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CAMBRIDGESHIRE & PETERBOROUGH CCG FORMULARY Classification of Prescribing Responsibility Skip to Alphabetical Index
Foreword
This document is an appendix to the Cambridgeshire and Peterborough CCG Formulary
Medicines considered by the CPJPG are included in this document. In general, only medicines classified as ‘NOT RECOMMENDED’ and ‘HOSPITAL ONLY’ are retained in this document long-term whilst all others are removed after 6 months as they are included in the CCG Formulary.
Definitions of the recommendations made by the Cambridgeshire and Peterborough Joint Prescribing Group (CPJPG) can be found in the explanatory notes
Any medication/drug licensed or becoming available after the revision date (below) for this document and not considered by CPJPG should be regarded as ‘Not Recommended’ or ‘Hospital only’. Omission of a drug from this table cannot be taken to indicate that it is recommended for prescribing in either primary or secondary care. (i.e. any medicine not listed in either the classification table or the formulary are classified as “Not recommended” ) Please contact the Medicines Management Team for further advice.
Cambridgeshire and Peterborough CCG have undertaken a prioritisation process and agreed that some therapies will not be a priority for funding and will therefore not be funded other than in exceptional circumstances.
This appendix to the formulary is a continually evolving document and will be updated after each CPJPG meeting (every 2 months). We want it to be as useful as possible for our clinicians therefore the Medicines Management Team would welcome any feedback.
Where commissioning responsibility for medication is now NHS England’s, the date last reviewed by CPJPG has been amended to Apr 2013*.
REVISION DATE: 18th March 2016 (More detailed information about amendments made can be found here)
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Alphabetical Index
Letters below are hyperlinked – click on the letter that corresponds to the first letter of the generic drug name, e.g. ‘p’ for paracetamol.
A N B O
C P D Q
E R
F S G T
H U I V
J W
K X L Y
M Z
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A Prior Approval Document Abatacept Rheumatoid Decision HOSPITAL ONLY March 2016 TA375 (Orencia) Arthritis √ remains active CCG Rheumatoid Arthritis Pathway Prior Approval Document(Adults Abatacept Juvenile idiopathic √ √ Decision HOSPITAL ONLY only) Nov 2016 TA373 (Orencia) arthritis (paeds) (adults) remains active
Paediatrics - NHSE Abiraterone Prostate cancer HOSPITAL ONLY √ N/A Apr 2013* N/A N/A
PrescQIPP Medical Accel-heal Devices Drop list (Electrical Wound NOT Decision √ Guidance March 2017 N/A stimulating wound management RECOMMENDED remains active (login may be device) required) Safety concerns, strict Psoriasis, Acitretin NOT monitoring Decision Ichthyosis, Darier’s √ N/A (Neotigason) RECOMMENDED requirements and remains active disease restricted availability. HOSPITAL ONLY Adjunctive therapy Acetylcysteine to immuno- Medication supplied CPJPG Decision or suppressants in direct from √ May 2010 N/A CG163 Summary N-acetylcysteine idiopathic Papworth Hospital pulmonary fibrosis for patients under their care Page 3 of 97
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CPJPG Decision Aclidinium + Summary Decision formoterol COPD RECOMMENDED √ July 2015 CG101 remain active (Duaklir Genuair) See COPD Pathway Ankylosing Adalimumab spondylitis & non- Prior Approval Decision HOSPITAL ONLY √ TA383 (Humira) radiographic axial Document remains active spondyloarthritis Adalimumab Crohn’s (Adult Prior Approval Decision HOSPITAL ONLY √ Nov 2010 TA187 (Humira) patients) Document remains active
Adalimumab Crohn’s (Paediatric Decision HOSPITAL ONLY √ N/A Apr 2013* N/A (Humira) patients) remains active Historical Adalimumab Prior Approval Decision Psoriasis HOSPITAL ONLY √ decision TA146 (Humira) Document remains active
Adalimumab Prior Approval Decision Psoriatic arthritis HOSPITAL ONLY √ Jul 2006 TA199 (Humira) Document remains active Adalimumab Rheumatoid HOSPITAL ONLY Prior Approval Decision √ March 2016 TA375 (Humira) arthritis Document remains active Prior Approval Document(Adults Adalimumab Juvenile idiopathic √ √ Decision HOSPITAL ONLY only) Nov 2016 TA373 (Humira) arthritis (paeds) (adults) remains active
Paediatrics - NHSE Ulcerative colitis Adalimumab Prior Approval Decision (moderate to HOSPITAL ONLY √ March 2015 TA329 (Humira) Document remains active severe)
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√ Adalimumab Non-infectious Decision HOSPITAL ONLY (Tertiary N/A Sept 2017 TA460 (Humira) uveitis remains active centre)
Non-small cell lung Afatinib HOSPITAL ONLY √ N/A Apr 2013* N/A N/A cancer Wet age-related Aflibercept Prior Approval Decision macular HOSPITAL ONLY √ Mar 2014 TA294 (Eylea) Document remains active degeneration Visual impairment caused by macular Aflibercept oedema secondary Prior Approval Jul 2014 Decision TA305 HOSPITAL ONLY √ (Eylea) to central or branch Document Nov 2016 remains active TA409 retinal vein occlusion Aflibercept Diabetic Macular Prior Approval Decision HOSPITAL ONLY √ Sep 2015 TA346 (Eylea) Oedema Document remains active Agalsidase beta (Fabrazyme, Fabrys disease HOSPITAL ONLY √ N/A Apr 2013* N/A N/A Replagal) Evidence for suggested place in therapy was insufficient to gain acceptance. Agomelatine NOT Decision Severe Depression √ Nov 2009 N/A (Valdoxan) RECOMMENDED remains active There is currently no view on use of the drug from the Mental Health Trust. The drug would not meet Page 5 of 97
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the NICE criteria for cost-effectiveness.
PrescQIPP Medical Devices Drop list Aknicare NOT Decision Acne √ Guidance March 2017 N/A (all formulations) RECOMMENDED remains active (login may be required)
RECOMMENDED with SHARED CARE Alemtuzumab Relapsing remitting Decision √ Shared care Jan 2015 TA312 (Lemtrada) Multiple Sclerosis (Medication not for remains active prescribing in primary care. This is supplied by CUHFT) Generic prescribing of alendronic acid is Alendronic acid/ advised with separate NOT Nov 2009 Decision colecalciferol Osteoporosis √ calcium and vitamin D TA161 RECOMMENDED remains active (Fosavance) supplementation.
Alirocumab Hypercholesterolae Prior Approval Decision HOSPITAL ONLY √ July 2016 TA 393 (Praluent) mia Document remains active
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Steroid Refractory Decision Alitretinoin Prior Approval Severe Chronic HOSPITAL ONLY √ May 2011 remains active TA177 (Toctino) Document Hand Eczema Alprostadil 3mg/g Erectile dysfunction NOT CPJPG Decision Decision √ Jul 2014 N/A cream (Vitaros) RECOMMENDED Summary remains active Acute ischaemic Historical Decision TA52 HOSPITAL ONLY √ N/A Alteplase stroke decision remains active TA122 Ambrisentan Class III Pulmonary (Volibris) Arterial HOSPITAL ONLY √ N/A Jan 2009 N/A N/A Hypertension Amifampridine Lambert-Eaton phosphate myasthenic HOSPITAL ONLY √ N/A Apr 2013* N/A N/A (Firdapse) syndrome (LEMS)
non-CF Decision HOSPITAL ONLY √ N/A March 2017 N/A bronchiectasis remains active Amikacin (via Homecare) Amlodipine Non-formulary. Historical besylate/ NOT Decision Hypertension √ Generic prescribing decision N/A valsartan RECOMMENDED remains active recommended. (Exforge) Contains a non- Amlodipine/ formulary angiotensin Historical olmesartan Essential NOT Decision √ II receptor antagonist. decision N/A (Sevikar) Hypertension RECOMMENDED remains active Inflexible dosage
form. Amorolfine % nail Fungal nail See Anti-fungal nail lacquers lacquer infection Licensed for 2nd line use following lack of Anagrelide Essential thrombo- Decision HOSPITAL ONLY √ effectiveness or May 2010 N/A (Xagrid) cythaemia remains active intolerance to a previous therapy Page 7 of 97
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(usually hydroxyurea) due to SE and cost. Rheumatoid Anakinra arthritis in (Kineret) HOSPITAL ONLY √ N/A Apr 2013* N/A CG79 combination with
methotrexate RECOMMENDED SPECIALIST INITIATION by an PrescQIPP Medical appropriate Devices Drop list Anal irrigation Specialist Decision Constipation √ Guidance March 2017 N/A systems (where less invasive remains active (login may be methods, i.e. required) medication, bowel re- training etc, have failed) Clinical Policies NOT Anticoagulant test Self management Forum Oral RECOMMENDED Decision strips of oral √ Anticoagulation May 2010 N/A Policy currently under remains active (Coaguchek) anticoagulation (Patient Self review Management) Systemic oral treatments Decision Anti-fungal nail Fungal nail NOT recommended first √ May 2014 remains N/A lacquers infections RECOMMENDED line. See CCG active Antimicrobial Guidelines Steroid-resistant Anti-thymocyte acute rejection immunoglobulin – following solid HOSPITAL ONLY √ N/A Apr 2013* N/A N/A ATG organ (Thymoglobuline) transplantation
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Steroid-resistant Anti-thymocyte acute rejection immunoglobulin – following solid HOSPITAL ONLY √ N/A Apr 2013* N/A N/A ATG organ (Thymoglobuline) transplantation Antiviral agents See HIV drugs or individual drug entries Prevention of VTE Apixaban in adults after Decision HOSPITAL ONLY √ N/A Feb 2012 TA245 (Eliquis) elective hip or knee remains active replacement DVT and PE RECOMMENDED- Apixaban Decision treatment and SPECIALIST √ NICE TA341 Sept 2015 TA341 (Eliquis) remains active prevention INITIATION Stroke and RECOMMENDED- Apixaban systemic embolism See CCG AF Decision √ NICE TA275 March 2015 TA275 (Eliquis) prevention non anticoagulation remains active valvular AF pathway Prior Approval Apremilast Decision Plaque Psoriasis HOSPITAL ONLY √ Document Jan 2017 TA419 (Otezla) remains active
Prior Approval Apremilast Active Psoriatic Decision HOSPITAL ONLY √ Document May 2017 TA433 (Otezla) Arthritis remains active
Anti-emetic for use Aprepitant NOT CPJPG Decision Decision in Chemotherapy √ Jan 2010 N/A (EMEND) RECOMMENDED Summary remains active patients Clinical case not Aquadrate NOT established. Historical Decision Dry skin conditions √ N/A products RECOMMENDED Formulary choices decision remains active should be tried. RECOMMENDED – Small for Decision Aspirin SPECIALIST √ RCOG Guidance March 2015 N/A gestational age remains active INITIATION/ADVICE Page 9 of 97
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CHILDREN: PrescQIPP Medical RECOMMENDED Auto inflation Devices Drop list Otitis media with Decision device √ Guidance March 2017 N/A effusion ADULT: NOT remains active (Otovent) (login may be RECOMMENDED required) (Self Care) Erectile CPJPG Decision Decision Avanafil (Spedra) RECOMMENDED √ Nov 2015 N/A Dysfunction Summary remains active Clinical case not Dry skin and NOT established. Historical Decision Aveeno products eczema prone √ N/A RECOMMENDED Formulary choices decision remains active conditions should be tried. High risk Azacitidine Myelodysplastic HOSPITAL ONLY √ N/A Apr 2013* N/A TA218 (Vidaza) Syndromes Azelastine/fluticas Seasonal NOT CPJPG Decision Decision one nasal spray and perennial √ Jul 2016 N/A RECOMMENDED Summary remains active (Dymista) allergic rhinitis Azilsartan Essential NOT √ CPJPG Decision Decision July 2012 CG127 (Edarbi) Hypertension RECOMMENDED Summary remains active B Baby Milks Soya Based, Lactose NOT √ CCG Governing Body Based, Stay Infant Nutrition July 2016 N/A N/A RECOMMENDED Decision Down and Thickener Baclofen (Lioresal) pump Multiple sclerosis HOSPITAL ONLY √ N/A Apr 2013* N/A CG8 (intrathecal)
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PrescQIPP Medical Bacterial Devices Drop list decolonisation MRSA carriage NOT Decision √ Guidance March 2017 N/A products eradication RECOMMENDED remains active (login may be (Prontoderm®) required) Prior Approval Baricitinib Moderate to severe Decision HOSPITAL ONLY √ Document August 2017 TA466 (Olumiant®) rheumatoid arthritis remains active
Beclomethasone/ formoterol DPI NOT CPJPG Decision Decision Asthma √ May 2015 N/A (Fostair RECOMMENDED Summary remains active NEXThaler®) Maintenance immune- Belatacept suppression in HOSPITAL ONLY √ N/A Apr 2013* N/A N/A (Nulojix) preventing rejection after renal transplant Active Belimumab autoantibody- HOSPITAL ONLY √ N/A Apr 2013* N/A N/A (Benlysta) positive SLE PrescQIPP Medical Devices Drop list Belladonna NOT Decision Relief of pain √ Guidance March 2017 N/A adhesive plasters RECOMMENDED remains active (login may be required) Chronic Bendamustine lymphocytic HOSPITAL ONLY √ N/A Apr 2013* N/A TA216 (Levact) leukaemia Bendamustine Non-Hodgkin’s √ TA206 (Levact) HOSPITAL ONLY N/A Jan 2011 N/A Lymphoma
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Betametasone Inflammatory skin NOT Economic analysis not Historical Decision √ N/A plaster (Betesil) disorders RECOMMENDED sufficiently robust. decision remains active Bevacizumab (Avastin) in Breast cancer HOSPITAL ONLY √ N/A Apr 2013* N/A TA214 combination with a taxane Choroidal Neovascularisation (CNV) in Non-Age Bevacizumab Prior Approval Decision Related Macular HOSPITAL ONLY √ Aug 2012 N/A (Avastin) Document remains active Degeneration (Non-AMD) Conditions Primary and Bile acid secondary sequestrants prevention of NOT Not recommended by Decision (colesevelam, cardiovascular √ Nov 2014 CG181 RECOMMENDED NICE CG181 remains active colestipol and disease alone or in colestyramine) combination with a statin Boceprevir Hepatitis C N/A HOSPITAL ONLY √ Apr 2013* N/A TA253 (Victrelis) (genotype 1) Bortezomib TA129 Multiple myeloma HOSPITAL ONLY √ N/A Apr 2013* N/A (Velcade) Bosentan Pulmonary arterial HOSPITAL ONLY √ N/A Apr 2013* N/A N/A (Tracleer) hypertension Bosentan Systemic Sclerosis HOSPITAL ONLY √ N/A Apr 2013* N/A N/A (Tracleer) Severe Bosentan NOT symptomatic √ N/A N/A N/A N/A (Tracleer) RECOMMENDED peripheral
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ischaemia in patients with secondary Raynaud’s disease due to autoimmune conditions other than systemic sclerosis.
