guideline

Other Information This drug is not routinely commissioned and should be requested from the commissioner via their IFR process. Specialist centre only.

Date Reviewed April 2017

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300

Drug OCTREOLIN BNF Section 8.3.4.3 (Mycapssa®) National Tariff Category Growth Hormone & Growth Hormone Receptor Antagonist Tariff Date 2014/15 Commissioner NHS England Indication(s) Acromegaly

Prescribed Services Manual (Section and title) Please note this link will take you to the front page of the Prescribed Services Manual. The manual can then be searched using the section number.

NICE Guidelines

Other Information This drug is not routinely commissioned and should be requested from the commissioner via their IFR process. Specialist centre only.

Date Reviewed April 2017

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301

Drug OCTREOTIDE BNF Section 8.3.4.3 (Sandostatin®, SandostatinLar®) National Tariff Category Somatostatin Analogues Tariff Date 2014/15 Commissioner NHS England Indication(s) 1 Acromegaly 2 Cancer 3 Congenital hyperinsulinism – highly specialised criteria only.

Prescribed Services Manual 42. Congenital hyperinsulinism service (children) (Section and title) Please note this link will take you to the front page of the Prescribed Services Manual. The manual can then be searched using the section number.

NICE Guidelines None issued

Other Information 1&2: NHS England recommends referring to Trust Guidelines. 3: Specialist centre only.

Date Reviewed April 2017

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302

Drug OFATUMUMAB BNF Section 8.2.4 (Arzerra®) National Tariff Category Cytokine Modulators Tariff Date 2015/16 Commissioner NHS England Indication(s) 1 Cancer 2 Pemphigus vulgaris

Prescribed Services Manual (Section and title) Please note this link will take you to the front page of the Prescribed Services Manual. The manual can then be searched using the section number.

NICE Guideline TA470 - Ofatumumab with chemotherapy for treating chronic lymphocytic leukaemia (terminated appraisal)

TA344 – Ofatumumab in combination with chlorambucil or bendamustine for untreated chronic lymphocytic leukaemia

Other Information 2: The manufacturer has discontinued this drug, for this indication.

Date Reviewed December 2017

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303

Drug OLAPARIB BNF Section (Lynparza®) National Tariff Category Cancer exclusion - This drug is NOT National Tariff excluded but is listed as the commissioning responsibility of NHS England and/or the Cancer Drugs Fund. Tariff Date 2016/17 Commissioner NHS England Indication(s) Cancer

Prescribed Services Manual (Section and title) Please note this link will take you to the front page of the Prescribed Services Manual. The manual can then be searched using the section number.

NICE Guidelines TA381 - Olaparib for maintenance treatment of relapsed, platinum-sensitive, BRCA mutation-positive ovarian, fallopian tube and peritoneal cancer after response to second-line or subsequent platinum-based chemotherapy

Other Information

Date Reviewed April 2017

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304

Drug OLARATUMAB BNF Section (Lartruvo®) National Tariff Category Cancer exclusion - This drug is NOT National Tariff excluded but is listed as the commissioning responsibility of NHS England and/or the Cancer Drugs Fund. Tariff Date Commissioner Indication(s)

Prescribed Services Manual (Section and title) Please note this link will take you to the front page of the Prescribed Services Manual. The manual can then be searched using the section number.

NICE Guidelines TA465 - Olaratumab in combination with doxorubicin for treating advanced soft tissue sarcoma

Other Information

Date Reviewed December 2017

305

Drug OMALIZUMAB BNF Section 3.4.2 (Xolair®) National Tariff Category Allergen Immunotherapy Tariff Date 2014/15 Commissioner NHS England Indication(s) Asthma

Prescribed Services Manual 128. Specialist respiratory services for children and young people (Section and title) Please note this link will take 59. Highly specialist allergy services (all ages) you to the front page of the Prescribed Services Manual. The manual can then be searched using the section number.

NICE Guidelines TA278 – Omalizumab for treating severe persistent allergic asthma (review of technology appraisal guidance 133 and 201)

Other Information Prior approval pro-forma required

Date Reviewed April 2017

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306

Drug OMALIZUMAB (CCG) BNF Section 3.4.2 (Xolair®) National Tariff Category Allergen Immunotherapy Tariff Date 2014/15 Commissioner CCGs Indication(s) Commissioned By; Severe Chronic Spontaneous Urticaria Mandatory – All CCGs

NICE Guidelines TA339 – Omalizumab for previously treated chronic spontaneous urticaria

Local Guidelines

Other Information Notification via Blueteq, including withdrawals. Manufacturer must provide this drug at the discount agreed in the Patient Access Scheme (PAS).

Date Reviewed April 2017

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307

OMBITASVIR/PARITAPREVIR/RITONAVIR BNF Drug 5.3.3 WITH DASABUVIR +/- RIBAVIRIN Section (Viekirax®) National Tariff Category Viral Hepatitis (B&C) & respiratory Syncytial Virus Tariff Date 2015/16 Commissioner NHS England Indication(s) Hepatitis C

131. Specialist services for complex liver, biliary and pancreatic disease (adults)

NICE Guideline TA365 - Ombitasvir–paritaprevir–ritonavir with or without dasabuvir for treating chronic hepatitis C

Other Information Prior approval pro-forma required. Specialist centre use only.

Date Reviewed April 2017

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308

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OSIMERTINIB New drug not Drug BNF Section (Tagrisso®) yet listed in BNF Cancer exclusion - This drug is NOT National Tariff excluded but is listed as National Tariff Category the commissioning responsibility of NHS England and/or the Cancer Drugs Fund. Tariff Date 2017/18 Commissioner CDF Indication(s) Cancer

Prescribed Services Manual (Section and title) Please note this link will take you to the front page of the Prescribed Services Manual. The manual can then be searched using the section number.

NICE Guidelines TA416 - Osimertinib for treating locally advanced or metastatic EGFR T790M mutation-positive non-small-cell lung cancer

Other Information

Date Reviewed April 2017

309

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BNF Drug OZANIMOD Section National Tariff Category Immunomodulating drugs Tariff Date 2017/18 Commissioner NHS England Indication(s) Multiple sclerosis

Prescribed Services Manual (Section and title) Please note this link will take you to the front page of the Prescribed Services Manual. The manual can then be searched using the section number.

NICE Guidelines

Date Reviewed December 2017

310

BNF Drug PACLITAXEL (Albumin bound) 8.1.5 (Abraxane®) Section National Tariff Category Cancer exclusion - This drug is NOT National Tariff excluded but is listed as the commissioning responsibility of NHS England and/or the Cancer Drugs Fund. Tariff Date 2015/16 Commissioner NHS England Indication(s) Breast cancer in patients with documented taxane hypersensitivity

Prescribed Services Manual (Section and title) Please note this link will take you to the front page of the Prescribed Services Manual. The manual can then be searched using the section number.

NICE Guideline TA476 – Paclitaxel as albumin-bound nanoparticles with gemcitabine for untreated metastatic pancreatic cancer

Other Information

Date Reviewed December 2017

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311

Drug PALIVIZUMAB BNF Section 5.3.5 (Synagis®) National Tariff Category Viral Hepatitis (B&C) & Respiratory Syncytial Virus Tariff Date 2014/15 Commissioner NHS England Indication(s) Respiratory Syncytial Virus Prophylaxis

Prescribed Services Manual (Section and title) Please note this link will take you to the front page of the Prescribed Services Manual. The manual can then be searched using the section number.

NICE Guidelines None issued

Other Information Prior approval pro-forma required. Prior approval pro-forma required.

To be used in line with JCVI Guidelines and PHE specification.

Date Reviewed April 2017

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312

Drug PANITUMUMAB BNF Section 8.1.5 (Vectibix®) National Tariff Category Cancer exclusion - This drug is NOT National Tariff excluded but is listed as the commissioning responsibility of NHS England and/or the Cancer Drugs Fund. Tariff Date 2014/15 Commissioner NHS England Indication(s) Cancer

Prescribed Services Manual (Section and title) Please note this link will take you to the front page of the Prescribed Services Manual. The manual can then be searched using the section number.

NICE Guidelines TA439 - Cetuximab and panitumumab for previously untreated metastatic colorectal cancer

TA242 Colorectal cancer (metastatic) 2nd line - cetuximab, bevacizumab and panitumumab (review) (negative appraisal)

TA240 - Colorectal cancer (metastatic) - panitumumab (terminated appraisal)

Other Information Specialist centre only. Prior approval pro-forma required. Please refer to Specialised Services Commissioning circular 1759

Date Reviewed December 2017

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313

Not in current Drug PANOBINOSTAT BNF Section (Farydak®) BNF National Tariff Category Cancer exclusion - This drug is NOT National Tariff Excluded but is listed as the commissioning responsibility of NHS England and/or the Cancer Drugs Fund. Tariff Date 2016/17 Commissioner NHS England Indication(s) Cancer

Prescribed Services Manual (Section and title) Please note this link will take you to the front page of the Prescribed Services Manual. The manual can then be searched using the section number.

NICE Guidelines TA380 – Panobinostat for treating multiple myeloma after at least 2 previous treatments

Other Information To be used in line with NICE TA380. Specialist centre only.

Date Reviewed April 2017

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314

Drug PARA-AMINOSALICYLIC ACID BNF Section 5.1.9 (GranuPAS®) National Tariff Category Antituberculosis Drugs Tariff Date 2016/17 Commissioner NHS England Indication(s) Tuberculosis

Prescribed Services Manual (Section and title) Please note this link will take you to the front page of the Prescribed Services Manual. The manual can then be searched using the section number.

NICE Guidelines

Other Information This drug is not routinely commissioned and should be requested from the commissioner via their IFR process. Specialist centre only.

Date Reviewed April 2017

315

Drug PARATHYROID HORMONE BNF Section 6.6.1 (Preotact®) National Tariff Category Parathyroid hormone Tariff Date 2014/15 Commissioner NHS England Indication(s) Specialist endocrinology conditions

Prescribed Services Manual (Section and title) Please note this link will take you to the front page of the Prescribed Services Manual. The manual can then be searched using the section number.

NICE Guidelines

Other Information NHS England recommends referring to Trust Guidelines.

For secondary prevention of osteoporosis in post-menopausal women please see next page.

Date Reviewed April 2017

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316

PARATHYROID HORMONE Drug (CCG) BNF Section 6.6.1 (Preotact®) National Tariff Category Drugs affecting bone metabolism Tariff Date 2014/15 Commissioner CCG Indication(s) Commissioned By Osteoporosis (secondary prevention, post- All Kent and Medway CCGs menopausal women)

NICE Guidelines None issued

Local Guidelines Kent and Medway osteoporosis network primary care guidelines for the secondary prevention of osteoporosis in post-menopausal women: (Guideline 12)

Other Information For patients unable to use teriparatide Invoice CCG monthly

Date Reviewed April 2017

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317

PARENTERAL NUTRITION Drug BNF Section 9.3 (Home use) National Tariff Category Parenteral Nutrition Tariff Date 2014/15 Commissioner NHS England Indication(s) Intestinal failure

Prescribed Services Manual 10. Adult specialist intestinal failure services (adults) (Section and title) Please note this link will take 22. Autoimmune paediatric gut syndromes service you to the front page of the Prescribed Services Manual. The manual can then be 101. Severe intestinal failure service (adults) searched using the section number. 118. Specialist neonatal care services

NICE Guidelines IPG232 - Serial transverse enteroplasty procedure (STEP) for bowel lengthening in parenteral nutrition-dependent children

CG32 - Nutrition support in adults

Other Information Prior approval proforma required. Specialist centre only.

When duration of PN is >14 days or initiated prior to admission. Adults; see also CG32. See also 'Manual for prescribed specialised services'.

Date Reviewed April 2016

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318

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PARENTERAL NUTRITION 9.3 Drug BNF Section (Inpatient use)

National Tariff Category Parenteral Nutrition Tariff Date 2014/15 Commissioner NHS England Indication(s) Intestinal failure; inadequate/ unsafe enteral feeding

NICE Guidelines IPG232 - Serial transverse enteroplasty procedure (STEP) for bowel lengthening in parenteral nutrition-dependent children

CG32 - Nutrition support in adults

Other Information When duration of PN is >14 days or initiated prior to admission. Adults; see also CG32. See also 'Manual for prescribed specialised services'.

Date Reviewed April 2017

319

Drug PARITAPREVIR BNF Section

National Tariff Category Viral hepatitis (B&C) & Respiratory Syncytial Virus Tariff Date 2016/17 Commissioner NHS England Indication(s) Hepatitis C

Prescribed Services Manual (Section and title) Please note this link will take you to the front page of the Prescribed Services Manual. The manual can then be searched using the section number.

NICE Guidelines

Other Information This drug is not routinely commissioned and should be requested from the commissioner via their IFR process. Specialist Centres only.

Date Reviewed April 2017

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320

Drug PASIREOTIDE BNF Section 8.3.4 (Signifor®) National Tariff Category Somatostatin Analogues Tariff Date 2014/15 Commissioner NHS England Indication(s) 1 Acromegaly 2 Cushing's Disease

Prescribed Services 9. Adult specialist endocrinology services Manual (Section and title) Please note this link will take you to the front page of the Prescribed Services Manual. The manual can then be searched using the section number.

