Re: Buprenorphine 7 Day Patches

Unit 1 St James Business Park Grimbald Crag Court Knaresborough HG5 8QB Our ref: MMT/AdvisoryNote/Buprenorphine patches Date September 2016 To: Practice Prescribing Leads Practice Managers Re: Buprenorphine 7 day patches

Dear Colleague,

For the September “Hints and Tips on Prescribing”, the Medicines Management Team would like to encourage practices to review their prescribing of 7 day buprenorphine transdermal patches, as they are now available in 5mcg, 10mcg and 20mcg per hour strengths from several manufacturers.

It is nationally recommended that these patches are prescribed by brand, in order to ensure that a patient always receives the appropriate patch that they are used to. It is also better value when a more cost effective branded generic is prescribed. The brands available in 7 day patches are BuTrans®, Butec®, Panitaz® and Reletrans®.

Our MMT reviewed all UK licensed brands of the 7 day patches, comparing the Summary of Product Characteristics, anticipated availability and prices. As a result, HaRD CCG recommends that practices prescribe the Butec® brand of patch. This decision has been highlighted to and accepted by HDFT.

Strength Generic (and BuTrans®) Buprenorphine Butec® 7 day transdermal patch (pack of 4) 7 day transdermal patch (pack of 4) 5mcg/hour £17.60 £9.86 10mcg/hour £31.55 £17.67 15mcg/hour £49.15 Launching end of 2016 20mcg/hour £57.46 £32.18 Prices correct as of September 2016 – Drug Tariff and NHS (BSA) DM&D browser

Over £260k is spent on buprenorphine patches per annum in HaRD CCG, with approximately £200k of this on the 7 day patches. Therefore there is the potential to save £88k per annum from the CCG drug budget by using Butec 7 day patches, instead of generic or other brands of 7 day patches.

Please note  The highest strength of 7-day patch is 20mcg/hour; whereas the buprenorphine patches which are changed every 3 or 4 days (72 or 96 hours) are available in higher strengths (e.g. 35mcg /hr, 52.5mcg/hr and 70mcg/hr). Therefore the 3 and 4 day patches are not directly interchangeable with the 7 day patches.  A 15mcg per hour Butec patch is being launched towards the end of 2016.

Buprenorphine Patches Monthly briefing/letter – Sept 16 Page 1 of 2 HaRD Medicines Management Team Buprenorphine patches (7 day) prescribed in HaRD CCG (April to June 2016)

Action points  Please prescribe the Butec brand to any patients started on buprenorphine 7-day patches.  Consider switching appropriate patients who are already prescribed buprenorphine 7 day patches (either generically or by brand) to the Butec brand.  Directions on prescriptions for Butec should specify the need to replace the patch every seven days, and patients should be advised to change the patch on the same day each week.  Advise patients to follow the manufacturer’s instructions for applying Butec patches, and remind them to always remove the old patch before applying a new one and to dispose of used patches safely.  Please ensure that the 3 and 4 day buprenorphine patches are also prescribed by brand, to ensure the patient receives the same product each time, and that it is clearly stated how often patients should change their patches.  Please share this information with all members of staff in the practice who are involved with the prescribing or dispensing of medicines, including the issuing of repeat prescriptions.

Our Prescribing Support Team is available to help practices with this work if required. HaRD versions of OptimiseRx and SystmOne and EMIS formularies will be amended to incorporate these recommendations.

Local community pharmacies have been e-mailed to inform them that practices will be undertaking this switch. As the timings of the switch will vary between practices it is advisable that each practice notifies its local pharmacies in advance of the switch to enable effective management of stock.

Should you have any queries, recommendations or ideas about these or future initiatives then we would be pleased to hear from you.

Yours sincerely,

HaRD Medicines Management Team.

References 1. BNF online – Accessed August 2016. 2. SPC for Butec® - EMC accessed August 2016 Buprenorphine Patches Monthly briefing/letter – Sept 16 Page 2 of 2 HaRD Medicines Management Team