East of England Funding Severe Botulinum toxin Priorities Advisory process to be Blepharospasm in HOSPITAL ONLY √ July 2016 N/A Type A Committee review reviewed July Adults For funding please 2017 complete IFR HOSPITAL ONLY for patients at high risk of perforation during pneumatic dilatation East of England Funding treatment or Priorities Advisory Botulinum toxin Dysphagia caused process to be aspiration √ Committee review July 2016 N/A Type A by Achalasia reviewed July For funding please 2017 NOT complete IFR RECOMMENDED for all other causes of Dysphagia Focal Spasticity after Brain or Botulinum toxin Prior Approval Decision Spinal Lesions or HOSPITAL ONLY √ Sep 2013 N/A Type A Document remains active neurodegenerative Conditions Facial palsy or Botulinum toxin NOT Decision following stroke or √ N/A Jan 2011 N/A Type A RECOMMENDED remains active head trauma Botulinum Toxin Torsion dystonias HOSPITAL ONLY √ Prior Approval Apr 2014 Decision N/A Page 13 of 97
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Type A and other Document remains active involuntary movements (Includes focal spasticity; wrist and hand disability due to upper limb spasticity associated with stroke; symptomatic relief of blepharospasm; symptomatic relief of hemifacial spasm; symptomatic relief of severe spasmodic torticollis (Cervical Dystonia); ankle disability due to lower limb spasticity associated with stroke in adults) Low Prior Approval Botulinum Toxin compliance/low Decision HOSPITAL ONLY √ Document Jan 2011 N/A Type A capacity bladders remains active
in paediatrics Prior Approval Document Botulinum Toxin Hyperhidrosis Decision HOSPITAL ONLY √ Jun 2007 N/A Type A (axillae only) remains active CCG Hyperhidrosis Policy RECOMMENDED- Prior Approval Botulinum Toxin Prophylaxis of only through Document Decision √ Sep 2011 TA260 Type A chronic migraine commissioned remains active Headache Clinics Botulinum Toxin Musculoskeletal HOSPITAL ONLY √ Prior Approval Jan 2010 Decision N/A
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Type A spasticity in Document remains active cerebral palsy Disease induced Botulinum Toxin Prior Approval Decision hypersalivation HOSPITAL ONLY √ Sept 2017 N/A Type A Document remains active (adults) Botulinum toxin Spasticity in Prior Approval Decision HOSPITAL ONLY √ Mar 2014 N/A Type A multiple sclerosis Document remains active Contracture of the Botulinum toxin Prior Approval Decision joint in multiple HOSPITAL ONLY √ Mar 2014 N/A Type A Document remains active sclerosis Botulinum Toxin Detrusor Prior Approval Decision Type A (Dysport HOSPITAL ONLY √ May 2011 CG171 Overactivity Document remains active and Botox) Anal outlet obstruction in patient with internal Botulinum Toxin HOSPITAL ONLY √ Prior Approval Decision anal sphincter Nov 2011 N/A (Dysport) Document remains active achalasia and Hirschsprung disease East of England Botulinum toxin Hidradenitis NOT Decision √ Priorities Advisory July 2016 N/A Type A Suppurativa RECOMMENDED remains active Committee review East of England Botulinum toxin Mechanical Neck NOT Decision √ Priorities Advisory July 2016 N/A Type A Disorders RECOMMENDED remains active Committee review East of England Botulinum toxin NOT Decision Raynaud’s Disease √ Priorities Advisory July 2016 N/A Type A RECOMMENDED remains active Committee review East of England Botulinum toxin Masseteric NOT Decision √ Priorities Advisory July 2016 N/A Type A Hypertrophy RECOMMENDED remains active Committee review Botulinum toxin Anal fissures HOSPITAL ONLY √ Prior Approval Nov 2011 Decision N/A
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(Dysport, Botox) Document remains active Brimonidine 0.5% NOT CPJPG Decision Decision Acne rosacea √ Jul 2014 N/A gel (Mirvaso) RECOMMENDED Summary remains active Adjunctive therapy CPJPG Decision RECOMMENDED – Brivaracetam in the treatment of Summary Decision SPECIALIST √ Nov 2016 N/A (Briviact) partial-onset remains active INITIATION seizures See Epilepsy Pathway CPJPG Decision Budesonide/form Summary oterol DPI Decision Asthma and COPD RECOMMENDED √ May 2015 CG101 (Duoresp remains active See CCG Asthma and Spiromax) COPD Pathways Buprenorphine Substitution Safety (differences in NOT Decision oral lyophilisate treatment for opioid √ bioequivalence with Jan 2017 N/A RECOMMENDED remains active (Espranor) drug dependence other formulations) Bupropion / East of England Weight NOT Decision Naltrexone √ Priorities Advisory March 2017 N/A Management RECOMMENDED remains active (Mysimba) Committee review C Hormone-refractory Cabazitaxel metastatic prostate HOSPITAL ONLY √ N/A N/A N/A TA255 (Jevtana) cancer – second- line Lack of evidence of Cabergoline Parkinson’s Sep 2004 Decision HOSPITAL ONLY √ superiority over other CG35 (Cabaser) disease remains active dopamine agonists Calcium acetate Hyperphosphatae and magnesium mia associated Decision HOSPITAL ONLY √ N/A Apr 2013* N/A carbonate with chronic renal remains active (Osvaren, insufficiency in
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formally patients Rephoren) undergoing dialysis East of England NOT Priorities Advisory Multiple sclerosis RECOMMENDED Committee (PAC) EoE PAC Cannabis sativa Decision (neuropathic pain (existing patients √ Policy Statement May 2015 policy extracts (Sativex) remains active and muscle spasm) may continue with CG186 treatment) CCG Pain Management Pathway
NOT Historical Decision Calmurid cream Dry skin conditions √ N/A N/A RECOMMENDED decision remains active
Adjuvant treatment Capecitabine/ of stage III Duke’s HOSPITAL ONLY √ N/A Apr 2013* N/A TA100 Oxaliplatin colon cancer Clinical and cost- effectiveness not Capsaicin NOT demonstrated. Decision patches Neuropathic pain √ Mar 2011 CG173 RECOMMENDED remains active (Qutenza) CCG Pain Management Pathway Carmellose Rationale for use not NOT Decision sodium eye drops Dry eye disease √ supported by Mar 2011 N/A RECOMMENDED remains active (Optive) evidence. CUHFT Business Prophylaxis of RECOMMENDED – case Carvedilol variceal bleeding in SPECIALIST √ Jan 2015 Jan 2016 N/A portal hypertension INITIATION Prescribing Support Document
non-CF Decision HOSPITAL ONLY √ N/A March 2017 N/A bronchiectasis remains active Ceftazidime (via Homecare)
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CERA – Continuous Anaemia of Erythropoetin Chronic Kidney HOSPITAL ONLY √ N/A N/A N/A N/A Receptor Disease Activator (Mircera) Prior Approval Certolizumab – Document Rheumatoid Decision TA375 pegol HOSPITAL ONLY √ March 2016 Arthritis remains active TA415 (Cimzia) CCG Rheumatoid Arthritis Pathway Ankylosing Prior Approval Certolizumab Spondylitis & Decision HOSPITAL ONLY √ Document March 2016 TA383 (Cimzia) radiographic axial remains active
spondyloarthritis May have a place in therapy for patients unresponsive to Certolizumab – adalimumab and Decision pegol Crohn’s Disease HOSPITAL ONLY √ infliximab with C May 2010 N/A remains active (Cimzia) reactive protein levels ≥ 10mg/l. Not Routinely Funded ahead of NICE. Prior Approval Certolizumab Decision Psoriatic arthritis HOSPITAL ONLY √ Document August 17 TA445 (Cimzia) remains active
Metastatic Cetuximab Colorectal Cancer TA176 HOSPITAL ONLY √ N/A Apr 2013* N/A (Erbitux) – second or TA242 subsequent line Ciclesonide Asthma NOT √ Evidence base is of Jul 2008 Decision TA138 Page 18 of 97
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(Alvesco) RECOMMENDED poor quality and long- remains active term effects unknown. Ciclosporin Eye RECOMMENDED – Severe dry eye Decision Drops SPECIALIST √ NICE TA369 Jan 2016 TA369 disease remains active (IKERVIS) INITIATION Evidence for the drug and place in therapy Cilomilast/ is limited. NOT Decision (Ariflo) Asthma and COPD √ May 2010 N/A RECOMMENDED remains active See CCG Asthma and COPD Pathways for further details Not highest priority for funding: other Decision Cilostazol Intermittent treatment measures – TA223 HOSPITAL ONLY √ Jan 2006 remains active (Pletal) Claudication stopping
smoking/exercise will have more impact. Lack of evidence Hypertriglyceridaemi NOT showing superior Decision Ciprofibrate a/Mixed √ July 2015 N/A hyperlipidaemia RECOMMENDED efficacy to other remains active fibrates Relapsing-remitting Cladribine HOSPITAL ONLY √ N/A Mar 2010 N/A N/A Multiple Sclerosis Clipper – Beclometasone Active ulcerative NOT Clinical case not Historical Decision √ N/A DP colitis RECOMMENDED demonstrated. decision remains active
Monitoring and Specialist follow up Clozapine Decision Atypical neuroleptic HOSPITAL ONLY √ required. Prescriber Mar 1997 CG178 (Clozaril) remains active and supplying pharmacy both have
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to be registered with Manufacturers’ monitoring service. To improve statin treatment adherence in NOT Not recommended by Decision Colecalciferol cardiovascular √ Nov 2014 CG181 RECOMMENDED NICE CG181 remains active disease prevention/ hypertriglyceridae mia Primary and secondary prevention of Colesevelam NOT Not recommended by Decision cardiovascular √ Nov 2014 CG181 (Cholestagel) RECOMMENDED NICE CG181 remains active disease alone or in combination with a statin Primary and secondary prevention of Colestipol NOT Not recommended by Decision cardiovascular √ Nov 2014 CG181 (Colestid) RECOMMENDED NICE CG181 remains active disease alone or in combination with a statin Primary and secondary Colestyramine prevention of NOT Not recommended by Decision (generic and cardiovascular √ Nov 2014 CG181 RECOMMENDED NICE CG181 remains active Questran) disease alone or in combination with a statin Collagenase NOT Prior Approval Dupuytren’s Sep 2011Sept Decision clostridium RECOMMENDEDHO √ DocumentCPJPG N/ATA459 Contracture 2017 remains active histolyticum SPITAL ONLY Decision Summary Page 20 of 97
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(Xiapex) Co-careldopa Parkinson’s Decision intestinal gel HOSPITAL ONLY √ Mar 2006 N/A disease remains active (DUODOPA) To improve statin treatment adherence in NOT Not recommended by Decision Co-enzyme Q10 cardiovascular √ Nov 2014 CG181 RECOMMENDED NICE CG181 remains active disease prevention/ hypertriglyceridae mia Highly toxic in even small overdoses. The MHRA has withdrawn the marketing authorisation for co- proxamol due to the poor benefit/risk profile for the drug.