NICE Guidelines None issued

Other Information 1: This drug is not routinely commissioned and should be requested from the commissioner via their IFR process. Specialist centre only. 2: Use in accordance with NHS England Clinical Commissioning Policy 16052/P and Specialised Commissioning Services circular 1693. Specialist Centre only.

Date Reviewed August 2017

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321

Drug PAZOPANIB BNF Section 8.1.5 (Votrient®) National Tariff Category Protein kinase inhibitor Tariff Date 2014/15 Commissioner NHS England Indication(s) Cancer

Prescribed Services Manual (Section and title) Please note this link will take you to the front page of the Prescribed Services Manual. The manual can then be searched using the section number.

NICE Guidelines TA215 - Renal cell carcinoma (first line metastatic) - pazopanib

Other Information To be used in line with NICE TA215.

Date Reviewed April 2017

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322

Drug PEGAPTANIB BNF Section 11.8.2 (Macugen®) National Tariff Category Subfoveal choroidal neovascularisation Tariff Date 2014/15 Commissioner Indication(s) Commissioned By Macular degeneration This drug is not currently commissioned, please do not prescribe. See “Other Information” below

NICE Guidelines TA155 - Macular degeneration (age-related) - ranibizumab and pegaptanib (negative appraisal)

Local Guidelines None issued

Other Information Not recommended for the treatment of wet age-related macular degeneration. Patients already receiving pegaptanib for any lesion type can continue therapy until it is considered appropriate to stop. New patients should NOT be initiated onto this treatment.

Date Reviewed December 2017

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323

BNF New drug not Drug PEGASPARGASE yet listed in (Oncaspar®) Section the BNF National Tariff Category Cancer exclusion - This drug is NOT National Tariff Excluded but is listed as the commissioning responsibility of NHS England and/or the Cancer Drugs Fund. Tariff Date 2016/17 Commissioner NHS England Indication(s) Cancer

Prescribed Services Manual (Section and title) Please note this link will take you to the front page of the Prescribed Services Manual. The manual can then be searched using the section number.

NICE Guidelines TA408 - Pegaspargase for treating acute lymphoblastic leukaemia

Other Information Specialist Centre only

Date Reviewed April 2017

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324

Drug PEGFILGRASTIM BNF Section 9.1.6 (Neulasta®) National Tariff Category Drugs used in neutropenia Tariff Date 2014/15 Commissioner NHS England Indication(s) Neutropenia

NICE Guidelines None issued

Other Information This is not routinely commissioned and should be requested from the commissioner via their IFR process. Specialist centre only.

Date Reviewed April 2017

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325

Drug PEGINTERFERON ALFA BNF Section 8.2.4 (Pegasys®, ViraferonPeg®) National Tariff Category Viral Hepatitis (B&C) & Respiratory Syncytial Virus Tariff Date 2014/15 Commissioner NHS England Indication(s) Hepatitis B and C

Prescribed Services Manual 16. Adult specialist services for patients infected with HIV (Section and title) Please note this link will take 65. Highly specialist services for adults with infectious diseases you to the front page of the Prescribed Services Manual. The manual can then be 131. Specialist services for complex liver, biliary and pancreatic disease searched using the section (adults) number.

NICE Guidelines TA300 - Hepatitis C (children and young people) - peginterferon alfa and ribavirin

TA200 - Hepatitis C - peginterferon alfa and ribavirin

TA106 – Hepatitis C - peginterferon alfa and ribavirin

TA96 – Hepatitis B (chronic) - adefovir dipivoxil and pegylated interferon alfa- 2a

TA75 - Hepatitis C - pegylated interferons, ribavirin and alfa interferon

CG165 Hepatitis B (chronic)

Other Information

Date Reviewed April 2017

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326

Drug PEGINTERFERON BETA-1A BNF Section 8.2.4 (Plegridy®) National Tariff Category Immunomodulating drugs Tariff Date 2014/15 Commissioner NHS England Indication(s) Multiple Sclerosis

Prescribed Services Manual (Section and title) Please note this link will take you to the front page of the Prescribed Services Manual. The manual can then be searched using the section number.

NICE Guidelines

Other Information Prior approval proforma required. Routinely commissioned as per SSC1534: Multiple Sclerosis first line disease modifying agents.

Date Reviewed April 2017

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327

Drug PEGVISOMANT BNF Section 6.5.1 (Somavert®) National Tariff Category Hypothalmic & anterior pituitary hormones & anti-oestrogens Tariff Date 2014/15 Commissioner NHS England Indication(s) Acromegaly

NICE Guidelines None issued

Other Information NHS England Clinical Commissioning Policy 16050/P. Specialist centre only.

Date Reviewed April 2017

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328

PEGYLATED LIPOSOMAL Drug DOXORUBICIN BNF Section 8.1.2 (Caelyx®, Myocet®) National Tariff Category Cancer exclusion - This drug is NOT National Tariff Excluded but is listed as the commissioning responsibility of NHS England and/or the Cancer Drugs Fund. Tariff Date 2014/15 Commissioner NHS England / CDF Indication(s) Cancer

Prescribed Services Manual (Section and title) Please note this link will take you to the front page of the Prescribed Services Manual. The manual can then be searched using the section number.

NICE Guidelines

TA389 – Topotecan, pegylated liposomal doxorubicin hydrochloride, paclitaxel, trabectedin and gemcitabine

TA91 - Ovarian cancer (advanced) - paclitaxel, pegylated liposomal doxorubicin hydrochloride and topotecan (review)

Other Information To be used in line with NICE TAs and the CDF Policy

Date Reviewed April 2017

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329

Drug PEMBROLIZUMAB BNF Section 8.2.4 (Keytruda®) National Tariff Category Cancer exclusion - This drug is NOT National Tariff Excluded but is listed as the commissioning responsibility of NHS England and/or the Cancer Drugs Fund. Tariff Date 2016/17 Commissioner NHS England Indication(s) 1 Melanoma (unresectable, metastatic) 2 Treatment Naïve Melanoma (unresectable, metastatic) 3 Non-small-cell lung cancer

Prescribed Services Manual (Section and title) Please note this link will take you to the front page of the Prescribed Services Manual. The manual can then be searched using the section number.

NICE Guidelines TA447 - Pembrolizumab for untreated PD-L1-positive metastatic non-small- cell lung cancer

TA428 - Pembrolizumab for treating PD-L1-positive non-small-cell lung cancer after chemotherapy

TA357 – Pembrolizumab for treating advanced melanoma after disease progression with ipilimumab

TA366 - Pembrolizumab for advanced melanoma not previously treated with ipilimumab

Other Information 1,2&3: Prior approval proforma required. 3: Please refer to Specialised Services Commissioning circular 1709 Date Reviewed December 2017

330

Drug PEMETREXED BNF Section 8.1.3 (Alimta®) National Tariff Category Cancer exclusion - This drug is NOT National Tariff Excluded but is listed as the commissioning responsibility of NHS England and/or the Cancer Drugs Fund. Tariff Date 2014/15 Commissioner NHS England Indication(s) Cancer

Prescribed Services Manual (Section and title) Please note this link will take you to the front page of the Prescribed Services Manual. The manual can then be searched using the section number.

NICE Guidelines TA309 Pemetrexed maintenance treatment following induction therapy with pemetrexed and cisplatin for non-squamous non-small-cell lung cancer

TA190 Lung cancer (non-small-cell) - pemetrexed (maintenance)

TA181 Lung cancer (non-small cell, first line treatment) – pemetrexed

TA135 - Mesothelioma - pemetrexed disodium

Other Information To be used in line with NICE TAs above.

Date Reviewed April 2017

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331

PEPTIDE RECEPTOR Drug RADIONUCLEOTIDE THERAPY BNF Section

This drug is NOT National Tariff Excluded but is listed as the commissioning National Tariff Category responsibility of the Cancer Drugs Fund. Tariff Date 2014/15 Commissioner CDF Indication(s) Cancer

Prescribed Services Manual (Section and title) Please note this link will take you to the front page of the Prescribed Services Manual. The manual can then be searched using the section number.

NICE Guidelines

Other Information This drug is not routinely commissioned and should be requested from the commissioner via their IFR process. Specialist centre only.

Date Reviewed April 2017

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332

Drug PERTUZUMAB BNF Section 8.1.5 (Perjeta®) Cancer exclusion - This drug is NOT National Tariff Excluded but is listed as National Tariff Category the commissioning responsibility of the Cancer Drugs Fund. Tariff Date 2014/15 Commissioner NHS England / CDF Indication(s) Cancer

Prescribed Services Manual (Section and title) Please note this link will take you to the front page of the Prescribed Services Manual. The manual can then be searched using the section number.

NICE Guidelines TA424 - Pertuzumab for the neoadjuvant treatment of HER2-positive breast cancer

Other Information To be used in line with the CDF Policy. Prior approval pro-forma required. Please refer to Specialised Services Commissioning circular 1730.

Date Reviewed August 2017

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333

Drug PIRFENIDONE BNF Section 10 (Esbriet®) National Tariff Category Pulmonary fibrosis Tariff Date 2014/15 Commissioner NHS England Indication(s) Idiopathic Pulmonary Fibrosis

Prescribed Services Manual (Section and title) Please note this link will take you to the front page of the Prescribed Services Manual. The manual can then be searched using the section number.

NICE Guidelines TA504 – Pirfenidone for treating idiopathic pulmonary fibrosis

Other Information Prior approval pro-forma required. Specialist Centres only.

Patient to be treated in accordance with NICE TA282.

Date Reviewed April 2017

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334

Drug PIXANTRONE BNF Section 8.1.5 (Pixuvri®) Cancer exclusion - This drug is NOT National Tariff Excluded but is listed as National Tariff Category the commissioning responsibility of the Cancer Drugs Fund and/or NHS England. Tariff Date 2014/15 Commissioner NHS England Indication(s) Cancer

Prescribed Services Manual (Section and title) Please note this link will take you to the front page of the Prescribed Services Manual. The manual can then be searched using the section number.

NICE Guidelines TA306 - Pixantrone monotherapy for treating multiply relapsed or refractory aggressive non-Hodgkin's B-cell lymphoma

Other Information Specialist Centre only.

Date Reviewed April 2017

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335

Drug PLERIXAFOR BNF Section 9.1.7 (Mozobil®) National Tariff Category Drugs affecting the immune response Tariff Date 2014/15 Commissioner NHS England Indication(s) Stem cell mobilisation

Prescribed Services Manual 29. Blood and bone marrow transplantation services (all ages) (Section and title) Please note this link will take you to the front page of the Prescribed Services Manual. The manual can then be searched using the section number.

NICE Guidelines None issued

Other Information Prior approval proforma required. To be used in line with the NHS England Policy: B04/P/2 and 16064/P Specialist centre only.

Date Reviewed April 2017

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336

Drug POMALIDOMIDE BNF Section 8.1 (Imnnovid®) National Tariff Category Immunomodulating drugs. Tariff Date 2014/15 Commissioner NHS England Indication(s) Cancer

Prescribed Services Manual (Section and title) Please note this link will take you to the front page of the Prescribed Services Manual. The manual can then be searched using the section number.

NICE Guidelines TA427 – Pomalidomide for multiple myeloma previously treated with lenalidomide and bortezomib

Other Information Prior approval proforma required. For other indications (myelofibrosis), please see Appendix 1. Please refer to Specialised Services Commissioning circular 1736.

Date Reviewed August 2017

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337

Drug PONATINIB BNF Section 8.1.5 (Iclusig®) National Tariff Category Cancer Tariff Date 2014/15 Commissioner NHS England Indication(s) Cancer

Prescribed Services Manual (Section and title) Please note this link will take you to the front page of the Prescribed Services Manual. The manual can then be searched using the section number.

NICE Guidelines TA451 - Ponatinib for treating chronic myeloid leukaemia and acute lymphoblastic leukaemia

Other Information

Date Reviewed December 2017

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338

Drug PORACTANT ALFA BNF Section 3.5.2 (Curosurf®) National Tariff Category Pulmonary surfactants Tariff Date 2014/15 Commissioner NHS England Indication(s) Respiratory distress syndrome

Prescribed Services Manual (Section and title) Please note this link will take you to the front page of the Prescribed Services Manual. The manual can then be searched using the section number.

NICE Guidelines None issued

Other Information Specialist centre only. NHS England recommends referring to Trust Guidelines.

Date Reviewed April 2017

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339

PORCINE FACTOR Drug BNF Section

National Tariff Category Blood-related products Tariff Date 2014/15 Commissioner Indication(s)

Prescribed Services Manual (Section and title) Please note this link will take you to the front page of the Prescribed Services Manual. The manual can then be searched using the section number.

NICE Guidelines None issued

Local Information

Other Information This drug is not commissioned, please do not prescribe.