None foreseen. For Co-proxamol NOT patients currently Decision Pain √ Sep 2009 N/A RECOMMENDED receiving the drug and remains active unable to switch to an alternative, continued provision of the unlicensed product may be made on the prescribers responsibility.
CCG Pain Management Pathway
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Current Commissioning Indication Last date Relevant Approved name Classification and Responsibility Rationale for Next Review Covered by this classified by NICE (Brand Name) Priority Funding Decision Due Classification CPJPG Guidance Position NHSE CCG
Contiform PrescQIPP Medical Devices Drop list (Insert for female Stress NOT Decision √ Guidance March 2017 N/A stress Incontinence RECOMMENDED remains active incontinence) (login may be required) Continuous Subcutaneous See Insulin Infusion Pump Therapy (continuous subcutaneous) Insulin Infusion Pump Therapy Cycloidal PrescQIPP Medical vibration Therapy for Devices Drop list accessories cellulitis, venous NOT Decision √ Guidance March 2017 N/A (Vibro-pulse leg ulcers and RECOMMENDED remains active (login may be accessories) lower limb oedema required)
D Prevention of VTE Dabigatran in adults after Decision HOSPITAL ONLY √ N/A Feb 2012 TA157 (Pradaxa) elective hip or knee remains active replacement VTE treatment and Dabigatran Decision secondary HOSPITAL ONLY √ N/A Jul 2015 TA327 (Pradaxa) remain active prevention RECOMMENDED – Dabigatran See CCG AF Decision Atrial Fibrillation √ N/A March 2015 TA249 (Pradaxa anticoagulation remain active pathway Dalfampridine For the CCG note: Decision HOSPITAL ONLY √ Apr 2013* N/A (AMPYRA) improvement of Unlicensed in the UK remains active Page 22 of 97
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Current Commissioning Indication Last date Relevant Approved name Classification and Responsibility Rationale for Next Review Covered by this classified by NICE (Brand Name) Priority Funding Decision Due Classification CPJPG Guidance Position NHSE CCG
walking in patients with multiple sclerosis Dalteparin See CCG LMWH See CCG LMWH Decision VTE √ Sep 2014 CG92 (Fragmin) Guidance Guidance remains active Dapoxetine Premature NOT CPJPG Decision Decision √ May 2014 N/A (Priligy) ejaculation RECOMMENDED Summary remains active Anaemia assoc. with chronic renal Darbepoetin failure in adult & HOSPITAL ONLY √ N/A Apr 2013* N/A CG114 (Aranesp) paediatric dialysis patients Anaemia in those Funded in secondary Darbepoetin Decision with cancer having HOSPITAL ONLY √ care in line with NICE Feb 2015 TA323 (Aranesp) remains active chemotherapy TA. Anaemia Decision Darbepoetin associated with Apr 2011 HOSPITAL ONLY √ N/A remains active N/A (Aranesp) renal failure in pre-
dialysis patients See CCG Female Urge and Stress Decision Darifenacin Incontinence RECOMMENDED √ May 2015 CG171 Urinary Incontinence remains active Pathways Second-line CML after imatinib Dasatinib 400mg N/A TA241 HOSPITAL ONLY √ Apr 2013* N/A (Sprycel) TA251 First-line Ph+ve CML Dasatinib Gastro-Intestinal N/A HOSPITAL ONLY √ Apr 2013* N/A N/A (Sprycel) Stromal Tumour
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Current Commissioning Indication Last date Relevant Approved name Classification and Responsibility Rationale for Next Review Covered by this classified by NICE (Brand Name) Priority Funding Decision Due Classification CPJPG Guidance Position NHSE CCG
Iron chelator for the treatment of chronic iron overload due to Deferasirox blood transfusion HOSPITAL ONLY √ N/A Apr 2013* N/A N/A (Exjade) only where desferrioxamine or deferiprone (for its licensed indication) are not an option Iron chelator for the treatment of chronic iron Deferiprone overload due to HOSPITAL ONLY √ N/A Apr 2013* N/A N/A (Ferriprox) blood transfusion in patients with beta thalassaemia Treatment of advanced Degarelix hormone- SPECIALIST NICE TA404 Decision (Firmagon) dependent prostate √ Nov 2016 TA404 INITIATION remains active cancer in people with spinal metastases Bone Metastases Denosumab Decision due from solid HOSPITAL ONLY √ N/A Mar 2013 TA265 (Xgeva) remains active tumours Local Enhanced Scheme
Denosumab Post-menopausal RECOMMENDED – Decision √ CPJPG Decision May 2015 TA204 (Prolia) Osteoporosis SPECIALIST ADVICE remains active Summary
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Current Commissioning Indication Last date Relevant Approved name Classification and Responsibility Rationale for Next Review Covered by this classified by NICE (Brand Name) Priority Funding Decision Due Classification CPJPG Guidance Position NHSE CCG
RECOMMENDED – SPECIALIST ADVICE, where PrescQIPP Medical household air- Devices Drop list Decision Deodorants Stoma fresheners are √ Guidance March 2017 N/A remains active clinically insufficient). (login may be Patients should be required) reviewed by Stoma Nurse for review. Evidence base not strong and concerns Deoxyspergualin regarding Decision (Spanidin) Wegener’s NOT Pending once immunosuppression, Jul 2007 remains active N/A granulomatosis RECOMMENDED licensed in UK side effects and (not yet licensed) efficacy against an unlicensed alternative. First Line Iron chelator for the Desferrioxamine treatment of HOSPITAL ONLY √ N/A Apr 2013* N/A N/A (Desferal) chronic iron overload due to blood transfusion No evidence of advantages over loratadine (now Desloratadine NOT Historical Decision Allergic conditions √ generic CatM). N/A (NEOCLARITYN) RECOMMENDED decision remains active
Try other less costly antihistamines first.
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Current Commissioning Indication Last date Relevant Approved name Classification and Responsibility Rationale for Next Review Covered by this classified by NICE (Brand Name) Priority Funding Decision Due Classification CPJPG Guidance Position NHSE CCG
Non-ischaemic Central retinal vein occlusion (CRVO), Dexamethasone complex or Intra-vitreal refractory branch Prior Approval Decision HOSPITAL ONLY √ Mar 2013 TA229 Implant retinal vein Document remains active (Ozurdex) occlusion (BRVO), where laser treatment is not suitable
Dexamethasone Visual impairment Intra-vitreal Prior Approval Prior Approval due to Diabetic HOSPITAL ONLY √ Sep 2015 TA349 Implant Document Document macular oedema (Ozurdex)
Dexamethasone Intra-vitreal Non-infectious Prior Approval Decision HOSPITAL ONLY √ Sept 2017 TA460 Implant uveitis Document remains active (Ozurdex)
Excessive sleepiness RECOMMENDED (with Decision Dexamfetamine √ Shared Care March 2016 N/A associated with shared care) remains active narcolepsy
Acute tibia Dibotermin alfa Prior Approval Decision fractures (Gustilo- HOSPITAL ONLY √ Jan 2014 N/A (InductOs) Anderson Grade Document remains active IIIB/C) Digoxin immune Poisons Decision HOSPITAL ONLY √ N/A 2014 N/A fab Information Service remains active
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Current Commissioning Indication Last date Relevant Approved name Classification and Responsibility Rationale for Next Review Covered by this classified by NICE (Brand Name) Priority Funding Decision Due Classification CPJPG Guidance Position NHSE CCG
Dimethyl Moderate to severe Decision HOSPITAL ONLY √ N/A Sept 2017 TA475 fumarate plaque psoriasis remains active Limited licence (Acute pain only). Contains cyclizine, which is Dipipanone+ subject to abuse. NOT Decision Cyclizine All indications √ Safer alternatives Jul 2011 N/A RECOMMENDED remains active (Diconal ) available.
CCG Pain Management Pathway Management of Cystic -March 2016 Fibrosis patients Patients are repatriated to now receiving Dornase alfa Cystic Fibrosis HOSPITAL ONLY √ N/A Secondary care at treatment from request of NHS Provider England. Trusts PrescQIPP Drop list Guidance NOT Decision Dosulepin Depression √ May 2016 N/A RECOMMENDED CPJPG Decision remains active Summary
Clinical case not Doublebase NOT established. Decision Dry skin conditions √ May 2015 N/A Dayleve gel RECOMMENDED Formulary choices remains active should be tried. Dronedarone Paroxysmal Atrial Decision HOSPITAL ONLY √ NICE TA197 Jan 2015 TA197 (Multaq) Fibrillation remains active Dronedarone Permanent Atrial Decision HOSPITAL ONLY √ NICE TA197 Jan 2015 TA197 (Multaq) Fibrillation remains active Duloxetine Stress induced HOSPITAL ONLY √ May be an option, in May 2010 Decision CG171
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(Yentreve) urinary secondary care, third remains active incontinence line before considering surgical intervention. Only modest effect in women with severe SUI and no benefit in women with mild SUI. DUODOPA (Duodopa- Advanced Monitoring and NOT Decision levodopa plus Parkinson’s √ Specialist follow up Mar 2006 CG35 RECOMMENDED remains active /carbidopa Disease required. intestinal gel) NOT ROUTINELY Severe Atopic RECOMMENDED Not routinely Decision Dupilumab √ March 2017 N/A Eczema FUNDING TO BE VIA recommended (IFR) remains active IFR NOT Decision Dicycloverine All Indications √ CPJPG Decision Summary July 2017 N/A RECOMMENDED remains active E NOT e- Cigarettes/ RECOMMENDED East of England Decision Nicotine (e- Smoking Cessation √ Priorities Advisory March 2016 N/A remains active Voke® ) devices Consider Self Care if Committee Statement necessary Treatment and RECOMMENDED- Edoxaban Decision prevention of DVT SPECIALIST √ NICE TA354 Nov 2015 TA354 (Lixiana) remains active and PE INITIATION Edoxaban Prevention of RECOMMENDED- Decision √ NICE TA355 Nov 2015 TA355 (Lixiana) stroke and SPECIALIST remains active
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Current Commissioning Indication Last date Relevant Approved name Classification and Responsibility Rationale for Next Review Covered by this classified by NICE (Brand Name) Priority Funding Decision Due Classification CPJPG Guidance Position NHSE CCG
systemic embolism INITIATION in non valvular atrial fibrillation To reduce Eflornithine NOT Historical Decision unwanted facial √ Evidence equivocal N/A cream (VANIQA) RECOMMENDED decision remains active hair PrescQIPP Medical Electrical Devices Drop list stimulating wound Wound NOT Decision √ Guidance March 2017 N/A device management RECOMMENDED remains active (login may be (Accel-heal) required) Thrombocytopenia Eltrombopag Prior Approval Decision associated with HOSPITAL ONLY √ Mar 2014 N/A (Promacta) Document remains active Hepatitis C Chronic immune Eltrombopag (idiopathic) Prior Approval Decision HOSPITAL ONLY √ Sep 2013 TA293 (Promacta) thrombocytopenic Document remains active purpura Irritable bowel RECOMMENDED Decision Eluxadoline syndrome with SPECIALIST √ Sept 2017 TA471 remains active diarrhoea INITATION Treatment of HIV-1 patients in combination with Enfuvirtide other anti – HOSPITAL ONLY √ N/A Apr 2013* N/A N/A (Fuzeon) retrovirals who have failed on or are intolerant of prior regimens. Enoxaparin NOT See CCG LMWH Decision VTE √ Sep 2014 CG92 (Clexane) RECOMMENDED Guidance remains active Entecavir Chronic hepatitis B HOSPITAL ONLY √ N/A Apr 2013* N/A TA153 (Baraclude) infection
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Current Commissioning Indication Last date Relevant Approved name Classification and Responsibility Rationale for Next Review Covered by this classified by NICE (Brand Name) Priority Funding Decision Due Classification CPJPG Guidance Position NHSE CCG
Metastatic hormone related Enzalutamide prostatic cancer HOSPITAL ONLY √ NICE TA377 March 2016 N/A TA377 (Xtandi) prior to chemotherapy Epinephrine 0.22mg Unlicensed with little Historical Decision Asthma HOSPITAL ONLY √ N/A (PRIMATENE evidence for use. decision remains active MIST) Epimax is a cost effective alternative to Oilatum, Diprobase and E-45 cream, which have similar Decision Epimax Cream Dry skin conditions RECOMMENDED √ May 2015 CG57 lipid contents. remains active
See also PrescQIPP review regarding cost- effective emollients Anaemia Epoetin associated with (all brands – alfa, HOSPITAL ONLY √ N/A Apr 2013* N/A CG114 renal failure in beta and zeta) dialysis patients Anaemia Epoetin associated with Decision (all brands – alfa, HOSPITAL ONLY √ N/A May 2008 N/A renal failure in pre- remains active beta and zeta) dialysis patients Epoetin Anaemia in those Funded in secondary Epoetin beta Decision with cancer having HOSPITAL ONLY √ care in line with NICE Feb 2015 TA323 (Eprex, remains active chemotherapy TA. NeoRecormon) Long bone non- Eptotermin – alfa HOSPITAL ONLY Prior Approval Decision union in patients √ Mar 2009 N/A (Osigraft) (CUHFT ONLY) Document remains active where treatment Page 30 of 97
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with autograft has failed or is unviable To improve statin treatment adherence in NOT Not recommended by Decision Ergocalciferol cardiovascular √ Nov 2014 CG181 RECOMMENDED NICE CG181 remains active disease prevention/ hypertriglyceridae mia NICE has indicated that eribulin is not a cost-effective option for the treatment of Eribulin (not Advanced breast NOT locally advanced or √ Sep 2012 Apr 2013* TA250 licensed) cancer RECOMMENDED metastatic breast cancer when used third or subsequent line (as per its licensed indication).
Non-small cell lung Erlotinib cancer HOSPITAL ONLY √ N/A Apr 2013* N/A TA227 (Tarceva) maintenance
No identified Eslicarbazepine advantage over NOT similar anti-epileptic Decision (ZEBINIX) Epilepsy √ May 2010 N/A RECOMMENDED drugs, and is remains active considerably more expensive. No evidence of Esomeprazole Reduce acid NOT Historical Decision √ advantage over N/A (NEXIUM) secretion RECOMMENDED decision remains active omeprazole. Page 31 of 97
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Etanercept Ankylosing (Benepali is spondylitis & non- Prior Approval Decision biosimilar of HOSPITAL ONLY √ March 2016 TA383 radiographic axial Document remains active choice for new spondyloarthritis patients) Etanercept (Benepali is Prior Approval Decision biosimilar of Psoriasis HOSPITAL ONLY √ Jul 2006 TA103 Document remains active choice for new patients) Etanercept (Benepali is Prior Approval Decision biosimilar of Psoriatic arthritis HOSPITAL ONLY √ Jul 2006 TA199 Document remains active choice for new patients) Etanercept Prior Approval (Benepali is Document Rheumatoid Decision biosimilar of HOSPITAL ONLY √ March 2016 TA375 arthritis remains active choice for new Rheumatoid Arthritis patients) Pathway. Etanercept Prior Approval (Benepali is Document(Adults Juvenile idiopathic √ √ Decision biosimilar of HOSPITAL ONLY only) Nov 2016 TA373 arthritis (paeds) (adults) remains active choice for new patients) Paediatrics - NHSE More frequent and severe risk of Pain and hypertension Etoricoxib inflammation in NOT compared to other Decision (ARCOXIA) √ Oct 2008 N/A rheumatoid arthritis RECOMMENDED NSAIDs and coxibs. remains active
and osteoarthritis CCG Pain Management Pathway
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Etravirine Decision HIV HOSPITAL ONLY √ N/A Jun 2009 N/A (Intelence) remains active No identified Eucerin intensive advantage and NOT Historical Decision treatment cream Dry skin conditions √ particularly expensive N/A RECOMMENDED decision remains active compared to formulary options.
Evolocumab Hypercholesterolae Prior Approval Decision HOSPITAL ONLY √ July 2016 TA 394 (Repatha) mia Document remains active
Eye compress PrescQIPP Medical Devices Drop list (including Hot NOT Decision Eye conditions √ Guidance March 2017 N/A Eye Compress, RECOMMENDED remains active Meibopatch, (login may be MGDRx Eye Bag) required)
F
Fampridine Multiple sclerosis HOSPITAL ONLY √ N/A Apr 2013* N/A N/A (FAMPYRA)
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Hypertriglyceridaemi Decision Fenofibrate RECOMMENDED √ July 2015 N/A a/ hyperlipidaemia remains active
Fentanyl immediate release formulations (e.g. ACTIQ lozenge, EFFENTORA Unlicensed buccal tablet, Severe Chronic HOSPITAL ONLY Decision ABSTRAL pain Not to be prescribed √ Jan 2015 N/A CCG Pain remains active sublingual tablet, (NOT palliative) in Primary Care Management Pathway RECIVIT sublingual tablet, BREAKYL buccal film, PECFENT and INSTANYL nasal sprays) Fentanyl immediate In line with SIGN and release SMC guidance. formulations (e.g. Limited evidence ACTIQ lozenge, compared to RECOMMENDED– EFFENTORA immediate-release SPECIALIST buccal tablet, √ morphine, and Jan 2015, May Decision Palliative Care INITIATION by N/A ABSTRAL significantly more 2016 remains Active Palliative Care sublingual tablet, expensive. Specialists only RECIVIT sublingual tablet, Where patient is BREAKYL buccal unable to take film, PECFENT immediate-release and INSTANYL morphine for Page 34 of 97
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nasal sprays) breakthrough cancer pain (or where breakthrough pain is of rapid onset and not controlled by oral morphine). Fentanyl immediate release formulations (e.g. SMC guidance. ACTIQ lozenge, Limited evidence EFFENTORA compared to buccal tablet, immediate-release ABSTRAL Acute and Chronic NOT √ Decision morphine, and May 2016 N/A sublingual tablet, Pain RECOMMENDED remains Active significantly more RECIVIT expensive. sublingual tablet,
BREAKYL buccal
film, PECFENT and INSTANYL nasal sprays)
See CCG Female Urge and Stress urinary incontinence Overactive Bladder RECOMMENDED– pathways. Fesoterodine Decision Syndrome (OAB) in SPECIALIST √ Recommended only if May 2015 CG171 (Toviaz) remains active adults INITIATION all other alternative including surgery have been considered.
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Current Commissioning Indication Last date Relevant Approved name Classification and Responsibility Rationale for Next Review Covered by this classified by NICE (Brand Name) Priority Funding Decision Due Classification CPJPG Guidance Position NHSE CCG
Iron deficiency Ferric maltol – RECOMMENDED- anaemia in patients Decision oral SPECALIST ADVICE √ N/A Sept 2017 N/A with inflammatory remains active (Feraccru) (3rd line) bowel disease
Decision Fiasp® (insulin Licensed NOT √ N/A July 2017 remains N/A aspart) indications RECOMMENDED active
Fibrin sealants & meshes (biologic Licensed Historical Decision HOSPITAL ONLY √ N/A N/A and non- indications decision remains active biologic/synthetic)
Filgrastim Neutropenia HOSPITAL ONLY √ N/A April 2013* N/A N/A (Neupogen)
Relapsing – Fingolimod remitting Multiple HOSPITAL ONLY √ N/A Apr 2013* N/A TA254 (Gilenia) Sclerosis
Fluocinolone acetonide Chronic diabetic Prior Approval Decision HOSPITAL ONLY √ Jan 2014 TA301 intravitreal macular oedema Document remains active implant
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Current Commissioning Indication Last date Relevant Approved name Classification and Responsibility Rationale for Next Review Covered by this classified by NICE (Brand Name) Priority Funding Decision Due Classification CPJPG Guidance Position NHSE CCG
Fluticasone CPJPG Decision Decision NOT Furoate (Avamys) Allergic Rhinitis √ Summary Nov 2014 remains N/A RECOMMENDED Nasal Spray active
Fluticasone + RECOMMENDED for CPJPG Decision Decision salmeterol MDI ( Asthma Adult Asthma √ Summary Sep 2015 remains N/A Sirdupla®) patients only active
CPJPG Decision Fluticasone Prophylaxis of Summary Decision furoate + asthma and NOT √ Mar 2014 remains CG101 vilanterol management RECOMMENDED See Asthma and active (Relvar Ellipta) COPD. COPD Pathways for further details
Decision Ethylene glycol and Historical Fomepizole HOSPITAL ONLY √ N/A remains N/A methanol poisoning decision active
Food Review by CJPG supplements indicates little claimed to help evidence of with certain effectiveness and medical some evidence of little conditions Various medical NOT or no benefit. Sep 2008 Decision √ N/A e.g. Ginkgo conditions RECOMMENDED remains active Biloba, St John’s No long term safety Wort, data. Glucosamine, Chondroitin, Consider drug Ocuvite interactions and
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Preservision, Eye advise patients who Q, Fish oils, Fatty consider self-care Acids and vitamin accordingly. preparations Glucosamine interacts with warfarin. St John’s Wort interacts with a wide range of drugs including SSRIs. Formoterol/Beclo methasone DPI NOT √ CPJPG Decision Decision Asthma May 2015 N/A (Fostair RECOMMENDED Summary remains active NEXThaler®) CPJPG Decision Formoterol/Budes Summary Decision onide DPI Asthma and COPD RECOMMENDED √ May 2015 CG101 remains active (Duoresp See Asthma and COPD Spiromax®) Pathways
Formoterol + CPJPG Decision Decision aclidinium COPD RECOMMENDED √ July 2015 CG101 Summary remain active (Duaklir Genuair)
Freestyle Libre® Flash Glucose NOT CPJPG Decision Decision Diabetes √ March 2017 N/A Monitoring RECOMMENDED Summary remain active System Fulvestrant Metastatic breast HOSPITAL ONLY √ N/A Apr 2013* N/A TA239 (Faslodex) cancer
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G eGFR expressing, locally advanced or Gefitinib metastatic Non HOSPITAL ONLY √ N/A Apr 2013* N/A TA192 (Iressa) Small Cell Lung Cancer Gliclazide Similar effects on Historical Decision modified release NOT Diabetes √ blood glucose control decision remains active N/A (DIAMICRON RECOMMENDED as standard release. MR) Cochrane review indicated limited Glucosamine Mild to moderate clinical benefit for Decision NOT (Alateris, Dolenio, osteoarthritis of the √ glucosamine. Sep 2008 remains active CG177 RECOMMENDED Glusartel) knee Not Recommended by NICE or SMC. Gluten-free foods- all Gluten intolerance / NOT CCG Governing Body Decision √ July 2016 N/A Coeliac disease RECOMMENDED Decision remains active
Ankylosing Golimumab spondylitis & non- Prior Approval Decision HOSPITAL ONLY √ March 2016 TA383 (Simponi) radiographic axial Document remains active spondyloarthritis Golimumab Prior Approval Decision Psoriatic arthritis HOSPITAL ONLY √ Jul 2011 TA220 (Simponi) Document remains active Rheumatoid Prior Approval Golimumab √ Decision Arthritis after failure HOSPITAL ONLY Document March 2016 TA375 (Simponi) remains active of previous anti-
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rheumatic drugs CCG Rheumatoid Arthritis Pathway Ulcerative colitis Golimumab Prior Approval Decision (moderate to HOSPITAL ONLY √ March 2015 TA329 (Simponi) Document remains active severe) Clinical Policies RECOMMENDED Forum Grass Pollen Grass Pollen with Decision √ Allergic Rhinitis Jan 2013 N/A Vaccine (Grazax) allergy Secondary/Tertiary remains active Primary Care care initiation Pathway Growth See Somatropin entry Hormones Agreed that all Glyceryl trinitrate paediatric ointment Anal fissures in Decision HOSPITAL ONLY √ prescriptions to be May 2011 N/A (RECTOGESIC) children remains active provided by in paediatric secondary care.
CPJPG Decision Glycopyronnium Summary + Indacterol Decision COPD RECOMMENDED √ March 2016 CG101 (Ultibro remains active See COPD Pathway Breezehaler) for further details
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H
Head lice PrescQIPP Medical treatment NOT Devices Drop list devices- ALL RECOMMENDED Decision Head Lice √ Guidance March 2017 N/A (including remains active (login may be (suitable for self care) solutions, required) lotions, kits and combs).
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HIV drugs
For etravirine, enfuvirtide, HIV HOSPITAL ONLY √ N/A Apr 2013* N/A N/A maraviroc, raltegravir, see separate entries RECOMMENDED- SPECIALIST INITIATION Historical Decision Humulin R Diabetes Mellitus √ Shared Care N/A with Shared care for decision remains active patients requiring high doses due to insulin resistance RECOMMENDED- SPECIALIST Hydroxychloro- Rheumatic Decision INITIATION √ N/A March 2017 N/A quine Diseases remains active With GP prescribing support document
RECOMMENDED PrescQIPP Medical SPECIALIST Cystic Fibrosis Devices Drop list Hypertonic INITIATION Decision (CF) or non-CF √ Guidance March 2017 N/A sodium chloride remains active bronchiectasis (login may be solutions for (All other indications – required) nebulisation. NOT RECOMMENDED) I Ibandronate Bone damage INTRAVENOUS = √ Patient group has May 2010 Decision remains N/A Page 42 of 97
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(Bondronat) Reduction for bone HOSPITAL ONLY complex needs of active metastases in which Ibandronate is breast cancer ORAL = only a part. Shared (oral/IV) RECOMMENDED care for oral with shared care Ibandronate improves flexibility of treatment for patients. No evidence for Ibandronate Hypercalcaemia May 2010 Decision remains HOSPITAL ONLY √ superiority over other N/A (Bondronat) (IV) active treatments.