Date Reviewed December 2017

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340

Drug POSACONAZOLE BNF Section 5.2.1 (Noxafil®) National Tariff Category Antifungals Tariff Date 2014/15 Commissioner NHS England Indication(s) Fungal infection

Prescribed Services Manual 34. Chronic pulmonary aspergillosis service (adults) (as IFR) (Section and title) Please note this link will take you to the front page of the Prescribed Services Manual. The manual can then be searched using the section number.

NICE Guidelines None issued

Other Information NHS England recommends referring to Trust Guidelines.

Date Reviewed April 2017

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341

PRIVIGEN® Drug BNF Section 14.5.1

National Tariff Category Intravenous/subcutaneous human normal immunoglobulins Tariff Date 2014/15 Commissioner NHS England Indication(s) As per National DMP

128. Specialist respiratory services for children and young people

129. Specialist rheumatology services for children and young people

NICE Guidelines None issued

Please use in accordance with Clinical Guidelines for immunoglobulin use, second edition update (July 2011).

Date Reviewed April 2017

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342

Drug PROTEIN C BNF Section 2.11 National Tariff Category Blood-related products Tariff Date 2014/15 Commissioner NHS England Indication(s) As per BCSH Guidelines for specialised indications

NICE Guidelines None issued

Other Information Patients should be treated as per BCSH Guidelines.

Date Reviewed April 2017

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343

PROTEIN KINASE INHIBITORS Drug BNF Section 8.1.5

National Tariff Category These drugs are NOT National Tariff Excluded but are listed as the commissioning responsibility of NHS England and/or the Cancer Drugs Fund. Commissioner NHS England Indication(s) Endocrinology; non-malignant conditions

Prescribed Services Manual (Section and title) Please note this link will take you to the front page of the Prescribed Services Manual. The manual can then be searched using the section number.

NICE Guidelines None issued

Other Information These drugs are not routinely commissioned and should be requested from the commissioner via their IFR process. Specialist centre only.

Date Reviewed April 2017

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344

PROTHROMBIN COMPLEX Drug BNF Section 2.11

National Tariff Category Blood-related products Tariff Date 2014/15 Commissioner NHS England Indication(s) As per BCSH Guidelines for specialised indications

NICE Guidelines None issued

Other Information Patients should be treated as per BCSH Guidelines.

Date Reviewed April 2017

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345

Drug RADIUM-223 DICHLORIDE BNF Section 8.1.5 (Xofigo®) Cancer exclusion - This drug is NOT National Tariff Excluded but is listed as National Tariff Category the commissioning responsibility of the Cancer Drugs Fund. Tariff Date 2014/15 Commissioner NHS England Indication(s) Cancer

Prescribed Services Manual (Section and title) Please note this link will take you to the front page of the Prescribed Services Manual. The manual can then be searched using the section number.

NICE Guidelines TA412 - Radium-223 dichloride for treating hormone-relapsed prostate cancer with bone metastases

TA376 - Radium-223 dichloride for treating hormone-relapsed prostate cancer with bone metastases (replaced by TA412)

Other Information Prior approval pro-forma required. To be used in line with the NICE TA stated above. Please refer to Specialised Services Commissioning circular 1699. Specialist centre only. Date Reviewed August 2017

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346

Drug RALTEGRAVIR BNF Section 5.3.1 (Isentress®) National Tariff Category AIDS/HIV antiretrovirals Tariff Date 2014/15 Commissioner NHS England Indication(s) HIV in combination with other anti-retroviral drugs

NICE Guidelines None issued

Other Information Patient to be treated in accordance with agreed Regional Guidelines . Date Reviewed April 2017

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347

Drug RAMUCIRUMAB BNF Section 8 (Cyramza®) National Tariff Category Cancer Exclusion Tariff Date 2014/15 Commissioner NHS England Indication(s) Cancer

Prescribed Services Manual (Section and title) Please note this link will take you to the front page of the Prescribed Services Manual. The manual can then be searched using the section number.

NICE Guidelines TA378 - Ramucirumab for treating advanced gastric cancer or gastro– oesophageal junction adenocarcinoma previously treated with chemotherapy

Other Information This drug is not routinely commissioned and should be requested from the prescriber via their IFR process. Date Reviewed April 2017

348

Drug RANIBIZUMAB BNF Section 11.8.2 (Lucentis®) National Tariff Category Subfoveal choroidal neovascularisation Tariff Date 2014/15 Commissioner CCG Indication(s) Commissioned By Macular oedema (retinal vein occlusion) Mandatory – All CCGs

Diabetic macular oedema Mandatory – All CCGs

Macular degeneration (age-related) Mandatory – All CCGs Choroidal neovascularisation (CNV) Mandatory – All CCGs associated with pathological myopia

NICE Guidelines TA298 – Choroidal neovascularisation (pathological myopia) – ranibizumab

TA283 – Macular oedema (retinal vein occlusion) - ranibizumab

TA274 - Ranibizumab for treating diabetic macular oedema (rapid review of technology appraisal guidance 237)

TA155 - Macular degeneration (age-related) - ranibizumab and pegaptanib

Local Guidelines None Issued

Other Information Notification via Blueteq. Indication of which eye is being treated must appear on notification form.

Date Reviewed April 2017

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349

Drug RASBURICASE BNF Section 10.1.4 (Fasturtec®) National Tariff Category Gout and cytotoxic-induced hyperuricaemia Tariff Date 2014/15 Commissioner NHS England Indication(s) Hyperuricaemia

Prescribed Services Manual (Section and title) Please note this link will take you to the front page of the Prescribed Services Manual. The manual can then be searched using the section number.

NICE Guidelines None issued

Other Information NHS England recommends referring to Trust Guidelines

Date Reviewed April 2017

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350

Drug REGORAFENIB BNF Section 8.1.5 (Stivarga®) National Tariff Category Cancer Tariff Date 2014/15 Commissioner CDF Indication(s) Cancer

Prescribed Services Manual (Section and title) Please note this link will take you to the front page of the Prescribed Services Manual. The manual can then be searched using the section number.

NICE Guidelines TA334 – Regorafenib for metastatic colorectal cancer after treatment for metastatic disease (terminated appraisal)

Other Information To be used in line with the CDF Policy

Date Reviewed April 2017

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351

Not listed in Drug RESLIZUMAB BNF Section the current (Cinquil®) BNF National Tariff Category Allergen Immunotherapy Tariff Date 2014/15 Commissioner NHS England Indication(s) Asthma

Prescribed Services Manual (Section and title) Please note this link will take you to the front page of the Prescribed Services Manual. The manual can then be searched using the section number.

NICE Guidelines

Other Information This drug is not routinely commissioned and should be requested from the commissioner via their IFR process. Specialist centre only.

Date Reviewed April 2017

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352

Drug RIBAVIRIN BNF Section 5.4 (Copegus®, Rebetol®, Virazole®) National Tariff Category Viral Hepatitis (B&C) & Respiratory Syncytial Virus Tariff Date 2014/15 Commissioner NHS England Indication(s) Hepatitis C

Prescribed Services Manual (Section and title) Please note this link will take you to the front page of the Prescribed Services Manual. The manual can then be searched using the section number.

NICE Guidelines TA300 - Hepatitis C (children and young people) - peginterferon alfa and ribavirin

TA200 - Hepatitis C - peginterferon alfa and ribavirin

TA106 – Hepatitis C - peginterferon alfa and ribavirin

TA75 - Hepatitis C - pegylated interferons, ribavirin and alfa interferon

Other Information To be used in accordance with NHS England Clinical Commissioning Policy B07/P/a and the NICE TAs listed above.

Date Reviewed April 2017

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353

Drug RILONACEPT BNF Section (Arcalyst®) National Tariff Category Immunomodulating drugs Tariff Date 2014/15 Commissioner NHS England Indication(s) Cryopyrin-associated periodic syndromes

NICE Guidelines None issued

Other Information This is not routinely commissioned and should be requested from the commissioner via their IFR process. Specialist centre only.

Date Reviewed April 2017

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354

Drug RILPIVIRINE BNF Section 5.3.1 (Edurant®) National Tariff Category AIDS/HIV antiretrovirals Tariff Date 2014/15 Commissioner NHS England Indication(s) HIV in combination with other anti-retroviral drugs

NICE Guidelines None issued

Other Information Patient to be treated in accordance with agreed Regional Guidelines

Date Reviewed April 2017

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355

Drug RILUZOLE BNF Section 4.9.3 (Rilutek®) National Tariff Category/Indication Torsion Dystonias and other involuntary movements Tariff Date 2014/15 Indication(s) Commissioned By Motor neurone disease Mandatory – All CCGs

NICE Guidelines TA20 - Motor neurone disease - riluzole

Local Guidelines None issued.

Other Information Shared Care Agreement with the patients GP is available and is the preferred method of obtaining treatment.

Invoice to CCG monthly Date Reviewed April 2107

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356

Drug RIOCIGUAT BNF Section 2.5.1 (Adempas®) National Tariff Category Vasodilator antihypertensive drugs/Pulmonary Arterial Hypertension Tariff Date 2014/15 Commissioner NHS England Indication(s) 1 Pulmonary Arterial Hypertension (CTEPH) 2 Pulmonary Arterial Hypertension

Prescribed Services Manual 14. Adult specialist pulmonary hypertension services (Section and title) Please note this link will take you to the front page of the Prescribed Services Manual. The manual can then be searched using the section number.

NICE Guidelines None issued

Other Information 1: To be used in accordance with NHS England Clinical Policy A11/P/c. Specialist centres only.

2: To be used in accordance with NHS England Clinical Commissioning Policy 16055/P. Specialist centres only. Date Reviewed April 2017

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357

Drug RITONAVIR BNF Section 5.3.1 (Norvir®) National Tariff Category AIDS/HIV antiretrovirals Tariff Date 2014/15 Commissioner NHS England Indication(s) HIV in combination with other anti-retroviral drugs

NICE Guidelines None issued

Other Information Patient to be treated in accordance with agreed Regional Guidelines

Date Reviewed April 2017

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358

Drug RITUXIMAB BNF Section 8.2.4 (MabThera®) National Tariff Category Cytokine modulators Tariff Date 2014/15 Commissioner NHS England 1 ABO-incompatible kidney transplants 2 Acquired Haemophilia 3 ANCA-positive vasculitis 4 Chronic inflammatory demyelinating polyneuropathy 5 Connective tissue disease - interstitial lung disease 6 Graft versus host disease 7 Juvenile arthritis - paediatric Indication(s) 8 Myositis 9 Nephritis 10 Neuromyelitis optica 11 Pemphigus vulgaris 12 Primary Sjogren’s syndrome (PSS) 13 Systemic Lupus Erythematosus 14 Steroid sensitive nephrotic syndrome 15 Immunoglobin G4 Related Disease

Prescribed Services 5. Adult highly specialist rheumatology services Manual (Section and title) 15. Adult specialist renal services Please note this link will take you to the front page of the Prescribed 29. Blood and marrow transplantation services (all ages) Services Manual. The manual can then be searched using the section number. NICE Guidelines TA308 – Vasculitis (anti-neutrophil cytoplasmic antibody-associated) – rituximab (with glucocorticoids)

TA195 - Rheumatoid arthritis - drugs for treatment after failure of a TNF inhibitor.

Other Information 1 & 10: To be used as per NHS England specification. Specialist centre only.

2: Please use in accordance with NHS England Clinical Commissioning Policy F02/P/a. Specialist centres only.

3: To be used in line with NICE TA308 and the NHS England Policy: A13/P/a

4, 5 & 12: This is not routinely commissioned and should be requested from the commissioner via their IFR process – a policy is in progress, Specialist centre only.

6, 8, 9, 11, 15: This is not routinely commissioned and should be requested from the commissioner via their IFR process. Specialist centre only.

7: To be used in accordance with NHS England Commissioning Policy: E03/P/d. Prior approval proforma required.

13: To be used in line with the NHS England Policy: A13/PS/a

14: To be used in line with the NHS England Policies: E03/P/b and E03/P/c. Specialist Centres only. Date Reviewed April 2017

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359

RITUXIMAB (iv and Drug subcutaneous formulations) BNF Section 8.2.4 (MabThera®) National Tariff Category Cytokine modulators Tariff Date 2014/15 Commissioner NHS England 1 Cancer (iv) Indication(s) 2 Cancer – Follicular Lymphoma maintenance treatment (subcutaneous)

Prescribed Services Manual (Section and title) Please note this link will take you to the front page of the Prescribed Services Manual. The manual can then be searched using the section number.

NICE Guidelines TA243 - Rituximab for the first-line treatment of stage III-IV follicular lymphoma: (review of NICE technology appraisal guidance 110)

TA226 - Lymphoma (follicular non-Hodgkin's) - rituximab

TA193 - Rituximab for the treatment of relapsed or refractory chronic lymphocytic leukaemia

TA174 - Rituximab for the first-line treatment of chronic lymphocytic leukaemia

TA137 - Lymphoma (follicular non-Hodgkin's) - rituximab

TA65 - Rituximab for aggressive non-Hodgkin's lymphoma

Other Information 1: As per NICE TA’s above and NHS England CDF letter

2: As per circular i.e. only commissioned for Follicular Lymphoma maintenance treatment.