Ibandronate was not included as a Treating treatment option in
postmenopausal recent NICE TA HOSPITAL May TA464 Ibandronate osteoporosisOsteo guidance. Decision remains ONLYNOT √ 2009Sept TA160 (IV) porosis – primary active RECOMMENDED 2017 TA161 and secondary Effectiveness is less
prevention than for other bisphosphonates.N/A
Relapsed/ Ibritumomab Decision remains refractory Non N/A Tiuxetan [90Y] HOSPITAL ONLY √ April 2013* active N/A Hodgkin’s (Zevalin) NHS-E Lymphoma Acute attacks of √ Icatibant (Firazyr) hereditary HOSPITAL ONLY N/A Apr 2013* N/A N/A
angioedema Peripheral ischaemia in Prior Approval Decision remains Iloprost infusion Raynaud’s disease HOSPITAL ONLY √ May 2012 N/A Document active or Systemic Sclerosis (SSc) Page 43 of 97
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Iloprost Pulmonary HOSPITAL ONLY √ N/A Apr 2013* N/A N/A (Ventavis) hypertension TA251 Imatinib Chronic myeloid HOSPITAL ONLY √ N/A Apr 2013* N/A TA70 (Glivec) leukaemia TA50 Gastrointestinal TA86 Imatinib stromal tumour HOSPITAL ONLY √ N/A Apr 2013* N/A TA209 (Glivec) (GIST) TA326 Imiglucerase Gauchers disease HOSPITAL ONLY √ N/A Apr 2013* N/A N/A (Cerezyme) Immunoglobulins Grey conditions HOSPITAL ONLY √ N/A Apr 2013* N/A N/A Immuno- suppressants : Basiliximab HOSPITAL ONLY √ N/A Apr 2013* N/A TA85 (Simulect) Renal Daclizumab transplantation (Zenapax) Limited short-term evidence, with no patient-orientated outcomes, and no Decision remains superiority over other active long-acting beta-
Indacaterol NOT agonists. COPD √ Jul 2011 On consideration CG101 (Onbrez) RECOMMENDED Another long-acting by NICE or at beta -agonist 2 request of available at lower physicians cost. See CCG COPD Pathway for further details
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Current Commissioning Indication Last date Relevant Approved name Classification and Responsibility Rationale for Next Review Covered by this classified by NICE (Brand Name) Priority Funding Decision Due Classification CPJPG Guidance Position NHSE CCG
CPJPG Decision Indacterol + Summary glycopyronnium Decision remains COPD RECOMMENDED √ March 2016 CG101 (Ultibro active See COPD Pathway Breezehaler) for further details
Infliximab Remsima is Crohn’s disease Prior Approval Decision remains biosimilar of HOSPITAL ONLY √ Jul 2006 TA187 (Adults) Document active choice for new patients) Infliximab Ankylosing Remsima is Spondylitis & non- Prior Approval Decision remains biosimilar of HOSPITAL ONLY √ March 2016 TA383 radiographic axial Document active choice for new spondyloarthritis patients) Infliximab (Remsima is Ulcerative colitis Prior Approval Decision remains TA329 biosimilar of (moderate to HOSPITAL ONLY √ March 2015 Document active CG166 choice for new severe) patients) Infliximab (Remsima is Paediatric TA329 biosimilar of ulcerative colitis HOSPITAL ONLY √ N/A Apr 2013* N/A CG166 choice for new maintenance patients) Infliximab Prior Approval Decision remains (Remsima is Psoriasis (Adults) HOSPITAL ONLY √ Jul 2006 TA134 Document active biosimilar of Page 45 of 97
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choice for new patients) Infliximab (Remsima is Prior Approval Decision remains biosimilar of Psoriatic arthritis HOSPITAL ONLY √ Jul 2006 TA199 Document active choice for new patients) Infliximab Prior Approval (Remsima is Rheumatoid Document Decision remains biosimilar of HOSPITAL ONLY √ March 2016 TA375 arthritis CCG Rheumatoid active choice for new Arthritis Pathway patients) Product withdrawn by Decision remains manufacturer. Inhaled insulin NOT active Diabetes √ NICE to review Jan 2007 TA113 (Exubera) RECOMMENDED situation in September September 2009 2009. Inositol nicotinate NICE does not Peripheral vascular NOT Decision remains (HEXOPAL) √ advocate use TA223 disease RECOMMENDED active (TA223). Insert for female PrescQIPP Medical stress Devices Drop list Stress NOT Decision remains √ Guidance March 2017 N/A incontinence Incontinence RECOMMENDED active (Contiform) (login may be required)
Inspiratory RECOMMENDED PrescQIPP Medical muscle training COPD, non- SPECIALIST Devices Drop list devices (including CF bronchiectasis INITIATION Decision remains √ Guidance March 2017 N/A POWERbreathe and upper spinal active (login may be Medic, Threshold cord injuries. (All other indications – required) IMT, Ultrabreath) NOT RECOMMENDED) Page 46 of 97
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RECOMMENDED-
SPECIALIST CPJPG Decision Insulin degludec INITIATION- Jan and Decision remains CG15 Diabetes mellitus √ Summary (Tresiba) restricted to certain May 2016 active CG87
patients (see . formulary) RECOMMENDED Insulin degludec+ CPJPG Decision SPECIALIST ADVICE Jan and Decision remains CG15 liraglutide Diabetes Mellitus Summary FROM A Sep 2016 active CG87 (Xultophy) CONSULTANT RECOMMENDED_ SPECIALIST ADVICE FROM A CONSULTANT
Only for patients with Type 2 diabetes in adults requiring basal insulin ≥42 March 2016 Insulin Glargine units/day with or CPJPG Decision updated Decision remains CG15 (Toujeo) Diabetes Mellitus √ without addition Summary September active CG87 300units/ml oral 2016 hypoglycaemics or meal-time insulin Type 1 or Type 2 who have recurrent problematic severe hypoglycaemia Insulin Lispro RECOMMENDED-for Bioequivalent and (Humalog patients requiring comparable gluco- Decision remains Diabetes Mellitus √ July 2015 N/A Kwikpen 200 greater than 40 units dynamic response active units/ml of Humalog per dose and cost to Insulin Page 47 of 97
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Lispro 100units/ml
Insulin Infusion Pump Therapy Type 1 Diabetes Prior Approval Decision remains RECOMMENDED √ Mar 2009 N/A (continuous Mellitus Document active subcutaneous) Interferon alfa (IntronA, Roferon High priority for Decision remains A, Viraferon Hepatitis C HOSPITAL ONLY √ funding but only in Apr 2013* active TA75 PegIntron secondary care. ViraferonPeg) May 2009 Interferon alfa Leukaemia, To be retained by (IntronA, Roferon- lymphoma, other Decision remains HOSPITAL ONLY √ secondary/tertiary Apr 2013* N/A A) malignancies, active care. hepatitis Interferon beta To be retained by (Avonex, Rebif, Decision remains Multiple sclerosis HOSPITAL ONLY √ secondary/tertiary Apr 2013* N/A Betaferon, active care. Extavia) Serious infection in Interferon chronic To be retained by gamma-1b granulomatous Decision remains HOSPITAL ONLY √ secondary/tertiary Apr 2013* N/A (Immukin) disease and severe active care. malignant osteopetrosis G551D-CFTR Ivacaftor Decision remains Mutation Cystic HOSPITAL ONLY √ N/A Apr 2013* N/A (Kalydeco) active Fibrosis IVF drugs for NOT Historical Decision remains private patients Fertility Treatment √ N/A N/A RECOMMENDED decision active
Ixekizumab Moderate to severe HOSPITAL ONLY √ Prior Approval July 2017 Decision remains TA442
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(Taltz) plaque psoriasis Document active J RECOMMENDED – East of England To treat trismus SPECIALIST Priorities Advisory and mandibular INITIATION Committee (PAC) hypomobility.followi Jaw rehabilitation Policy Statement. Decision ng head and neck √ Nov 2015 N/A device All other indications June 2015. Available remains active radiotherapy or NOT via PrescQIPP head and neck RECOMMENDED website (password surgery may be required) Juxta CURES NOT CPJPG Decision Decision compression Venous leg ulcers √ Sep 2015 N/A RECOMMENDED Summary remains active system K L Lanreotide Gastroenteropan- Decision (Somatuline creatic tumours HOSPITAL ONLY √ N/A Apr 2013* N/A remains active Autogel) RECOMMENDED Commissioning Decision Lanreotide Acromegaly √ March 2015 N/A with SHARED CARE responsibility change remains active
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Current Commissioning Indication Last date Relevant Approved name Classification and Responsibility Rationale for Next Review Covered by this classified by NICE (Brand Name) Priority Funding Decision Due Classification CPJPG Guidance Position NHSE CCG
When not part of a RECOMMENDED Decision Lanreotide Palliative care √ chemotherapy March 2015 N/A with SHARED CARE remains active regimen RECOMMENDED Original safety Lanthanum Hyperphosphat- with specialist concerns reviewed Decision Carbonate aemia in end stage √ Apr 2013* N/A initiation and following longer term remains active (Fosrenol) kidney disease monitoring studies. Treatment of Lapatinib metastatic breast HOSPITAL ONLY √ N/A Apr 2013* N/A TA 257 (Tyverb) cancer
Lenalidomide Multiple Myeloma HOSPITAL ONLY √ N/A Apr 2013* N/A TA171 (Revlimid)
Lesinurad Hyperuricaemia NOT Decision √ N/A July 2017 N/A (Zurampic) (chronic) in gout RECOMMENDED remains active
No evidence of advantages over cetirizine (now generic Levocetirizine NOT Historical Decision Relief of allergy √ CatM). N/A (Xyzal) RECOMMENDED decision remains active
Try other less costly antihistamines first. East of England Priorities Advisory Committee (PAC) Lidocaine HOSPITAL ONLY Policy Statement Decision patches (Versatis, All indications √ Jan 2017 N/A remains active Lidoderm)
CCG Pain Management Pathway Linaclotide Treatment of RECOMMENDED- √ Linaclotide July 2015 Decision CG61 Page 50 of 97
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(Constella) moderate to SPECIALIST Prescribing Support remains active severe irritable INITIATION Document bowel syndrome with constipation. Evidence review: alogliptin 1st line, RECOMMENDED Decision Linagliptin Type 2 diabetes √ sitagliptin 2nd line, January 2015 CG87 (Renal patients only) remains active linagliptin reserved for renal patients. Use of Linezolid Complicated and/or should be restricted to resistant infections MRSA resistant to where resistance is other alternative Linezolid May 2010 Decision documented or HOSPITAL ONLY √ antibiotics unless N/A (Zyvox) remains active strongly suspected specifically or other agents recommended by a have failed consultant microbiologist. Hypothyroidism CPJPG Decision (Monotherapy in Summary RECOMMENDED- Decision Liothyronine (T3) patients resistant to √ PresCQIPP March 2016 N/A SPECIALIST ADVICE remains active levothyroxine evaluation 2015 (T4)) CPJPG Decision Hypothyroidism Summary NOT Decision Liothyronine (T3) (Combination √ PresCQIPP March 2016 N/A RECOMMENDED remains active treatment) evaluation 2015
Resistant CPJPG Decision depression – Summary adjunct to tricyclic RECOMMENDED- Decision Liothyronine (T3) √ PresCQIPP March 2016 N/A antidepressants SPECIALIST ADVICE remains active evaluation 2015 (unlicensed
indication) Page 51 of 97
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NOT RECOMMENDED
Liraglutide plus Type 2 Diabetes Please note liraglutide CPJPG Decision Decision √ Jul 2014 N/A basal insulin mellitus 1.2mg remains Summary remains active available as per NICE TA203 (see formulary). East of England Priorities Advisory Committee (PAC) NOT Liraglutide Weight Policy Statement. Decision RECOMMENDED √ March 2017 N/A (Saxenda) Management Available via remains active
PrescQIPP website (password may be required) Homozygous Commissioning Lomitapide familial Decision HOSPITAL ONLY √ responsibility change March 2015 N/A (Lojuxta) hypercholesterola remains active from 1st April 2015 emia
Obesity or Lorcaserin NOT √ CPJPG Decision Decision Overweight with Jul 2012 N/A (Lorqess) RECOMMENDED Summary remains active co-morbidity
Low molecular See CCG LMWH √ See CCG LMWH Decision VTE Sept 2014 CG92 weight heparin Guidance Guidance remains active
Chronic Idiopathic RECOMMENDED– Lubiprostone constipation in SPECIALIST Recommendation as Decision √ March 2014 TA318 (Amitiza) adults, INITIATION per NICE remains active unresponsive to Page 52 of 97
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diet and other pharmacological measures M Not reimbursable under the NHS Malaria (guidance FHSL Decision For travel (see also NOT Historical prophylaxis √ (95)7). remains N/A travel vaccines) RECOMMENDED decision active Provide private prescription. Mannitol Cystic Fibrosis HOSPITAL ONLY √ N/A Apr 2013* N/A TA266 Maraviroc HIV HOSPITAL ONLY √ N/A Apr 2013* N/A N/A (Celsentri) Unlicensed indication. Low level of evidence Narcolepsy and Decision Mazindol NOT and concerns that associated √ May 2010 remains N/A (Tenorac) RECOMMENDED similar drugs have cataplexy active been withdrawn on safety grounds. Treatment currently provided by GOSH Severe primary and mecasermin is insulin-like growth Decision Mecasermin NOT being referred to factor deficiency √ Apr 2013* remains N/A (Increlex) RECOMMENDED Specialist and active Commissioning for Insulin resistance consideration as a nationally Page 53 of 97
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commissioned service.