Date Reviewed April 2017

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360

Drug RITUXIMAB (CCG) BNF Section 8.2.3 (MabThera®) National Tariff Category National Tariff Category Tariff Date 2014/15 Commissioner CCG Indication(s) Commissioned By 1 Rheumatoid arthritis Mandatory – all CCGs 2 Immune (idiopathic) NHS Ashford CCG thrombocytopenic purpura (ITP) NHS Canterbury and Coastal CCG NHS Medway CCG NHS South Kent Coast CCG NHS Swale CCG NHS Thanet CCG NHS West Kent CCG

NICE Guidelines TA195 - Rheumatoid arthritis - drugs for treatment after failure of a TNF inhibitor.

Local Guidelines Kent and Medway Policy Recommendation and Guidance Committee Policy Recommendation PR 2015-13: Rituximab for the treatment of immune (idiopathic) thrombocytopenic purpura (ITP)

Other Information Notification via Blueteq (including withdrawals).

2: Please note NHS DGS CCG does not commission this treatment for this indication.

Date Reviewed April 2017

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361

Drug ROMIPLOSTIM (CCG) BNF Section 9.1.4 (Nplate®) National Tariff Category Platelet Disorder Drugs Tariff Date 2014/15 Commissioner CCG Indication(s) Commissioned By Thrombocytopenia purpura Mandatory – all CCGs

NICE Guidelines

NICE TA 221 - Romiplostim for the treatment of chronic immune (idiopathic) thrombocytopenic purpura

Local Guidelines

Other Information Notification, including withdrawals, should be made via Blueteq.

Date Reviewed May 2016

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362

Drug RUXOLITINIB BNF Section 8.1.5 (Jakavi®) National Tariff Category Protein kinase inhibitor Tariff Date 2014/15 Commissioner NHS England Indication(s) Cancer

Prescribed Services Manual (Section and title) Please note this link will take you to the front page of the Prescribed Services Manual. The manual can then be searched using the section number.

NICE Guidelines TA386 – Ruxolitinib for treating disease-related splenomegaly or symptoms in adults with myelofibrosis

TA289 – Myelofibrosis (splenomegaly, symptoms) -ruxolitinib (negative appraisal)

Other Information Please see NHS England Specialised Services Circular 1624

Date Reviewed April 2017

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363

SANDOGLOBULIN BNF Drug 14.5 Section National Tariff Category Intravenous/subcutaneous human normal immunoglobulins Tariff Date 2014/15 Commissioner NHS England Indication(s) As per National DMP

128. Specialist respiratory services for children and young people

129. Specialist rheumatology services for children and young people

NICE Guidelines None issued

Please use in accordance with Clinical Guidelines for immunoglobulin use, second edition update (July 2011).

Date Reviewed April 2017

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364

BNF Drug SAPROPTERIN 9.4.1 (Kuvan®) Section National Tariff Category Drugs used in Metabolic disorders Tariff Date 2014/15 Commissioner NHS England Indication(s) 1 Children with phenylketonuria 2 Maternal phenylketonuria

NICE Guidelines None issued

Other Information 1: This drug is not routinely commissioned and should be requesterd from the commissioner via their IFR process. Specialist centre only. Please refer to NHS England Clinical Commissioning Policy: E06/P/a. Specialist centre only.

2: To be used in line with the NHS England Policy: E12/P/a. Specialist centre only.

Date Reviewed April 2017

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365

Drug SAQUINAVIR BNF Section 5.3.1 (Invirase®) National Tariff Category AIDS/HIV antiretrovirals Tariff Date 2014/15 Commissioner NHS England Indication(s) HIV in combination with other anti-retroviral drugs

NICE Guidelines None issued

Other Information Patient to be treated in accordance with agreed Regional Guidelines

Date Reviewed April 2017

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366

BNF Drug SARILUMAB Section National Tariff Category Cytokine modulators Tariff Date 2017/18 Commissioner NHS England Indication(s) Paediatric indications (where adult TA available)

Prescribed Services Manual (Section and title) Please note this link will take you to the front page of the Prescribed Services Manual. The manual can then be searched using the section number.

NICE Guidelines None issued

Other Information This drug is not routinely commissioned and should be requested from the commissioner via their IFR process

Date Reviewed November 2017

367

Sarilumab (CCG) 10.1.3 Drug (Kevzara®) BNF Section

National Tariff Category Cytokine modulators

Tariff Date 2017/18

Commissioner CCG

Indication(s) Commissioned By

Rheumatoid arthritis Mandatory – All CCGs

NICE Guidelines TA485 - Sarilumab for moderate to severe rheumatoid arthritis

Local Guidelines

Other Information *for use in adults only

Notification using Blueteq

Sub-cutaneous formulation supplied via Homecare and billed directly to the Trust.

Consultant Teams must also notify of withdrawals.

Date Reviewed February 2018

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368

See “Other Drug SEBELIPASE ALFA BNF Section Information” (Kanuma®) section National Tariff Category Lysosomal Storage Disorder Drugs Tariff Date 2014/15 Commissioner NHS England Indication(s) Lysosomal acid lipase deficiency

Prescribed Services Manual (Section and title) Please note this link will take you to the front page of the Prescribed Services Manual. The manual can then be searched using the section number.

NICE Guidelines NICE HST in progress

Other Information This drug is not routinely commissioned and should be requested from the commissioner via their IFR process. Specialist centre only.

Date Reviewed April 2017

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369

Drug SECUKINUMAB BNF Section 10.1.3 (Cosentyx®) National Tariff Category Cytokine modulators Tariff Date 2014/15 Commissioner NHS England 1 Ankylosing spondylitis (paediatric patients only) 2 Psoriasis (paediatric patients only) Indication(s) 3 Psoriatic arthritis (paediatric patients only) 4 Rheumatoid arthritis (paediatric patients only) 5 Uveitis (paediatric patients only)

Prescribed Services Manual (Section and title) Please note this link will take you to the front page of the Prescribed Services Manual. The manual can then be searched using the section number.

NICE Guidelines TA445 - Certolizumab pegol and secukinumab for treating active psoriatic arthritis after inadequate response to DMARDs

TA407 - Secukinumab for active ankylosing spondylitis after treatment with non-steroidal anti-inflammatory drugs or TNF-alpha inhibitors

TA350 – Secukinumab for treating moderate to severe plaque psoriasis

Other Information 1, 2, 3 & 5: This drug is not routinely commissioned for this indication and should be requested from the commissioner via their IFR process. Specialist centres only.

4: This drug, for this indication, is currently in Phase III Clinical Trials and is not expected to be launched until 2020. Once launched it will not be routinely commissioned and should be requested from the commissioner via their IFR process.

Date Reviewed December 2017

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370

Drug SECUKINUMAB (CCG) BNF Section 10.1.3 National Tariff Category Cytokine modulators Tariff Date 2014/15 Commissioner CCG Indication(s) Commissioned by Ankylosing spondylitis Mandatory – All CCGs Plaque psoriasis Psoriatic arthritis

NICE Guidelines TA445 - Certolizumab pegol and secukinumab for treating active psoriatic arthritis after inadequate response to DMARDs

TA407 - Secukinumab for active ankylosing spondylitis after treatment with non-steroidal anti-inflammatory drugs or TNF-alpha inhibitors

TA350 – Secukinumab for treating moderate to severe plaque psoriasis

Local Guidelines

Other Information Drug supplied via Homecare and billed directly to the Trust.

Date Reviewed September 2017

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371

Drug SELEXIPAG BNF Section 2.5.1 (Uptravi®) National Tariff Category Vasodilator antihypertensive drugs/Pulmonary Arterial Hypertension Tariff Date 2014/15 Commissioner NHS England Indication(s) Pulmonary hypertension

Prescribed Services Manual (Section and title) Please note this link will take you to the front page of the Prescribed Services Manual. The manual can then be searched using the section number.

NICE Guideline

Local Guidelines

Other Information This drug is not routinely commissioned and should be requested from the commissioner via their IFR process. Specialist centre only.

Date Reviewed April 2017

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372

Drug SEVELAMER CARBONATE BNF Section 9.5.2.2 (Renvela®) National Tariff Category Drugs for mineral bone disorders - This drug is NOT National Tariff Excluded but is listed as the commissioning responsibility of NHS England. Tariff Date 2014/15 Commissioner NHS England Indication(s) Adult renal dialysis only

NICE Guidelines None issued

Other Information NHS England recommends referring to Trust Guidelines

Date Reviewed April 2017

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373

Drug SEVELAMER HYDROCHLORIDE BNF Section 9.5.2.2 (Renagel®) National Tariff Category Drugs for mineral bone disorders - This drug is NOT National Tariff Excluded but is listed as the commissioning responsibility of NHS England. Tariff Date 2014/15 Commissioner NHS England Indication(s) Adult renal dialysis only

NICE Guidelines None issued

Other Information NHS England recommends referring to Trust Guidelines

Date Reviewed April 2017

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374

Drug SIALIC ACID BNF Section 9.8.1 National Tariff Category Drugs used in metabolic disorders Tariff Date 2016/17 Commissioner NHS England Indication(s) Myopathy

NICE Guidelines

Local Guidelines

Other Information This drug is not routinely commissioned and should be requested from the commissioner via their IFR process. Specialist centre only.

Date Reviewed April 2017

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375

Drug SILDENAFIL BNF Section 2.5.1 (Revatio®) National Tariff Category Vasodilator antihypertensive drugs/Pulmonary Arterial Hypertension Tariff Date 2014/15 Commissioner NHS England Indication(s) Pulmonary Arterial Hypertension

NICE Guidelines None issued

Other Information To be used in line with the NHS England Policy: A11/P/c

Date Reviewed April 2017

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376

Drug SILTUXIMAB BNF Section 8.2.4 (Sylvant®) National Tariff Category Cytokine Modulators Tariff Date 2015/16 Commissioner Indication(s)

Prescribed Services Manual (Section and title) Please note this link will take you to the front page of the Prescribed Services Manual. The manual can then be searched using the section number.

NICE Guidelines

Other Information This drug is not commissioned and should be not requested.

Date Reviewed December 2017

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377

SIMEPREVIR/PEGINTERFERON Drug BNF Section 5.3.3 + RIBAVIRIN National Tariff Category Viral Hepatitis (B&C) & Respiratory Syncytial Virus Tariff Date 2014/15 Commissioner NHS England Central Team Indication(s) Hepatitis C

Prescribed Services Manual (Section and title) Please note this link will take you to the front page of the Prescribed Services Manual. The manual can then be searched using the section number.

NICE Guidelines TA331 – Simeprevir in combination with peginterferon alfa and ribavirin for treating genotypes 1 and 4 chronic hepatitis C

Other Information To be used in line with NHS England Interim Policy: B07/P/a and NICE TA331. Specialist centre only.

Prior approval pro-forma required.

Date Reviewed April 2017

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378

Drug SIROLIMUS BNF Section 8.2.2 (Rapamune®) National Tariff Category Immunosuppressants - This drug is NOT National Tariff Excluded but is listed as the commissioning responsibility of NHS England. Tariff Date 2014/15 Commissioner NHS England Indication(s) Transplant immunosuppression only

127. Specialist renal services for children and young people

128. Specialist respiratory services for children and young people

NICE Guidelines TA99 Renal transplantation - immunosuppressive regimens for children and adolescents

TA85 - Renal transplantation - immuno-suppressive regimens (adults) (review)

Other Information New patients only until formal repatriation agreed.

Date Reviewed April 2017

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379

Drug SODIUM OXYBATE BNF Section 4.1.1 (Xyrem®) National Tariff Category Hypnotics and anxiolytics Tariff Date 2014/15 Commissioner NHS England Indication(s) Narcolepsy – paediatric services only.

NICE Guidelines None issued

Local Guidelines None issued

Other Information To be used in accordance with NHS England Clinical Commissioning Policy 16065/P and Specialised Services Commissioning circular 1684. Prior approval proforma required. Specialist centre only.

Date Reviewed August 2017

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380

Drug SODIUM PHENYLBUTYRATE BNF Section 9.8.1 (Ammonaps®) National Tariff Category Drugs used in Metabolic disorders Tariff Drug 2014/15 Commissioner NHS England Indication(s) Urea cycle disorders

NICE Guidelines None issued

Other Information To be used in line with the NHS England Service Specification. Highly specialised criteria only. Specialist centre only.

Date Reviewed April 2017

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381

SOFOSBUVIR/DACLATASVIR + Drug BNF Section 5.3.3 RIBAVIRIN National Tariff Category Viral Hepatitis (B&C) & Respiratory Syncytial Virus Tariff Date 2014/15 Commissioner NHS England Central Team Indication(s) Hepatitis C

Prescribed Services Manual (Section and title) Please note this link will take you to the front page of the Prescribed Services Manual. The manual can then be searched using the section number.

NICE Guideline TA364 – Daclatasvir for treating chronic hepatitis C

Local Guidelines

Other Information To be used according to NHS England Clinical Commissioning Policy: B07/P/a.

Prior approval pro-forma required. Specialist centre only.