Being considered as specialist commissioning service. 1ST dose to be given Meningococcal RECOMMENDED- in hospital following Decision Group B vaccine Post Splenectomy SPECIALIST √ splenectomy. 2nd dose Nov 2015 remains N/A (Bexsero) INITIATION to be given 8 weeks active later in primary care
Decision non-CF HOSPITAL ONLY √ N/A March 2017 remains N/A bronchiectasis (via Homecare) Meropenem active
Indications including inflammatory bowel RECOMMENDED Decision disease, SPECIALIST Methotrexate √ Shared Care May 2016 remains N/A dermatological, INITIATION with active rheumatology, SHARED CARE vasculitis, opthalmology Decision Methylnaltrexone Opioid-induced NOT NICE terminated √ August 2017 remains TA468 bromide constipation RECOMMENDED appraisal active Mifamurtide Osteosarcoma HOSPITAL ONLY √ N/A Apr 2013* N/A TA235 (Mepact) See CCG Female RECOMMENDED– Urinary Urge and Stress Mirabegron SPECIALIST √ May 2015 N/A TA290 Incontinence urinary incontinence INITIATION pathways
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Monitoring and Specialist follow up required.
Reviewed by CJPG and not Night Shift recommended. Risk Decision Modafinil Workers/ NOT outweighs benefit in √ May 2010 remains N/A (Provigil) Disabling RECOMMENDED shift work sleep active sleepiness disorder (MHRA).
None foreseen. Use restricted by European Medicines Agency to narcolepsy only. Reserved for limited Decision Moxifloxacin Infections HOSPITAL ONLY √ secondary care Feb 2011 remains N/A (AVELOX) prescribing only. active N
RECOMMENDED- Naloxegol Opioid induced Decision SPECIALIST √ NICE TA345 Sep-2015 TA345 (Moventig) constipation remains active INITIATION Naltrexone / East of England Weight NOT Decision Bupropion √ Priorities Advisory March 2017 N/A Management RECOMMENDED remains active (Mysimba) Committee review Arthritis, Contains Naproxen/esome NOT Historical Decision Ankylosing √ esomeprazole – not N/A prazole (Vimovo) RECOMMENDED decision remains active Spondylitis funded.
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NOT RECOMMENDED (unless there is a diagnosis of needle PrescQIPP Medical phobia, which would Devices Drop list Jul 2014 Needle free result in the patient Decision Diabetes √ Guidance Nov 2015 N/A insulin devices not injecting insulin. remains active (login may be March 2017 Treatment should be required) initiated and stabilised by an appropriate Specialist).
NOT RECOMMENDED with the exception of No identified Neutrogena advantage and Neutrogena Historical Decision Skin care Dermatological √ particularly expensive N/A products decision remains active Cream for patients compared to formulary who require a non- options. paraffin based emollient. NOT RECOMMENDED for NEW patients. New data regarding (Existing patients safety profile Decision Nicorandil Angina √ July 2016 N/A can remain on published by the remains active treatment if MHRA January 2016 clinically appropriate) NOT RECOMMENDED East of England Nicotine (e-Voke ) Decision Smoking Cessation √ Priorities Advisory March 2016 N/A devices remains active Consider Self Care if Committee Statement necessary Page 56 of 97
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Hyperlipidaemias; primary or secondary Nicotinic acid prevention of Not recommended by NOT Decision modified release cardiovascular √ NICE CG181 Nov 2014 CG181 RECOMMENDED remains active (Niaspan) disease, alone or in combination with a statin
HOSPITAL ONLY
Shared Care agreement for GPs NICE TA379 Idiopathic Nintedanib (Ofev) to monitor liver √ March 2016 N/A TA379 pulmonary Fibrosis function available. Shared care Prescribing & Supply is hospital only Second- line option for Ph+ve CP and AC CML after imatinib 400mg. Nilotinib TA241 HOSPITAL ONLY √ N/A Apr 2013* N/A (Tasigna) First-line option in TA 251 Ph+ve CP CML
Only as monotherapy. Nilotinib Gastro-Intestinal N/A HOSPITAL ONLY √ Apr 2013* N/A N/A (Tasigna) Stromal Tumour Normal Saline Nasal Spray All See sodium chloride 0.9% Nasal Spray (Sterimar) (e.g.Sterimar) Nortriptyline Pain NOT √ N/A March 2016 Decision N/A Page 57 of 97
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RECOMMENDED remains active advanced Nivolumab (unresectable or Decision HOSPITAL ONLY √ NICE TA384 March 2016 TA384 (Opdivo) metastatic) remains active melanoma Cost-effective only in patients unable to use combined oral contraceptive tablets, and lower-cost non- NUVARING oral alternatives vaginal NOT available (patches). Decision Contraception √ Jul 2011 N/A contraceptive ring RECOMMENDED remains active Where patient is unable or unwilling to take combined oral contraceptive tablets, or use contraceptive patches. O Vitreomacular Prior Approval Decision Ocriplasmin HOSPITAL ONLY √ Jan 2014 TA297 traction Document remains active RECOMMENDED Commissioning Decision Octreotide Acromegaly √ March 2015 N/A with SHARED CARE responsibility change remains active When not part of a RECOMMENDED Decision Octreotide Palliative care √ chemotherapy March 2015 N/A with SHARED CARE remains active regimen No identified Oilatum shower NOT Historical Decision Dry skin conditions √ advantage and N/A gel RECOMMENDED decision remains active particularly expensive
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compared to formulary options. Octreotide Gastroenteropanc- (Sandostatin, reatic endocrine HOSPITAL ONLY √ N/A Apr 2013* N/A N/A Sandostatin LAR) tumours maintenance treatment of relapsed, platinum- sensitive, BRCA mutation-positive ovarian, fallopian Olaparib tube and peritoneal HOSPITAL ONLY √ NICETA381 March 2016 N/A TA381 (Lynparza) cancer after response to second-line or subsequent platinum-based chemotherapy CPJPG Decision Summary Olodaterol NOT Decision (Striverdi COPD √ Sept 2014 CG101 RECOMMENDED See CCG COPD remains active Respimat) Pathway for further details CPJPG Decision Olodaterol + summary Decision tiotropium COPD RECOMMENDED √ March 2016 CG101 remains active (Spiolto Respimat See COPD Pathway Allergic asthma Omalizumab inadequately TA 278 HOSPITAL ONLY √ N/A Apr 2013* N/A (Xolair) controlled by corticosteroids Omalizumab Previously treated NICE TA399 HOSPITAL ONLY √ Jan 2016 N/A TA399 (Xolair) chronic Page 59 of 97
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spontaneous Commissioning urticaria responsibility transferred to CCG December 2015.
Prior Approval Document
.Not recommended by NICE CG181, CG71, CG181, NOT CG71, Omega-3 acid CG172, CG186, RECOMMENDED – Nov 2014 Decision CG172, ethyl esters All indications √ CG170, NG49 LIMITED CLINICAL July 2017 remains active CG186, (All brands) VALUE CPJPG Decision CG170, NG49 Summary
Oral Insulin Type 1 and Type 2 Not highest priority for Decision HOSPITAL ONLY √ Jan 2006 N/A (not yet licensed) Diabetes funding. remains active Medical conditions RECOMMENDED for PrescQIPP Medical Oscillating with excessive Cystic Fibrosis and Devices Drop list positive Jul 2014 Decision mucus non-CF √ Guidance N/A expiratory March 2017 remains active production/reduced bronchiectasis (login may be pressure device mucus clearance patients only required) NOT RECOMMENDED Ostomy PrescQIPP Medical underwear (Specialist stoma Devices Drop list (Brands include Colostomy and May 2016 Decision nurses may √ Guidance N/A Vanilla Blush, Ileostomy March 2017 remains active recommend (login may be Comfizz) (SPECIALIST required)
ADVICE) support belts for the
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prevention of parastomal hernias) East of England Priorities Advisory Committee (PAC) Oxybutynin Focal/primary Policy Statement Decision immediate hyperhidrosis (off- RECOMMENDED √ May 2014 N/A remains active release label) Clinical Policies Forum to develop pathway Acute pain and Decision Oxycodone HOSPITAL ONLY √ March 2016 N/A post surgery remains active RECOMMENDED- second line to Chronic pain and Decision Oxycodone Morphine in Chronic √ March 2016 N/A Palliative Care remains active pain or Palliative Care patients only. Oxycodone once NOT Decision daily All √ March 2017 N/A RECOMMENDED remains active (Onexila XL) Evidence of Oxycodone/ For severe chronic NOT superiority over Decision naloxone √ Aug 2013 N/A pain RECOMMENDED alternative treatment remains active (TARGINACT) pathways weak. P Pabinostat Multiple Myeloma HOSPITAL ONLY √ NICE TA380 March 2016 N/A TA380 (Farydak) Prevention of Palivizumab serious lower HOSPITAL ONLY √ N/A Apr 2013* N/A N/A (Synagis) respiratory tract
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infection caused by RSV Metastatic Panitumumab Colorectal Cancer HOSPITAL ONLY √ N/A Apr 2013* N/A N/A (Vectibix) (mCRC) Paracetamol 500mg/5ml Oral NOT CPJPG Decision Analgesia, pyrexia √ Mar 2014 N/A N/A Suspension or RECOMMENDED Summary Oral Solution Osteoporosis in Parathyroid men and Decision Hormone HOSPITAL ONLY √ Jul 2011 N/A postmenopausal remains active (Preotact) women Cushing’s disease and Pasireotide Gastroenteropanc- HOSPITAL ONLY √ N/A Apr 2013* N/A N/A (Signifor) reatic neuroendocrine tumours Pazopanib Renal Cell Decision HOSPITAL ONLY √ N/A Apr 2013* TA215 (Votrient) Carcinoma remains active Age-related Pegaptanib NOT Decision macular √ See NICE TA155 Nov 2006 TA155 (Macugen) RECOMMENDED remains active degeneration Peginterferon alfa (Viraferonpeg, Pegasys) PLUS Paediatric hepatitis HOSPITAL ONLY √ N/A Apr 2013* N/A N/A Ribavirin (Copegus, Rebetol, Virazole) CCG responsibility Effective alternatives Pegvisomant May 2010 Decision Acromegaly HOSPITAL ONLY but not available at much N/A (Somavert) remains active commissioned by lower cost. May be
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C&PCCG considered only in secondary care for exceptional cases. PrescQIPP Medical Devices Drop list Pelvic Toning Stress NOT Decision √ Guidance Nov 2015 N/A devices incontinence RECOMMENDED remains active (login may be required) Antibacterial for HIV, Pneumocystis Monitoring and Pentamidine Decision pneumonia, HOSPITAL ONLY √ Specialist follow up March 1997 N/A (Pentacarinat) remains active leishmaniasis, required. trypanosomiasis Pentoxifylline NICE does not Peripheral vascular NOT Historical Decision (Trental) √ advocate use TA223 disease RECOMMENDED decision remains active (TA223). NICE TA282 HOSPITAL ONLY May 2015 Shared Care to Pirfenidone Idiopathic (Shared Care policy July 2015 Decision √ support monitoring TA282 (Esbriet) pulmonary fibrosis to support (Shared Care remains active prior to hospital monitoring) added) appointments Plantar Pressure Offloading Devices RECOMMENDED (including SPECIALIST BeneFoot® PrescQIPP Medical ADVICE Medical Shoe, Devices Drop list by an appropriate Decision Cellona® Shoe, Foot Problems √ Guidance March 2017 N/A practitioner (i.e. foot remains active Kerraped® All (login may be protection service or Purpose Boot, required) multidisciplinary Kerraped® foot care service) Plantar Ulcer Shoe System, Liqua Page 63 of 97
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Current Commissioning Indication Last date Relevant Approved name Classification and Responsibility Rationale for Next Review Covered by this classified by NICE (Brand Name) Priority Funding Decision Due Classification CPJPG Guidance Position NHSE CCG
Care® Diabetic FlowGel Orthotics) Plerixafor Stem cell HOSPITAL ONLY √ N/A Apr 2013* N/A N/A (Mozobil) mobilisation Anti-fungal agent Posaconazole for Prophylactic HOSPITAL ONLY √ N/A Apr 2013* N/A N/A (Noxafil) use in haemato- oncology patients Posaconazole Aspergillosis HOSPITAL ONLY √ N/A Apr 2013* N/A N/A (Noxafil) Posaconazole Decision Mucormycosis HOSPITAL ONLY √ N/A Apr 2013* (Noxafil) remains active Potassium PrescQIPP Medical Hydroxide Treatment of Devices Drop list NOT Nov 2015 Decision Solution Molluscum √ Guidance N/A RECOMMENDED March 2017 remains active (e.g.Molludab contagiosum (login may be 5%) required) Generalised RECOMMENDED Decision Pregabalin Anxiety Disorder & SPECIALIST √ Nov 2008 N/A remains active Epilepsy only INITIATION RECOMMENDED Neuropathic pain SPECIALIST Neuropathic Pain Decision Pregabalin √ Sept 2017 N/A only INITIATION as a 4th Guidance remains active line option. PrescQIPP Medical Prontoderm® Devices Drop list (Bacterial MRSA carriage NOT Decision √ Guidance March 2017 N/A decolonisation eradication RECOMMENDED remains active (login may be products) required)
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Current Commissioning Indication Last date Relevant Approved name Classification and Responsibility Rationale for Next Review Covered by this classified by NICE (Brand Name) Priority Funding Decision Due Classification CPJPG Guidance Position NHSE CCG