Date Reviewed April 2017

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382

SOFOSBUVIR/LEDIPASVIR +/- Drug RIBAVIRIN BNF Section 5.3.3 (Harvoni®) National Tariff Category Viral Hepatitis (B&C) & Respiratory Syncytial Virus Tariff Date 2014/15 Commissioner NHS England Central Team Indication(s) Hepatitis C

Prescribed Services Manual (Section and title) Please note this link will take you to the front page of the Prescribed Services Manual. The manual can then be searched using the section number.

NICE Guideline TA363- Ledipasvir–sofosbuvir for treating chronic hepatitis C

Local Guidelines

Other Information To be used according to NHS England Clinical Commissioning Policy: B07/P/a.

Prior approval pro-forma required. Specialist centre only.

Date Reviewed April 2017

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383

SOFOSBUVIR/PEGINTERFERON Drug BNF Section 5.3.3 + RIBAVIRIN National Tariff Category Viral Hepatitis (B&C) & Respiratory Syncytial Virus Tariff Date 2014/15 Commissioner NHS England Central Team Indication(s) Hepatitis C

Prescribed Services Manual (Section and title) Please note this link will take you to the front page of the Prescribed Services Manual. The manual can then be searched using the section number.

NICE Guideline TA330 - Sofosbuvir for treating chronic hepatitis C

Other Information To be used according to NHS England Clinical Commissioning Policy: B07/P/a.

Prior approval pro-forma required. Specialist centre only.

Date Reviewed April 2017

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384

Drug SOFOSBUVIR / VELPATASVIR BNF Section 5.3.3 (Epclusa®) National Tariff Category Viral Hepatitis (B&C) & Respiratory Syncytial Virus Tariff Date 2014/15 Commissioner NHS England Central Team Indication(s) Hepatitis C

Prescribed Services Manual (Section and title) Please note this link will take you to the front page of the Prescribed Services Manual. The manual can then be searched using the section number.

NICE Guideline TA430 - Sofosbuvir–velpatasvir for treating chronic hepatitis C

TA330 - Sofosbuvir for treating chronic hepatitis C

Other Information Prior approval pro-forma required. Specialist centre only.

Date Reviewed April 2017

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385

Drug SOMATROPIN BNF Section 6.5.1 National Tariff Category Growth Hormone & growth hormone Receptor Antagonist Tariff Date 2014/15 Commissioner NHS England Indication(s) Those not covered by NICE

Prescribed Services Manual (Section and title) Please note this link will take you to the front page of the Prescribed Services Manual. The manual can then be searched using the section number.

NICE Guideline

Other Information Specialist centre only.

Date Reviewed April 2017

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386

SOMATROPIN CCG Drug (Genotropin®, Humatrope®, Norditropin®, NutropinAq®, BNF Section 6.5.1 Omnitrope®, Saizen®, Zomacton®) National Tariff Category Growth Hormone & growth hormone Receptor Antagonist Tariff Date 2014/15 Commissioner CCG Indication(s) Commissioned By Growth failure / hormone deficiency Mandatory – All CCGs

NICE Guidelines TA64 – Growth hormone deficiency (adults) - human growth hormone

TA188 - Human growth hormone (somatropin) for the treatment of growth failure in children

Local Guidelines

Other Information MM1 form to be completed by consultant.

Children: Trust invoices the CCG until the patient is stabilised for Shared Care as per guidelines.

Adults: First 9 months of treatment may be provided by secondary care. Trust invoices the CCG for first 9 months of treatment, provided the Blueteq form has been sent to the CCG on initiation. If continuation is clinically indicated, then Shared Care should be initiated.

Drug supplied via Homecare and billed directly to the Trust.

Date Reviewed September 2017

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387

Drug SORAFENIB BNF Section 8.1.5 (Nexavar®) National Tariff Category Protein kinase inhibitors Tariff Date 2014/15 Commissioner NHS England Indication(s) Cancer

Prescribed Services Manual (Section and title) Please note this link will take you to the front page of the Prescribed Services Manual. The manual can then be searched using the section number.

NICE Guidelines TA474 - Sorafenib for treating advanced hepatocellular carcinoma

Other Information Prior approval pro-forma required

Date Reviewed December 2017

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388

Drug STAVUDINE BNF Section 5.3.1 (Zerit®) National Tariff Category AIDS/HIV antiretrovirals Tariff Date 2014/15 Commissioner NHS England Indication(s) HIV in combination with other anti-retroviral drugs

NICE Guidelines None issued

Other Information Patient to be treated in accordance with agreed Regional Guidelines

Date Reviewed April 2017

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389

SUBCUVIA® Drug BNF Section 14.5

National Tariff Category Intravenous/subcutaneous human normal immunoglobulins Tariff Date 014/15 Commissioner NHS England Indication(s) As per National DMP

128. Specialist respiratory services for children and young people

129. Specialist rheumatology services for children and young people

NICE Guidelines None issued

Please use in accordance with Clinical Guidelines for immunoglobulin use, second edition update (July 2011).

Date Reviewed April 2017

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390

BNF Drug 14.5 SUBGAM® Section National Tariff Category Intravenous/subcutaneous human normal immunoglobulins Tariff Date 2014/15 Commissioner NHS England Indication(s) As per National DMP

128. Specialist respiratory services for children and young people

129. Specialist rheumatology services for children and young people

NICE Guidelines None issued

Please use in accordance with Clinical Guidelines for immunoglobulin use, second edition update (July 2011).

Date Reviewed April 2017

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391

BNF Drug SUCROFERRIC OXYHYDROXIDE 9.5.2.2 (Velphoro®) Section National Tariff Category Phosphate Binding Agents Tariff Date 2016/17 Commissioner NHS England Indication(s) Control of serum phosphorus levels in dialysis patients

Prescribed Services Manual (Section and title) Please note this link will take you to the front page of the Prescribed Services Manual. The manual can then be searched using the section number.

NICE Guidelines

Other Information NHS England recommends referring to Agreed Trust Guidelines

Date Reviewed April 2017

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392

Drug SUNITINIB BNF Section 8.1.5 (Sutent®) National Tariff Category Protein kinase inhibitors Tariff Date 2014/15 Commissioner NHS England Indication(s) Cancer

Prescribed Services Manual (Section and title) Please note this link will take you to the front page of the Prescribed Services Manual. The manual can then be searched using the section number.

NICE Guidelines TA449 - Everolimus and sunitinib for treating unresectable or metastatic neuroendocrine tumours in people with progressive disease

TA179 – Gastrointestinal stromal tumours - sunitinib

TA178 - Renal cell carcinoma (negative appraisal)

TA169 – Renal cell carcinoma - sunitinib

Other Information To be used in line with the NICE TAs above

Date Reviewed December 2017

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393

Drug SUSOCTOCOG ALFA BNF Section 9.1.3 (Obizur®) National Tariff Category Blood-related products except fibrin sealants Tariff Date 2016/17 Commissioner NHS England Indication(s) Haemophilia A

Prescribed Services Manual (Section and title) Please note this link will take you to the front page of the Prescribed Services Manual. The manual can then be searched using the section number.

NICE Guidelines

Other Information This drug is not be routinely commissioned and should be requested from the commissioner via their IFR process. Specialist Centre only.

Date Reviewed April 2017

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394

TACROLIMUS Drug (Adoport®, Capexion®, Modigraf®, Prograf®, Tacni®, BNF Section 8.2.2 Vivadex®, Advagraf®) National Tariff Category This drug is NOT National Tariff Excluded but is listed as the commissioning responsibility of NHS England. Tariff Date 2014/15 Commissioner NHS England Indication(s) Transplant immunosuppression only

127. Specialist renal services for children and young people

128. Specialist respiratory services for children and young people

NICE Guidelines TA85 - Renal transplantation - immuno-suppressive regimens (adults) (review)

TA99 Renal transplantation - immunosuppressive regimens for children and adolescents

Other Information New patients only until formal repatriation agreed

Date Reviewed April 2017

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395

Drug TADALAFIL BNF Section 2.5.1 (Adcirca®) National Tariff Category Vasodilator antihypertensive drugs/Pulmonary Arterial Hypertension Tariff Date 2014/15 Commissioner NHS England Indication(s) Pulmonary Arterial Hypertension

Prescribed Services Manual 92. Pulmonary hypertension service to children (Section and title) Please note this link will take you to the front page of the Prescribed Services Manual. The manual can then be searched using the section number.

NICE Guidelines None issued

Other Information To be used in line with the NHS England Policies: A11/P/c

Date Reviewed April 2017

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396

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BNF Drug TANEZUMAB Section National Tariff Category Cytokine modulators Tariff Date 2017/18 Commissioner Indication(s)

Prescribed Services Manual (Section and title) Please note this link will take you to the front page of the Prescribed Services Manual. The manual can then be searched using the section number.

NICE Guidelines

Local Guidelines

Other Information This drug is currently in Phase III Clinical Trials and is not expected to be launched until 2020.

Date Reviewed December 2017

397

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TALIMOGENE

Drug BNF Section LAHERPAREPVEC 8.4 (Imlygic®) Cancer exclusion - This drug is NOT National Tariff Excluded but is listed as National Tariff Category the commissioning responsibility of NHS England. Tariff Date 2016/17 Commissioner NHS England Indication(s) Cancer

Prescribed Services Manual (Section and title) Please note this link will take you to the front page of the Prescribed Services Manual. The manual can then be searched using the section number.

NICE Guidelines TA410 - Talimogene laherparepvec for treating unresectable metastatic melanoma

Other Information Prior approval pro-forma required. Specialist centre only. Please refer to Specialised Services Commissioning circular 1679. Date Reviewed August 2017

398

Drug TEDUGLUTIDE BNF Section (Revestive®) National Tariff Category Cytokine modulators Tariff Date 2014/15 Commissioner NHS England Indication(s) Short bowel syndrome

Prescribed Services Manual 10. Adult specialist intestinal failure services (Section and title) Please note this link will take you to the front page of the 101. Severe intestinal failure service (adults) Prescribed Services Manual. The manual can then be 110. Specialist gastroenterology, hepatology and nutritional support (GHNS) searched using the section services for children and young people number.

NICE Guidelines None published.

Other Information This drug is not be routinely commissioned and should be requested from the commissioner via their IFR process. Specialist centre only.

Date Reviewed April 2017

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399

Drug TELAPREVIR BNF Section 5.3.3 (Incivo®) National Tariff Category Viral Hepatitis (B&C) & Respiratory Syncytial Virus Tariff Date 2014/15 Commissioner NHS England Indication(s) Hepatitis C

NICE Guidelines TA252 - Hepatitis C (genotype 1) - telaprevir

Other Information Prior approval pro-forma required.

Date Reviewed April 2017

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400

Drug TELBIVUDINE BNF Section 5.3.3 (Sebivo®) National Tariff Category Viral Hepatitis (B&C) & Respiratory Syncytial Virus Tariff Date 2014/15 Commissioner NHS England – not routinely commissioned Indication(s) Hepatitis B

Prescribed Services Manual (Section and title) Please note this link will take you to the front page of the Prescribed Services Manual. The manual can then be searched using the section number.

NICE Guidelines TA154 – Hepatitis B - telbivudine (negative appraisal)

Other Information This drug is not routinely commissioned and should be requested from the commissioner via their IFR process. Specialist centre only.

Date Reviewed April 2017

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401

Drug TEMOZOLOMIDE BNF Section 8.1.5 (Temodal®) National Tariff Category Cancer exclusion - This drug is NOT National Tariff Excluded but is listed as the commissioning responsibility of NHS England. Tariff Date 2014/15 Commissioner NHS England Indication(s) Endocrinology; non-malignant conditions

Prescribed Services Manual (Section and title) Please note this link will take you to the front page of the Prescribed Services Manual. The manual can then be searched using the section number.

NICE Guidelines TA121 - Glioma (newly diagnosed and high grade) - carmustine implants and temozolomide

TA23 - Brain cancer - temozolomide

Other Information This is not routinely commissioned and should be requested from the commissioner via their IFR process.

Date Reviewed April 2017

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402

Drug TEMSIROLIMUS BNF Section 8.1.5 (Torisel®) National Tariff Category Protein kinase inhibitors Tariff Date 2014/15 Commissioner CDF Indication(s) Cancer

Prescribed Services Manual (Section and title) Please note this link will take you to the front page of the Prescribed Services Manual. The manual can then be searched using the section number.

NICE Guidelines TA207 – Mantle cell lymphoma (relapsed) - temsirolimus (terminated appraisal)

TA178 - Renal cell carcinoma (negative appraisal)

Other Information To be used in line with the CDF Policy.

Not recommended as first-line treatment option for advanced and/or metastatic renal cell carcinoma (TA178).

Not recommended for the treatment of relapsed or refractory mantle cell lymphoma (TA207).

Date Reviewed April 2017

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403

Drug TENOFOVIR BNF Section 5.3.1 (Viread®) National Tariff Category AIDS/HIV antiretrovirals Tariff Date 2014/15 Commissioner NHS England Indication(s) 1 HIV in combination with other anti-retroviral drugs 2 Hepatitis B +/- other anti-retroviral drugs

Prescribed Services Manual 16. Adult specialist services for patients infected with HIV (Section and title) Please note this link will take 130. Specialist services for children and young people with infectious you to the front page of the Prescribed Services Manual. diseases The manual can then be searched using the section number.

NICE Guidelines TA173 - Hepatitis B - tenofovir disoproxil fumarate

Further guidance in progress.

Other Information 1: Patient to be treated in accordance with BHIVA Guidelines

2: Patient to be treated in accordance with NICE TA173.

Date Reviewed April 2017

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404

Drug TENOFOVIR ALAFENAMIDE BNF Section 5.3.1 (Vemlidy®) National Tariff Category AIDS/HIV antiretrovirals Tariff Date 2016/17 Commissioner NHS England 1 Hepatitis B Indication(s) 2 HIV in combination with other anti-retroviral drugs

Prescribed Services Manual 16. Adult specialist services for patients infected with HIV (Section and title) Please note this link will take 130. Specialist services for children and young people with infectious you to the front page of the Prescribed Services Manual. diseases The manual can then be searched using the section number.

NICE Guidelines

Other Information 1: This drug is not routinely commissioned and should be requested from the commissioner via their IFR process.

2: To be used in line with NHS England Clinical Commissioning Policy 16043/P.

Date Reviewed June 2017

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405

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TENOFOVIR ALAFENAMIDE + 6.4 Drug BNF Section COBICISTAT + ELVITEGRAVIR + EMTRICITABINE (Genvoya®) National Tariff Category AIDS/HIV antiretrovirals Tariff Date 2017/18 Commissioner NHS England Indication(s) HIV in combination with other antiretroviral drugs

NICE Guidelines

Other Information To be used in line with NHS England Clinical Commissioning Policy 16043/P.

Date Reviewed April 2017

406

TENOFOVIR DISOPROXIL + COBICISTAT BNF Drug 5.3.1 + ELVITEGRAVIR + EMTRICITABINE Section (Stribild®) National Tariff Category AIDS/HIV antiretrovirals Tariff Date 2014/15 Commissioner NHS England Indication(s) HIV in combination with other anti-retroviral drugs

NICE Guidelines None issued

Other Information To be used in line with NHS England Commissioning Policy: F03/P/a and agreed Regional Guidelines Date Reviewed April 2017

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407

TENOFOVIR with

Drug EMTRICITABINE and BNF Section 5.3.1 EFAVIRENZ (Atripla®) National Tariff Category AIDS/HIV antiretrovirals Tariff Date 2014/15 Commissioner NHS England Indication(s) HIV in combination with other anti-retroviral drugs

NICE Guidelines None issued

Other Information Patient to be treated in accordance with agreed Regional Guidelines

Date Reviewed April 2017

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408

TENOFOVIR with EMTRICITABINE BNF Drug 5.3.1 and RILPIVIRINE Section (Eviplera®) National Tariff Category AIDS/HIV antiretrovirals Tariff Date 2014/15 Commissioner NHS England Indication(s) HIV in combination with other anti-retroviral drugs

NICE Guidelines None issued

Other Information Patient to be treated in accordance with agreed Regional Guidelines

Date Reviewed April 2017

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409

Please see “Other Drug TERIFLUNOMIDE BNF Section (Aubagio®) Information” section National Tariff Category Immunomodulating drugs Tariff Date 2014/15 Commissioner NHS England Indication(s) Multiple sclerosis

Prescribed Services Manual (Section and title) Please note this link will take you to the front page of the Prescribed Services Manual. The manual can then be searched using the section number.

NICE Guidelines TA303 – Multiple sclerosis (relapsing) – teriflunomide

Other Information Patient should be treated in accordance with NICE TA above and NHS England Policy: D04/P/b

Prior approval pro-forma required

Date Reviewed April 2017

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410

Drug TERIPARATIDE BNF Section 6.6.1 (Forsteo®) National Tariff Category Drugs affecting bone metabolism Tariff Date 2016/17 Commissioner NHS England 1 Osteogenesis Imperfecta Indication(s) 2 Male and juvenile osteoporosis

Prescribed Services Manual (Section and title) Please note this link will take you to the front page of the Prescribed Services Manual. The manual can then be searched using the section number.

NICE Guidelines

Other Information 1: This drug is not routinely commissioned and should be requested from the commissioner via their IFR process. NHS England Clinical Commissioning Policy 16002/P. Specialist centre only.

2: This drug is not routinely commissioned and should be requested from the commissioning using their IR process. Specialist centre only.

Date Reviewed April 2017

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411

Drug TERIPARATIDE (CCG) BNF Section 6.6.1 (Forsteo®) National Tariff Category Drugs affecting bone metabolism Tariff Date 2014/15 Commissioner CCGs Indication(s) Commissioned By Osteoporosis Mandatory – All CCGs

NICE Guidelines TA161 – Osteoporosis - secondary prevention including strontium ranelate

Local Guidelines Kent and Medway osteoporosis network primary care guidelines for the secondary prevention of osteoporosis in post-menopausal women: (Guideline 12)

PR2016-03 – Teriparatide for osteoporosis

Other Information Can only be prescribed by the following named clinicians: Medway Maritime Hospital – Dr Paul Ryan East Kent Hospitals Trust – Dr Shelagh O’Riordan Darent Valley Hospital – Dr Yasser el Miedany Maidstone & Tunbridge Wells – Dr Taher Mahmud

Please ensure drug withdrawals are communicated to CCGs

Course of treatment is 18 months

Kent and Medway Osteoporosis Network will audit use of drug.

Drug supplied via Homecare and billed directly to the Trust.

Date Reviewed September 2017

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412

TETRAHYDROBIOPTERIN Drug BNF Section 9.4.1

National Tariff Category Drugs used in Metabolic disorders Tariff Date 2014/15 Commissioner NHS England Indication(s) Phenylketonuria

NICE Guidelines None issued

Other Information To be used in line with the NHS England Service Specification – highly specialised criteria only. Specialist centre only.

Available from “special-order” manufacturers or specialist importing companies.

Date Reviewed April 2017

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413

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BNF Drug TEZACAFTOR Section National Tariff Category Mucolytics Tariff Date 2017/18 Commissioner NHS England Indication(s) Cystic fibrosis

Prescribed Services Manual (Section and title) Please note this link will take you to the front page of the Prescribed Services Manual. The manual can then be searched using the section number.

NICE Guidelines

Date Reviewed December 2017

414

Drug THALIDOMIDE BNF Section 8.2.4 (Thalidomide Celegene®) National Tariff Category Immunomodulating drugs Tariff Date 2014/15 Commissioner NHS England Indication(s) Cancer

Prescribed Services Manual (Section and title) Please note this link will take you to the front page of the Prescribed Services Manual. The manual can then be searched using the section number.

NICE Guidelines TA228 - Multiple myeloma (first line) - bortezomib and thalidomide

Other Information

Date Reviewed April 2017

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415

THROMBIN Drug BNF Section

National Tariff Category Blood-related products Tariff Date 2014/15 Commissioner NHS England Indication(s) Pseudoaneurysm

Prescribed Services Manual 132.Specialist services for haemophilia and other related bleeding disorders (Section and title) (all ages) Please note this link will take you to the front page of the Prescribed Services Manual. The manual can then be searched using the section number.

NICE Guidelines IPG60 - Thrombin injections for pseudoaneurysms

Other Information

Date Reviewed April 2017

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416

Return to Contents page THROMBOMODULIN, BNF Drug RECOMBINANT HUMAN Section (Recomodulin®) National Tariff Category Fibrinolytics Tariff Date 2016/17 Commissioner Indication(s)

Prescribed Services Manual (Section and title) Please note this link will take you to the front page of the Prescribed Services Manual. The manual can then be searched using the section number.

NICE Guidelines

Other Information This drug is currently in Phase III Clinical Trials and is not expected to be launched in 2018.

Date Reviewed December 2017

417

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BNF Drug TILDRAKIZUMAB Section National Tariff Category Fibrinolytics Tariff Date 2016/17 Commissioner Indication(s)

Prescribed Services Manual (Section and title) Please note this link will take you to the front page of the Prescribed Services Manual. The manual can then be searched using the section number.

NICE Guidelines

Local Guidelines

Other Information This drug is expected to be launched in 2018.

Date Reviewed December 2017

418

Drug TIPRANAVIR BNF Section 5.3.1 (Aptivus®) National Tariff Category AIDS/HIV antiretrovirals Tariff Date 2014/15 Commissioner NHS England Indication(s) HIV in combination with other anti-retroviral drugs

NICE Guidelines None issued

Other Information Patient to be treated in accordance with agreed Regional Guidelines

Date Reviewed April 2017

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419

Drug TOBRAMYCIN (for nebulisation) BNF Section 5.1.4 (Tobi®, Bramitob®) National Tariff Category Antibacterial Drugs Tariff Date 2014/15 Commissioner NHS England Indication(s) Cystic Fibrosis

NICE Guidelines TA276 - Cystic fibrosis (pseudomonas lung infection) - colistimethate sodium and tobramycin

Other Information To be used in line with NHS England Policy: A01/P/b and NICE TA276.

Date Reviewed April 2017

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420

Drug TOCILIZUMAB BNF Section 10.1.3 (RoActemra®) National Tariff Category Cytokine modulators Tariff Date 2014/15 Commissioner NHS England 1 Juvenile arthritis - paediatric 2 Takayasu arteritis Indication(s) 3 Giant cell arteritis 4 Paediatric indications (where adult TAs are available)

Prescribed Services Manual 5. Adult highly specialist rheumatology services (Section and title) Please note this link will take 129. Specialist rheumatology services for children and young people you to the front page of the Prescribed Services Manual. The manual can then be searched using the section number.

TA373 – Abatacept, adalimumab, etanercept and tocilizumab for treating juvenile idiopathic arthritis

TA247 - Tocilizumab for the treatment of rheumatoid arthritis (rapid review of technology appraisal guidance 198)

TA518 - Tocilizumab for treating giant cell arteritis

Other Information 1: Use in accordance with NHS England Clinical Commissioning Policy E03/P/d and NICE TAs above. Prior approval proforma required.

2: To be used in accordance with NHS England Clinical Commissiong Policy 16056/P. Specialist centre only.

4: Use in accordance with NICE TA247 and TA375.

Date Reviewed November 2018

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421

Drug TOCILIZUMAB (CCG) BNF Section 10.1.3 (RoActemra®) National Tariff Category Cytokine modulators Tariff Date 2014/15 Commissioner CCG Indication(s) Commissioned By Rheumatoid arthritis Mandatory – All CCGs

TA373 – Abatacept, adalimumab, etanercept and tocilizumab for treating juvenile idiopathic arthritis

TA247 - Tocilizumab for the treatment of rheumatoid arthritis (rapid review of technology appraisal guidance 198)

Local Guidelines Kent and Medway guidelines for rheumatoid arthritis treatment pathways: (guideline 19)

Other Information *for use in adults only, for use in children please see previous page.

Notification using Blueteq. Sub-cutaneous formulation supplied via Homecare and billed directly to the Trust. Consultant Teams must also notify of withdrawals.

Date Reviewed September 2017

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422

TOFACITINIB Drug BNF Section 10.1.3 (Xeljanz®) National Tariff Category Cytokine modulators Tariff Date Commissioner . Indication(s) Commissioned By Rheumatoid arthritis All CCGS Psoriatic arthritis All CCGS

NICE Guidelines NICE TA480 - Tofacitinib for moderate to severe rheumatoid arthritis

NICE TA543 - Tofacitinib for treating active psoriatic arthritis after inadequate response to DMARDs

Local Guidelines

Other Information Approval via Blueteq. Available via homecare. Date Reviewed November 2018

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423

Drug TOFACITINIB BNF Section 10.1.3 (Xeljanz®) National Tariff Category Cytokine modulators Tariff Date Commissioner NHS England Paediatric indications (where adult TA available) – See Other Information Indication(s) box below for individual indications

Prescribed Services Manual (Section and title) Please note this link will take you to the front page of the Prescribed Services Manual. The manual can then be searched using the section number.

NICE Guidelines

NICE TA480 - Tofacitinib for moderate to severe rheumatoid arthritis

NICE TA543 - Tofacitinib for treating active psoriatic arthritis after inadequate response to DMARDs

Other Information This drug is not routinely commissioned and should be requested from the commissioner via their IFR process.

Date Reviewed November 2018

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424

Drug TOLVAPTAN BNF Section 6.5.2 (Samsca®) National Tariff Category Posterior pituitary hormones and antagonists Tariff Date 2014/15 Commissioner NHS England Indication(s) Hyponatraemia in cancer

NICE Guidelines None issued

Other Information Use in accordance with NHS England Clinical Commissioning Policy 16051/P

Date Reviewed April 2017

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425

Drug TOLVAPTAN (CCG) BNF Section 6.5.2 (Jinarc®) National Tariff Category Posterior pituitary hormones and antagonists Tariff Date 2015/16 Commissioner CCG Indication(s) Commissioned By Autosomal dominant Mandatory – All CCGs polycystic kidney disease

NICE Guidelines TA358 – Tolvaptan for treating autosomal dominant polycystic kidney disease

Local Guidelines

Other Information

Date Reviewed April 2017

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426

Drug TRABECTADIN BNF Section 8.1.5 (Yondelis®) Cancer exclusion - This drug is NOT National Tariff Excluded but is listed as National Tariff Category the commissioning responsibility of the Cancer Drugs Fund and/or NHS England. Tariff Date 2015/16 Commissioner NHS England Indication(s) Cancer

Prescribed Services Manual (Section and title) Please note this link will take you to the front page of the Prescribed Services Manual. The manual can then be searched using the section number.