Q RECOMMENDED– SPECIALIST Schizophrenia, INITIATION treatment of mania but restricted to or depression n patients who Quetiapine XL Evidence review cost- bipolar, prevention experience Jan 2015; (Biquelle® XL, effective products Decision of mania and excessive side √ updated May N/A Ebesque® XL) Quetiapine XL Review remains active depression in effects with 2016 Guidance mania, adjunctive Immediate release treatment of major products or in depression patients with significant compliance issues R Raltegravir N/A Decision HIV HOSPITAL ONLY √ Apr 2013* N/A (Isentress) remains active Raltitrexed Advanced Decision HOSPITAL ONLY √ N/A Apr 2013* CG131 (Tomudex) colorectal cancer remains active Ramelteon Offers no benefit over NOT Decision (Rozerem) Insomnia √ currently available May 2010 N/A RECOMMENDED remains active (Not yet licensed) treatments. Visual impairment caused by macular Ranibizumab Prior Approval Decision oedema secondary HOSPITAL ONLY √ Dec 2013 TA283 (Lucentis) Document remains active to retinal vein occlusion Page 65 of 97
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Ranibizumab Diabetic macular Prior Approval Decision HOSPITAL ONLY √ Mar 2013 TA274 (Lucentis) oedema Document remains active Decision Age-Related remains active Ranibizumab Prior Approval TA155 Macular HOSPITAL ONLY √ Mar 2008 (Lucentis) Document Degeneration Reviewed August 2008 Choroidal neovascularisation Prior Approval Decision Ranibizumab associated with HOSPITAL ONLY √ Jul 2011 TA298 Document remains active pathological myopia
RECOMMENDED Late stage SPECIALIST Idiopathic INITIATION – CPJPG Decision Decisions Rasagiline Parkinson’s restricted to patients CG35 √ Summary May 2016 remain active (Azilect) Disease who are intolerant to NICE Guidance. selegiline or where selegiline is contra- indicated
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Early Parkinson’s Rasagiline Disease ( neuro NOT √ (Azilect) protective/disease RECOMMENDED modifying
Poor level of Reboxetine NOT evidence, and some Decision CG91 Depression √ Mar 2011 (Edronax) RECOMMENDED evidence of harm. remains active Use SSRIs or TCAs. This adjunctive device NOT May 2012 Decision RESPeRATE Hypertension √ had a weak evidence N/A RECOMMENDED Nov 2015 remains active base. Ribavirin Apr 2013* Decision (Copegus, Paediatric hepatitis HOSPITAL ONLY √ N/A N/A remains active Rebetol, Virazole) NICE TA337 Prevention and RECOMMENDED – treatment of Decision Rifaximin SPECIALIST √ Prescribing Support May 2015 TA337 hepatic remains active INITIATION Document encephalopathy
Chronic Gastro indications including Crohn’s East of England disease, ulcerative NOT Priorities Advisory Decision Rifaximin colitis, diverticular √ July 2016 N/A RECOMMENDED Committee (PAC) remains active disease, irritable document bowel syndrome and small bacterial intestinal over Page 67 of 97
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growth. For use in Pouchitis, please complete exceptional or individual funding request Amyotrophic lateral RECOMMENDED (with June & July Decision Riluzole sclerosis of motor √ Shared Care N/A shared care) 2015 remains active neurone disease Marketing authorisation suspended October 2008. Other drugs available with known side effect profiles Rimonabant Treatment of NOT Decision √ and without the Jul 2008 N/A (Acomplia) obesity RECOMMENDED remains active potentially severe side effects, e.g. psychoses in this new class of drug. Evidence for efficacy weak. Prior Approval Document Rituximab Rheumatoid Decision HOSPITAL ONLY √ Nov 2010 TA195 (MabThera) arthritis remains active CCG Rheumatoid Arthritis Pathway Idiopathic Rituximab Prior Approval May 2010 Decision Thrombo-cytopenic HOSPITAL ONLY √ N/A (MabThera) Document remains active Purpura HOSPITAL ONLY For individual patients Rituximab Acquired there may be few and May 2010 Decision √ N/A (MabThera) Haemophilia By agreement with often poorly remains active NHSE evidenced based Page 68 of 97
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alternative treatment options. Rituximab will be funded on approval of an individual funding request detailing prior therapies, rationale for the requested use and expected outcomes. May 2010 Autoimmune Rituximab Prior Approval (GPA Decision Haemolytic HOSPITAL ONLY √ N/A (MabThera) Document approved Nov remains active Anaemia 2014) Last line treatment as HOSPITAL ONLY per pathway, for defined patient Rituximab Funded in line with groups. Decision SLE √ Mar 2012 N/A (MabThera) agreed SLE remains active pathway, for defined See information for patient groups Prior Approval Document For individual patients there may be few and often poorly evidenced based HOSPITAL ONLY alternative treatment Thrombotic options. Rituximab Decision thrombocytopenic Funded through √ Rituximab will be May 2010 N/A (MabThera) remains active purpura Individual Funding funded on approval of request an individual funding request detailing prior therapies, rationale for the requested use and expected outcomes. Page 69 of 97
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Local agreement. HOSPITAL ONLY Rituximab Severe refractory Decision (relevant provider √ July 2015 N/A (Mabthera) vasculitis Prior Approval remains active trusts) Document
HOSPITAL ONLY for Outpatient DVT Rivaroxaban Venous service for Catch and Sept 2014 and TA287 √ Business Case Sept 2015 (Xarelto) thromboembolism CAM Health only March 2014 TA261
All other LCGs Specialist Initiation Prevention of adverse outcomes RECOMMENDED- Rivaroxaban Decision after acute SPECIALIST √ NICE TA335 July 2015 TA335 (Xarelto) remains active management of INITIATION coronary syndrome VTE prevention Rivaroxaban Decision following hip and HOSPITAL ONLY √ March 2014 TA170 (Xarelto) remains active knee surgery RECOMMENDED- Rivaroxaban see CCG AF Decision Atrial Fibrillation √ March 2015 TA256 (Xarelto) Anticoagulation remains active pathway Evidence of efficacy weak. Concerns regarding risk and NOT benefit profile. Roflumilast RECOMMENDEDRE Jul 2010Sep Decision (Daxas, COPD COMMENDED – √ TA461244 New drug with no 2017 remains active Nycomed) SPECIALIST clear meaningful INITATION advantages over existing COPD treatment. Side Page 70 of 97
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effects are nausea, diarrhoea, weight loss and headache. Chronic immune or Romiplostim idiopathic Prior Approval Decision TA221 HOSPITAL ONLY √ May 2011 (Nplate) thrombocytopenic Document remains active purpura Rosuvastatin Lipid Modifying NOT Not cost-effective as Decision CG67 √ Nov 2014 (Crestor) agent RECOMMENDED per NICE CG181 remains active Rubefacients (e.g. Movelat®, Algesal®, Difflam®, NICE do not do Transvasin®, recommendation Balmosa®, (CG177) Radian-B®, Deep Treatment of soft- NOT
Heat®, tissue disorders RECOMMENDED – Decision √ PrescQIPP Bulletin July 2017 CG177 Mentholatum and topical pain LIMITED CLINICAL remains active 144 Vapour Rub®, relief VALUE
Ralgex®, Bell’s CPJPG Decision Muscle Rub®, Summary Deep Freeze®, Elliman’s Universal Muscle Lotion®) S RECOMMENDED- Sacubitril/ May 2016, SPECIALIST valsartan Heart Failure √ NICE TA388 April updated TA388 INITIATION (Entresto) 2016 January 2017 (CONSULTANT
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CARDIOLOGIST) WITH PRESCRIBING SUPPORT RECOMMENDED SPECIALIST Neuromuscular Decision Salbutamol (oral) INITIATION √ Historical decision March 2017 N/A Conditions remains active (liquid formulation only) Salmeterol + RECOMMENDED for CPJPG Decision Decision fluticasone MDI Asthma Adult asthma √ Sep 2015 N/A Summary remains active (Sirdupla) patients only Evidence review: alogliptin 1st line, NOT Decision Saxagliptin Type 2 diabetes √ sitagliptin 2nd line, January 2015 CG87 RECOMMENDED remains active Linagliptin reserved for renal patients. Secukinumab Moderate to severe Prior Approval Decision HOSPITAL ONLY √ Sep 2015 TA350 (Cosentyx) plaque psoriasis Document remains active Secukinumab Active ankylosing Prior Approval Decision HOSPITAL ONLY √ Nov 2016 TA407 (Cosentyx) spondylitis Document remains active Prior Approval Secukinumab Decision Psoriatic arthritis HOSPITAL ONLY √ Document August 17 TA445 (Cosentyx) remains active
Sildenafil Primary Pulmonary HOSPITAL ONLY √ N/A Apr 2013* N/A N/A (Revatio) Hypertension In line with CCG process for supply of formulary dressings Silver dressings - NOT through a central Decision All silver and SSD Wound care √ Nov 2010 N/A RECOMMENDED purchase system. remains active dressings
Formulary items (Silvercel and Page 72 of 97
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Acticoat) available for use following recommendation by Cambridgeshire Community services Specialist Tissue Viability Nurses, through supply chain. Prescribe only within Drug Tariff Guidelines; Sip feeds should not be prescribed Sip Feeds, routinely for patients RECOMMENDED toiletries and in care homes. Historical Decision under Drug Tariff √ N/A cosmetic preps decision remains active Indications - Restricted use See ACBS guidance and CCG guidance on sip feeds available for GPs, nurses and care homes Sirdupla® MDI RECOMMENDED for CPJPG Decision Decision (fluticasone + Asthma Adult asthma √ Sep 2015 N/A Summary remains active salmeterol) patients only Evidence review: alogliptin 1st line, RECOMMENDED Decision Sitagliptin Type 2 diabetes √ sitagliptin 2nd line, January 2015 CG87 (2nd line choice) remains active Linagliptin reserved for renal patients.
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PrescQIPP Medical Sodium chloride Devices Drop list NOT Decision 0.9% Nasal Spray All √ Guidance March 2017 N/A RECOMMENDED remains active (e.g. Sterimar) (login may be required) Sodium hyaluronate eye Not suitable for NOT Decision drops (Hyloforte, Dry eye conditions √ prescribing in primary Mar 2011 N/A RECOMMENDED remains active HyloTears, or secondary care. HyloCare brands) Sodium Interstitial Cystitis Hyaluronate Recurrent Cystitis CUHFT Business Decision HOSPITAL ONLY √ Jan 2015 N/A Bladder irrigation Chemotherapy case remains active (Cystistat) induced Cystitis See CCG Female RECOMMENDED- Urge and Stress Solifenacin Urinary Decision SPECIALIST √ Urinary incontinence May 2015 CG171 (Vesicare) Incontinence remains active INITIATION pathways for place in therapy RECOMMENDED – Prior Approval Growth hormone SPECIALIST Document required for Decision Somatropin √ Mar 2014 TA64 deficiency (Adults) INITIATION inline audit and monitoring remains active with NICE TA64 purposes Growth failure (a RECOMMENDED- Prior Approval SHOX-D gene SPECIALIST Document required for Decision Somatropin √ Mar 2014 TA188 mutation INTITIATION in-line audit and monitoring remains active (Paediatrics) with NICE TA188 purposes Sorafenib Metastatic renal HOSPITAL ONLY √ N/A April 2013* N/A TA178 (Nexavar) cell carcinoma Sorafenib Hepatocellular HOSPITAL ONLY √ N/A April 2013* N/A TA189 (Nexavar) carcinoma
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Subcutaneous Continuous See Insulin Infusion Pump Therapy (continuous subcutaneous) Insulin Infusion Pump Therapy Monitoring and Specialist follow up HOSPITAL ONLY in- required. line with Fertility Sub-fertility drug Services: assisted Clinical Policies Sept 2017 Decision - √ CG156 treatments conception/pre- Forum Fertility remains active implantation genetic Services: assisted diagnosis conception/pre- implantation genetic diagnosis Barrier cream for Decision Sudocrem RECOMMENDED √ Cost effective choice May 2015 N/A general use remains active First line in Stage II/IV Metastatic Sunitinib Renal Cell HOSPITAL ONLY √ N/A Apr 2013* N/A TA169 (Sutent) Carcinoma in Good Performance status patients Gastro-Intestinal Sunitinib Stromal Tumour HOSPITAL ONLY √ N/A Apr 2013* N/A TA179 (Sutent) (GIST) T Tadalafil (Cialis) Decision ONCE DAILY Erectile dysfunction HOSPITAL ONLY √ Historical decision 2009 N/A remains active
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CPJPG Decision Summary
Prescribing to be retained by hospital Tadalafil (Cialis) Penile urologists. After 3 Decision ONCE DAILY Rehabilitation post HOSPITAL ONLY √ Nov 2015 N/A months patients with remain active prostate surgery ongoing erectile dysfunction will be switched to a formulary choice on demand PD5 inhibitor Jul 2014 Tadalafil (Cialis) Benign Prostatic NOT CPJPG Decision Decision √ Nov 2015 N/A ONCE DAILY Hyperplasia RECOMMENDED Summary remains active Nov 2016 Tadalafil Pulmonary Arterial HOSPITAL ONLY √ N/A Apr 2013* N/A N/A (Adcirca) Hypertension Place of prostaglandin therapy defined by NICE. No evidence of Tafluprost eye NOT Decision Glaucoma √ greater efficacy Mar 2011 N/A drops (Saflutan) RECOMMENDED remains active compared to other prostaglandin alternatives. Tapentadol NOT Local evaluation not Decision (PALEXIA) Pain √ Jan 2012 N/A RECOMMENDED yet undertaken. remains active
Targinact shows some efficacy in patients Targinact Severe chronic NOT not receiving regular Decision (Oxycodone + √ Sep 2009 N/A pain RECOMMENDED laxative therapy. remains active naloxone) However the clinical benefit in patients
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receiving regular laxative therapy is uncertain.