NICE Guidelines TA389 – Topotecan, pegylated liposomal doxorubicin hydrochloride, paclitaxel, trabectedin and gemcitabine

TA185 - Trabectedin for the treatment of advanced soft tissue sarcoma

Other Information

Date Reviewed April 2017

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Drug TRAMETINIB BNF Section (Mekinist®) 8.6 Cancer exclusion - This drug is NOT National Tariff Excluded but is listed as National Tariff Category the commissioning responsibility of the Cancer Drugs Fund and/or NHS England. Tariff Date 2016/17 Commissioner NHS England Indication(s) Cancer

Prescribed Services Manual (Section and title) Please note this link will take you to the front page of the Prescribed Services Manual. The manual can then be searched using the section number.

NICE Guidelines TA396 - Trametinib in combination with dabrafenib for treating unresectable or metastatic melanoma

Other Information Prior approval pro-forma required. Please refer to Specialised Services Commissioning circular 1639.

Date Reviewed August 2017

428

Drug TRASTUZUMAB BNF Section 8.1.5 (Herceptin®) Cancer exclusion - This drug is NOT National Tariff Excluded but is listed as National Tariff Category the commissioning responsibility of the Cancer Drugs Fund. Tariff Date 2014/15 Commissioner NHS England Indication(s) Cancer

Prescribed Services Manual (Section and title) Please note this link will take you to the front page of the Prescribed Services Manual. The manual can then be searched using the section number.

NICE Guidelines TA208 - Trastuzumab for the treatment of HER2-positive metastatic gastric cancer

TA107 - Trastuzumab for the adjuvant treatment of early-stage HER2- positive breast cancer

TA34 - Guidance on the use of trastuzumab for the treatment of advanced breast cancer

Other Information

Date Reviewed April 2017

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429

Drug TRASTUZUMAB EMTANSINE BNF Section 8.1.5 (Kadcyla®) Cancer exclusion - This drug is NOT National Tariff Excluded but is listed as National Tariff Category the commissioning responsibility of the Cancer Drugs Fund. Tariff Date 2014/15 Commissioner NHS England Indication(s) Cancer

Prescribed Services Manual (Section and title) Please note this link will take you to the front page of the Prescribed Services Manual. The manual can then be searched using the section number.

NICE Guidelines TA458 - Trastuzumab emtansine for treating HER2-positive advanced breast cancer after trastuzumab and a taxane

Other Information To be used in line with the NICE TA above.

Date Reviewed November 2017

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Drug TRENONACOG ALFA BNF Section (IXinity®) National Tariff Category Blood related products Tariff Date 2016/17 Commissioner NHS England Indication(s) Haemophilia B

Prescribed Services Manual (Section and title) Please note this link will take you to the front page of the Prescribed Services Manual. The manual can then be searched using the section number.

NICE Guidelines

Other Information This drug is currently in Phase III Clinical Trials and is expected to be launched in 2017. Once launched it will not be routinely commissioned and should be requested from the commissioner via their IFR process. Specialist centre only.

Date Reviewed December 2017

431

Drug TREPROSTINIL SODIUM BNF Section 2.5.1 (Tyvaso®) National Tariff Category Vasodilator antihypertensive drugs/Pulmonary arterial hypertension Tariff Date 2014/15 Commissioner NHS England Indication(s) Pulmonary Arterial Hypertension

NICE Guidelines

Other Information Not routinely commissioned for new patients. Please follow the commissioners IFR process.

To be used in line with the NHS England Policy: A11/P/c.

Date Reviewed April 2017

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432

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BNF Drug 2.12 TRIENTINE Section National Tariff Category Drugs used in metabolic disorders Tariff Date 2017/18 Commissioner NHS England Indication(s) Wilson’s Disease

Prescribed Services Manual (Section and title) Please note this link will take you to the front page of the Prescribed Services Manual. The manual can then be searched using the section number.

NICE Guidelines

Other Information This drug is not routinely commissioned and should be requested from the commissioner via their IFR process. Specialist centres only.

Date Reviewed April 2017

433

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Drug TRIFLURIDINE with TIPIRACIL BNF Section 8.13 (Lonsurf®) Cancer exclusion - This drug is NOT National Tariff Excluded but is listed as National Tariff Category the commissioning responsibility of the Cancer Drugs Fund. Tariff Date 2017/18 Commissioner NHS England Indication(s) Cancer

Prescribed Services Manual (Section and title) Please note this link will take you to the front page of the Prescribed Services Manual. The manual can then be searched using the section number.

NICE Guidelines TA405 - Trifluridine–tipiracil for previously treated metastatic colorectal cancer

Other Information Prior approval pro-forma required. Please refer to Specialised Services Commissioning circular 1662. Date Reviewed August 2017

434

Please see “Other Drug TUROCTOCOG ALFA BNF Section (Novoeight®) Information” section National Tariff Category Blood-related products Tariff Date 2014/15 Commissioner NHS England Indication(s) As per BCSH Guidelines

Prescribed Services Manual (Section and title) Please note this link will take you to the front page of the Prescribed Services Manual. The manual can then be searched using the section number.

NICE Guidelines None issued

Other Information Treatment must be as per BCSH Guidelines.

Date Reviewed April 2017

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435

Drug USTEKINUMAB BNF Section 13.5.3 (Stelara®) National Tariff Category Drugs affecting immune response Tariff Date 2015/16 Commissioner NHS England Indication(s) Paediatric indications – where an adult TA is available.

Prescribed Services Manual (Section and title) Please note this link will take you to the front page of the Prescribed Services Manual. The manual can then be searched using the section number.

NICE Guidelines TA456 – Ustekinumab for moderately to severely active Crohn’s disease after previous treatment

TA455 - Adalimumab, etanercept and ustekinumab for treating plaque psoriasis in children and young people

TA340 - Ustekinumab for treating active psoriatic arthritis

TA180 - Psoriasis - ustekinumab

Other Information Prior approval proforma required. To be used as per NICE TA’s above

Date Reviewed December 2017

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436

Drug USTEKINUMAB (CCG) BNF Section 13.5.3 (Stelara®) National Tariff Category Drugs affecting the immune response Tariff Date 2014/15 Commissioner CCG Indication(s) Commissioned By Psoriasis Mandatory – All CCGs Psoriatic Arthritis

NICE Guidelines TA456 – Ustekinumab for moderately to severely active Crohn’s disease after previous treatment

TA340 – Ustekinumab for treating active psoriatic arthritis (rapid review of TA313)

TA313 – Psoriatic arthritis (active) – (negative appraisal)

TA180 - Psoriasis - ustekinumab

Local Guidelines Kent and Medway guidelines for psoriasis and Biologic agents: (guideline 15)

Other Information Drug supplied via Homecare and billed directly to the Trust.

Date Reviewed October 2017

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437

Drug VALGANCICLOVIR BNF Section 5.3.2.2 (Valcyte®) National Tariff Category Cytomegalovirus infection Tariff Date 2014/15 Commissioner NHS England Indication(s) Cytomegalovirus

Prescribed Services Manual 16. Adult specialist services for patients infected with HIV (Section and title) Please note this link will take 130. Specialist services for children and young people with infectious you to the front page of the Prescribed Services Manual. diseases The manual can then be searched using the section number.

NICE Guidelines None issued

Other Information NHS England recommends referring to Trust Guidelines

Date Reviewed April 2017

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438

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VANCOMYCIN (via unique delivery BNF Drug 5.2.1 system) Section National Tariff Category Antibacterial drugs Tariff Date 2017/18 Commissioner Indication(s)

Prescribed Services Manual (Section and title) Please note this link will take you to the front page of the Prescribed Services Manual. The manual can then be searched using the section number.

NICE Guidelines

Local Guidelines

Other Information This drug via this system is not currently commissioned and should not be used.

Date Reviewed December 2017

439

Drug VANDETANIB BNF Section 8.1.5 (Caprelsa®) National Tariff Category Protein kinase inhibitors Tariff Date 2014/15 Commissioner CDF Indication(s) Thyroid Cancer

Prescribed Services Manual (Section and title) Please note this link will take you to the front page of the Prescribed Services Manual. The manual can then be searched using the section number.

NICE Guidelines

Other Information To be used in line with the CDF Policy. Specialist centre only.

Date Reviewed April 2017

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440

Please see BNF “other Drug VEDOLIZUMAB (Entyvio®) Section Information” section National Tariff Category Drugs used in Metabolic disorders Tariff Date 2014/15 Commissioner NHS England Indication(s) Paediatric indications (where adult TA available)

Prescribed Services Manual (Section and title) Please note this link will take you to the front page of the Prescribed Services Manual. The manual can then be searched using the section number.

NICE Guidelines TA352 – Vedolizumab for treating moderately to severely active Crohn’s disease after prior therapy.

TA342 – Vedolizumab for treating moderately to severely active ulcerative colitis

Other Information Prior approval proforma required. As per NICE TAs above. Specialist Centres only.

Date Reviewed April 2017

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441

Drug VEDOLIZUMAB (CCG) BNF Section (Entyvio®) National Tariff Category Drugs affecting the immune response Tariff Date 2015/16 Commissioner CCG Indication(s) Commissioned By Moderate to severe ulcerative colitis Mandatory – All CCGs Moderately to severely active Mandatory – All CCGs Crohn’s disease

NICE Guidelines TA352 – Vedolizumab for treating moderately to severely active Crohn’s disease after prior therapy.

TA342 – Vedolizumab for treating moderately to severely active ulcerative colitis

Local Guidelines

Other Information

Date Reviewed April 2017

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442

Drug VELAGLUCERASE ALFA BNF Section 9.8.1 (VPRIV®) National Tariff Category Lysosomal Storage Disorder Drugs Tariff Date 2014/15 Commissioner NHS England Indication(s) Gaucher's Disease

Prescribed Services Manual (Section and title) Please note this link will take you to the front page of the Prescribed Services Manual. The manual can then be searched using the section number.

NICE Guidelines None issued

Other Information To be used in line with the NHS England Service Specification. Specialist centres only.

Date Reviewed April 2017

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443

Drug VEMURAFENIB BNF Section 8.6 (Zelboraf®) National Tariff Category Protein Kinase Inhibitors Tariff Date 2014/15 Commissioner NHS England Indication(s) Melanoma

Prescribed Services Manual (Section and title) Please note this link will take you to the front page of the Prescribed Services Manual. The manual can then be searched using the section number.

NICE Guideline TA269 – Melanoma (BRAF V600 mutation positive, unresectable metastatic) - vemurafenib

Local Guidelines

Other Information Patient to be treated in line with NICE TA above. Specialist centre only.

Date Reviewed April 2017

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444

Drug VERTEPORFIN BNF Section 11.8.2 (Visudyne®) National Tariff Subfoveal choroidal neovascularisation Category Tariff Date 2014/15 Commissioner CCG Indication(s) 1. Central serous chorioretinopathy 2. Polypoidal choroidal vasculopathy

NICE Guidelines None issued

Local Guidelines 1 Kent and Medway Policy Recommendation and Guidance Committee Policy Recommendation PR. 2017-12 2 Kent and Medway Policy Recommendation and Guidance Committee Policy Recommendation PR 2018-06 Other Information Notification, including withdrawals, should be made via Blueteq.

Date Reviewed June 2018

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445

Drug VIGAM® BNF Section 14.5 National Tariff Category Intravenous/subcutaneous human normal immunoglobulins Tariff Date 2014/15 Commissioner NHS England Indication(s) As per National DMP

128. Specialist respiratory services for children and young people

129. Specialist rheumatology services for children and young people

NICE Guidelines None issued

Please use in accordance with Clinical Guidelines for immunoglobulin use, second edition update (July 2011).

Date Reviewed April 2017

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446

Drug VISMODEGIB BNF Section N/A (Erivedge®) Cancer exclusion - This drug is NOT National Tariff Excluded but is listed as National Tariff Category the commissioning responsibility of the Cancer Drugs Fund. Tariff Date 2014/15 Commissioner CDF Indication(s) Cancer

Prescribed Services Manual (Section and title) Please note this link will take you to the front page of the Prescribed Services Manual. The manual can then be searched using the section number.

NICE Guidelines

Other Information To be used in line with the CDF Policy.

Date Reviewed April 2017

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447

VIVAGLOBIN Drug BNF Section 14.5.1

National Tariff Category Intravenous/subcutaneous human normal immunoglobulins Tariff Date 2014/15 Commissioner NHS England Indication(s) As per National DMP

Prescribed Services Manual (Section and title) Please note this link will take you to the front page of the Prescribed Services Manual. The manual can then be searched using the section number.

NICE Guidelines None issued

Please use in accordance with Clinical Guidelines for immunoglobulin use, second edition update (July 2011).

Date Reviewed April 2017

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448

VON WILLEBRAND FACTOR, See “Other Drug BNF Section Information” RECOMBINANT section (Vonvendi®) National Tariff Category Blood Related Products Tariff Date 2014/15 Commissioner NHS England Indication(s) Von Willebrand Deficiency

Prescribed Services Manual (Section and title) Please note this link will take you to the front page of the Prescribed Services Manual. The manual can then be searched using the section number.

NICE Guidelines

Date Reviewed December 2017

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449

Drug VORICONAZOLE BNF Section 5.2.1 (Vfend®) National Tariff Category Antifungals Tariff Date 2014/15 Commissioner NHS England Indication(s) 1 Fungal infection 2 Chronic pulmonary aspergillosis – See “Other Information”

NICE Guidelines None issued

Other Information 1: NHS England recommends referring to Trust Guidelines.

2: Highly specialised criteria only. Specialist centre only.

Date Reviewed April 2017

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450

Drug ZICONOTIDE BNF Section 4.7.1 (Prialt®) National Tariff Category Non-opioid analgesics Tariff Date 2014/15 Commissioner NHS England Indication(s) Intrathecal analgesia

Prescribed Services Manual 3. Adult highly specialist pain management services (Section and title) Please note this link will take 63. Highly specialist pain management services for children and young you to the front page of the Prescribed Services Manual. people The manual can then be searched using the section number.

NICE Guidelines None issued

Other Information This is not routinely commissioned and should be requested from the commissioner via their IFR process. NHS England Policy 16011/P Specialist centre only.

A policy is in progress.

Date Reviewed April 2017

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451

Drug ZIDOVUDINE BNF Section 5.3.1 (Retrovir®) National Tariff Category AIDS/HIV antiretrovirals Tariff Date 2014/15 Commissioner NHS England Indication(s) HIV in combination with other anti-retroviral drugs

NICE Guidelines None issued

Other Information Patient to be treated in accordance with agreed Regional Guidelines

Date Reviewed April 2017

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452

Drug ZIDOVUDINE with LAMIVUDINE BNF Section 5.3.1 (Combivir®) National Tariff Category AIDS/HIV antiretrovirals Tariff Date 2014/15 Commissioner NHS England Indication(s) HIV in combination with other anti-retroviral drugs

NICE Guidelines None issued

Other Information Patient to be treated in accordance with agreed Regional Guidelines

Date Reviewed April 2017

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453

ZIDOVUDINE with LAMIVUDINE Drug and ABACAVIR BNF Section 5.3.1 (Trizivir®) National Tariff Category AIDS/HIV antiretroviral Tariff Date 2014/15 Commissioner NHS England Indication(s) HIV in combination with other anti-retroviral drugs

NICE Guidelines None issued

Other Information Patient to be treated in accordance with agreed Regional Guidelines

Date Reviewed April 2017

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454

APPENDIX 1 : Drugs that have been discontinued or have no UK development This list contains details of the drugs currently included on the National Tariff excluded drugs list that have been discontinued by the manufacturer.

Drug Name National Tariff Category Status

Actoxumab + Cytokine modulators Sep 15: Development discontinued due to lack Bezlotoxumab of efficacy of actoxumab; bezlotoxumab will be developed as a single ingredient product Albutropin Adult onset growth hormone Jan 17: Teva have previously terminated deficiency development of TV-1106 and decided to stop all ongoing clinical activities in the area of growth hormones. Alisporivir Viral Hepatitis (B&C) & Development discontinued Respiratory Syncytial Virus Antipseudomonas Antibacterial Drugs Aug 16: Valneva has discontinued development aeruginosa IgY of intramuscular IC 43 for prevention of pseudomonal infections because of disappointing phase II/III trial results Asunaprevir Viral Hepatitis (B&C) & July 15: Bristol-Myers Squibb has not filed for Respiratory Syncytial Virus marketing authorisation of asunaprevir (ASV) as a single agent in Europe and cannot comment on future filing or potential regulatory timelines. Development is focussed on drug combinations Avacincaptad pegol Subfoveal choroidal No UK development neovascularisation Avoralstat Hereditary angioedema Oct 17: Removed from SPS website Bimagrumab Inclusion body myositis Sept 16: discontinued as primary outcome was not met in the pivotal PIII trial Brincidofovir Cytomegalovirus Development of this drug has been discontinued. Should it become available it will not be routinely commissioned and should be requested from the commissioner via their IFR process. Brolucizumab Cytokine modulators This drug is currently in Phase III Clinical Trials and is not expected to be launched until 2019. Ceralifimod There is currently no information on this drug. Doravirine HIV in combination with other No UK development anti-retroviral drugs Drisapersen Duchenne muscular May 16: BioMarin withdraws its EU application, dystrophy and discontinues development of drisapersen and three follow-on therapies Ecallantide Hereditary angioedema – This drug has been withdrawn and should no Acute treatment only. longer be prescribed. Edratide SLE No UK development Elvucitabine HIV in combination with other No UK development anti-retroviral drugs Emricasan Non-alcoholic steatohepatitis No UK development but UK launch is still (NASH) Fibrosis expected in 2019 Epratuzumab Systemic lupus The development of this drug has been erythematosus discontinued. Eprodisate Amyloidosis The development of this drug has been discontinued. Faldaprevir Viral Hepatitis (B&C) & The filing for this drug has been withdrawn Respiratory Syncytial Virus Fasinumab Cytokine modulators The development of this drug has been discontinued. Filgotinib Drugs affecting the immune The development of this drug has been response discontinued.

455

Drug Name National Tariff Category Status

Filibuvir Hepatitis C Pfizer has discontinued development of Filibuvir following a strategic review. Fitusiran Blood related products No UK development Ganetespib Drugs affecting the immune Discontinued by manufacturer response Gevokizumab Uveitis This drug is no longer in development and has been discontinued by the manufacturer. Glucarpidase Methotrexate induced renal The filing for this drug has been withdrawn. dysfunction Halofuginone Musculoskeletal and joint No UK development diseases Ibalizumab AIDS/HIV antiretrovirals No UK development Idebenone Duchenne Muscular Not recommended for approval – No UK launch Dystrophy plans. Laquinimod Immunomodulating Drugs Discontinued by manufacturer Lebrikizumab Allergen Immunotherapy Development of this drug has been discontinued. Macimorelin Growth Failure Development of this drug has been discontinued. Mavrilimumab Drugs Affecting the Immune No UK development Response Momelotinib Cancer Discontinued by manufacturer Motavizumab RSV prophylaxis Discontinued by manufacturer Nitazoxanide Hepatitis C Discontinued by manufacturer Odanacatib Drugs affecting bone Development of this drug has been metabolism discontinued. Olesoxime Neuromuscular Disorders Dec 17: Removed from SPS website Osilodrostat Other endocrine drugs No UK development Pacritinib Protein kinase inhibitors Filing withdrawn Peginterferon Hepatitis C The manufacturer has discontinued Lambda-1A development of this drug. Pegloticase Gout and cytotoxic-induced The UK licence for this drug has been hyperuricaemia withdrawn. Pegpleranib Wet AMD The manufacturer has discontinued development of this drug. Pomalidomide Myelofibrosis The manufacturer has discontinued development of this drug for this indication. For use in Cancer please see page 336. Ponesimod Drugs used for Phase III Clinical Trials – launch expected in neuromuscular disorders 2020. Once launched it will only be available from NHS England through their IFR process in Specialist Centres. Pretomanid Anti-tuberculosis drugs There is currently no information on this drug and it is likely in Clinical Trials. Once launched it will only be available from NHS England through their IFR process in Specialist Centres. Reveglucosidase Lysosomal storage disorder The manufacturer has discontinued alfa drugs development of this drug. If launched it will only be available from NHS England through their IFR process in Specialist Centres. Rigosertib Myelodysplastic syndromes Phase III Clinical Trials – launched expected (MDS) 2019. Once launched it will only be available from NHS England through their IFR process in Specialist Centres Pancreatic cancer Development of this drug has been discontinued. Ropeginterferon Viral hepatitis (B&C) & There is currently no information on this drug

456

Drug Name National Tariff Category Status

Alfa-2b respiratory syncytial virus and it is likely in Clinical Trials. Once launched it will only be available from NHS England through their IFR process in Specialist Centres. Roxadustat Drugs used in hypoplastic, Phase III Clinical Trials – launched expected haemolytic and renal 2019. Once launched it will only be available anaemias from NHS England through their IFR process in Specialist Centres Setrobuvir Hepatitis C Development of this drug has been discontinued Serelaxin Acute heart failure, Development of this drug has been decompensated discontinued. Sirukumab Paediatric indications (where Development of this drug has been adult TA available) discontinued. Solanezumab Drugs affecting the immune Development of this drug has been system discontinued. Tabalumab Cytokine modulators Development of this drug has been discontinued. Tafamidis Neurogenative conditions Development of this drug has been discontinued. Taliglucerase Alfa Gaucher’s disease This drug has been discontinued. Taribavirin Hepatitis C Phase III Clinical Trials – studies completed some years ago and no current studies ongoing. If launched it will only be available from NHS England through their IFR process in Specialist Centres Tesamorelin Growth hormone and growth Filing withdrawn hormone receptor antagonist Tralokinumab Allergen immunotherapy Phase III Clinical Trials – launched expected 2019. Once launched it will only be available from NHS England through their IFR process in Specialist Centres Treprostinil Pulmonary hypertension Phase III Clinical Trials - launch expected in diethanolamine 2018. Once launched it will only be available from NHS England through their IFR process in Specialist Centres Uridine triacetate Poisoning Development of this drug has been discontinued Vadadustat Drugs used in hypoplastic, Development of this drug has been haemolytic and renal discontinued. If it was to be launched it would anaemias not be routinely commissioned and should be requested from the commissioner via their IFR process. Vapreotide Growth hormone and growth The current development status of this drug is hormone receptor antagonist unknown. Vercirnon Cytokine modulators Development of this drug has been discontinued Vicriviroc AIDS/HIV antiretrovirals Development of this drug has been discontinued Winfuran (KP-1461) AIDS/HIV Development of this drug has been discontinued

457

APPENDIX 2 : Clinical Commissioning Groups Organisational and Payables Details for CCGs within Kent and Medway

Organisation Name Payables Code Invoice Address Invoice Address City Postcode (Address line 1) (Address line 2) (Address line 3) (Address line 4) (Address line 5) (Address line 6) NHS ASHFORD CCG 09C PAYABLES K015 PHOENIX HOUSE TOPCLIFFE LANE WAKEFIELD WF3 1WE NHS CANTERBURY AND COASTAL CCG 09E PAYABLES K035 PHOENIX HOUSE TOPCLIFFE LANE WAKEFIELD WF3 1WE NHS DARTFORD, GRAVESHAM AND 09J PAYABLES M085 PHOENIX HOUSE TOPCLIFFE LANE WAKEFIELD WF3 1WE SWANLEY CCG NHS MEDWAY CCG 09W PAYABLES K055 PHOENIX HOUSE TOPCLIFFE LANE WAKEFIELD WF3 1WE NHS SOUTH KENT COAST CCG 10A PAYABLES K095 PHOENIX HOUSE TOPCLIFFE LANE WAKEFIELD WF3 1WE NHS SWALE CCG 10D PAYABLES K115 PHOENIX HOUSE TOPCLIFFE LANE WAKEFIELD WF3 1WE NHS THANET CCG 10E PAYABLES K125 PHOENIX HOUSE TOPCLIFFE LANE WAKEFIELD WF3 1WE NHS WEST KENT CCG 99J PAYABLES K145 PHOENIX HOUSE TOPCLIFFE LANE WAKEFIELD WF3 1WE

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458

APPENDIX 3 : Invoice template

[Your Company Name]

INVOICE

“[Your Address]” INVOICE No [xxx]

“[Your Town, County, Postcode]” DATE: DD/MM/YY

Phone: “[0xxxx xxxxxx]” Fax: “[0xxxx xxxxxx]”

VAT Registration No. xxxxxx

Billing Address: Delivery Address: Trust / Org Name (name of Trust you are billing) Contact Name XXX Payables XXXX (Org code and Payables code) Department Phoenix House Address Line 1 Topcliffe Lane Address Line 2 Wakefield Address Line 3 West Yorkshire Address Line 4 WF3 1WE Postcode

Comments or special instructions:

ACCOUNT P.O. NUMBER REQUISITIONER DELIVERY NOTE TERMS NUMBER

QUANTITY DESCRIPTION UNIT PRICE AMOUNT

SUBTOTAL Bank Details: Sort Code (XX-XX-XX) DISCOUNT AMOUNT Account Number (XXXXXXXX) SHIPPING/HANDLING Please Make Cheques Payable to (XXXXXXXXX) VAT

TOTAL DUE Supplier comments or Instructions: (XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX) Return to Contents page No personally identifiable data is to be put on an invoice. This includes any patient names and addresses. Use initials or the patients NHS number where appropriate.