CCG Pain Management Pathway To be used where Decision Teicoplanin {& patients can not IV treatment of RECOMMENDED– remains active other IV tolerate or absorb oral serious Gram +ve SPECIALIST √ Aug 2003 N/A antibiotics} medication or where infections INITIATION Policy in (Targocid) no oral antibiotic is development available. Telbivudine Hepatitis B NOT Apr 2013* Decision √ See NICE TA154 TA154 (Tyzeka) Infection RECOMMENDED remains active Temsirolimus Mantle cell Decision HOSPITAL ONLY √ N/A April 2013* TA207 (Torisel) carcinoma remains active Temsirolimus Advanced renal HOSPITAL ONLY √ N/A Apr 2013* N/A TA178 (Torisel) cell carcinoma Tenofovir (Viread) Hepatitis B TA173 HOSPITAL ONLY √ N/A Apr 2013* N/A Infection Telaprevir Hepatitis C HOSPITAL ONLY √ N/A Apr 2013* N/A TA252 (INCIVO) (genotype 1)
Treatment of Prior Approval Teriparatide established Decision HOSPITAL ONLY √ Document Nov 2011 TA161 (Forsteo) postmenopausal remains active
osteoporosis
Treatment of HOSPITAL ONLY Teriparatide established Not routinely Decision (NOT ROUTINELY √ Jan 2017 N/A (Forsteo) osteoporosis in recommended (IFR) remains active RECOMMENDED) men
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Not considered by Testosterone Testosterone NOT CPJPG – risk: benefit Decision patch deficiency or √ N/A N/A RECOMMENDED ratio not assessed. remains active (INTRINSA) impotence
Testosterone gel – for impotence. Testosterone NOT Little evidence to Decision (TOSTRAN, deficiency or RECOMMENDED √ support its use for this N/A N/A remains active TESTIM, impotence indication. TESTOGEL Thalidomide (Thalidomide Myelofibrosis HOSPITAL ONLY √ N/A Apr 2013* N/A TA228 Celgene) Tinzaparin NOT See CCG LMWH Decision VTE √ Sep 2014 CG92 (Innohep) RECOMMENDED Guidance remains active CPJPG Decision Tiotropium + summary Decision olodaterol COPD RECOMMENDED √ March 2016 CG101 remains active (Spiolto Respimat See COPD Pathway Tiotropium Decision (Spiriva COPD RECOMMENDED √ See COPD Pathway CG101 remains active Respimat) Tiotropium CPJPG Decision NOT Decision (Spiriva Asthma √ summary March 2016 N/A RECOMMENDED remains active Respimat) Management of Cystic -March 2016 Chronic Fibrosis patients Patients are Pseudomonas repatriated to now receiving Tobramycin aeruginosa HOSPITAL ONLY √ N/A Secondary care at treatment from infection in Cystic request of NHS Provider Fibrosis patients England. Trusts Tocilizumab Rheumatoid Prior Approval Decision (Actemra) Arthritis – HOSPITAL ONLY √ Document March 2016 remains active TA375 moderate/severe
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Rheumatoid Arthritis Pathway Prior Approval Document(Adults Tocilizumab Juvenile idiopathic √ √ Decision HOSPITAL ONLY only) Nov 2016 TA373 (Actemra) arthritis (paeds) (adults) remains active
Paediatrics - NHSE Non-Rheumatoid Tocilizumab Apr 2013* Decision arthritis conditions HOSPITAL ONLY √ √ N/A N/A (Actemra) remains active e.g. Still’s disease Hyponatraemia secondary to Tolvaptan Decision inappropriate anti- HOSPITAL ONLY √ Sep 2010 N/A (Samsca) remains active diuretic hormone secretion (SAIHD) Autosomal SHARED CARE for dominant monitoring only Prior Approval Decision Tolvaptan (Jinarc) √ Jan 2016 TA358 polycystic kidney (Prescribing remains Document remains active disease with secondary care) Topotecan Ovarian cancer HOSPITAL ONLY √ N/A Apr 2013* N/A TA91 (Hycamtin) (variation regimen) Parenteral Nutrition Total Parenteral Prior Approval Decision (after initial 14 RECOMMENDED √ May 2013 N/A Nutrition (TPN) Document remains active days) Trabectedin Soft Tissue HOSPITAL ONLY √ N/A Apr 2013* N/A TA185 (Yondelis) Sarcoma Not to be prescribed on the NHS except for Vaccination prior to RESTRICTED – See Historical Decision Travel Vaccines √ designated exceptions N/A travelling further information decision remains active – see NaTHNaC for further information NOT Decision Trimipramine All Indications √ CPJPG Decision Summary July 2017 N/A RECOMMENDED remains active
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U
Pre-surgery RECOMMENDED- See also Clinical Ulipristal Historical Decision treatment of SPECIALIST √ Priorities Forum policy N/A (Esmya) decision remains active Fibroids ADVICE regarding Heavy Menstrual Bleeding Medical Treatment See also Clinical of Fibroids in peri- RECOMMENDED- Ulipristal Priorities Forum policy Decision menopause and SPECIALIST √ July 2016 N/A (Esmya) regarding Heavy remains active pre-pregnancy ADVICE Menstrual Bleeding women only No identified advantage and Ultrabase NOT Historical Decision Dry skin conditions √ particularly expensive N/A products RECOMMENDED decision remains active compared to formulary options. CPJPG Decision Summary Umeclidinium + NOT Decision Vilanterol (Anoro COPD √ March 2016 CG101 RECOMMENDED See CCG COPD remains active Ellipta) Pathway for further details Moderate to severe Prior Approval May 2010 Decision Ustekinumab HOSPITAL ONLY √ TA180 plaque psoriasis. Document remains active Moderate to severe Prior Approval May 2010 Decision Ustekinumab HOSPITAL ONLY √ TA180 plaque psoriasis. Document remains active Moderate to severe Prior Approval Decision Ustekinumab active Crohn’s HOSPITAL ONLY √ July 2017 TA456 Document remains active disease
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V East of England Priorities Advisory Committee (PAC) Policy Statement. Decision Vacuum Pumps Erectile dysfunction RECOMMENDED √ Nov 2015 N/A Available via remains active PrescQIPP website (password may be required). East of England Priorities Advisory Committee (PAC) Vaginal Dilators NOT Policy Statement. Decision or Trainer (e.g. Vaginismus √ Jul 2014 N/A RECOMMENDED Available via remains active Femmez) PrescQIPP website (password may be required). East of England Priorities Advisory Rehabilitation Committee (PAC) Vaginal Dilators following Vaginal RECOMMENDED- Policy Statement. Decision or Trainer (e.g. reconstruction SPECIALIST √ Nov 2015 N/A Available via remains active Femmez) surgery or following INITIATION PrescQIPP website pelvic radiotherapy (password may be required). Prevention of cytomegalovirus Valganciclovir disease following HOSPITAL ONLY √ N/A Apr 2013* N/A (Valcyte) solid organ transplant.
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RECOMMENDED- SPECIALIST Sacubitril/ INITIATION May 2016, NICE TA388 April valsartan Heart Failure (CONSULTANT √ updated TA388 2016 (Entresto) CARDIOLOGIST) January 2017 WITH PRESCRIBING SUPPORT Moderate to Prior Approval Decision Vedolizumab Severe active HOSPITAL ONLY √ July 2015 TA342 Document remains active ulcerative Colitis Moderate to Severe active Prior Approval Decision Vedolizumab HOSPITAL ONLY √ Nov 2015 TA352 Crohn’s disease Document remains active after prior therapy Photodynamic therapy for age- Prior Approval Decision Verteporfin HOSPITAL ONLY √ Sep 2013 TA68 related macular Document remains active degeneration Vibro-pulse PrescQIPP Medical accessories Therapy for Devices Drop list cellulitis, venous NOT Decision (Cycloidal √ Guidance March 2017 N/A leg ulcers and RECOMMENDED remains active vibration (login may be lower limb oedema accessories) required)
NICE guidance has defined place in Vildagliptin therapy. (Galvus ▼) NOT Decision CG87 Type 2 Diabetes √ Concerns over MHRA Nov 2010 RECOMMENDED remains active (with metformin, reported ADRs places Eucreas ▼) vildagliptin as a secondary care only drug.
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Not consistent with local treatment pathways. CPJPG Decision Fluticasone Prophylaxis of Summary Decision furoate + asthma and NOT √ Mar 2014 remains CG101 vilanterol management RECOMMENDED See CCG Asthma and active (Relvar Ellipta) COPD. COPD Pathways for further details CPJPG Decision Summary Vilanterol + NOT Decision Umeclidinium COPD √ Sept 2014 CG101 RECOMMENDED See CCG COPD remains active (Anoro Ellipta) Pathway for further details NOT Decision TA272 Vinflunine (Javlor) Bladder cancer RECOMMENDED √ √ N/A Jan 2013 remains active
Virulite NOT Evidence equivocal Historical Decision Cold sore Cold sore √ N/A RECOMMENDED and limited. decision remains active machine To improve statin treatment adherence in NOT Not recommended by Decision Vitamin D cardiovascular √ Nov 2014 CG181 RECOMMENDED NICE CG181 remains active disease prevention/ hypertriglyceridae mia Voriconazole N/A Decision Aspergillosis HOSPITAL ONLY √ Apr 2013* N/A (Vfend) remains active Major depressive RECOMMENDED- Decision Vortioxetine √ NICE TA367 Jan 2016 TA367 episodes SPECIALIST remains active
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INITIATION W X Y
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Z
Zerocream is similar to Oilatum, Diprobase and E-45 cream, Zeroderm is similar to Epaderm and Zerocream, Hydromol ointment Zeroderm Decision Dry skin conditions RECOMMENDED √ and Zerodouble gel is May 2015 CG57 ointment and remains active similar to Doublebase Zerodouble gel gel.
See also PrescQIPP review regarding cost- effective emollients N/A Ziconotide Severe Chronic HOSPITAL ONLY √ Apr 2013* N/A N/A (Prialt) Pain CCG Pain Management Pathway Bone damage reduction in Administered by Zoledronic acid Decision advanced HOSPITAL ONLY √ infusion – not suitable May 2010 N/A (Zometa) (IV) remains active malignancies / for primary care. hypercalcaemia Treating Concerns regarding postmenopausal the long term effects Zoledronic acid May 2010 Decision osteoporosis and HOSPITAL ONLY √ and side effects in an N/ATA464 (Aclasta) (IV) Sept 2017 remains active osteoporosis in annual I/V infusion. men (including
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corticosteroid- induced osteoporosis)Post menopausal osteoporosis in women at increased risk of fracture. Lack of long term safety and efficacy data. Lack of clinical trial comparison with Annual injection for currently used Zoledronic acid postmenopausal Decision NOT bisphosphonates and (Zometa) (IV) osteoporosis √ Jan 2005 remains active N/A RECOMMENDED uncertainty over place . (Not marketed for in therapy and over this indication) who should administer the product.
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Explanatory Notes – Classifications: Criteria Considered by CPJPG
Recommended- Recommended – Recommended (with Not Recommended Specialist initiation Specialist advice Hospital Only shared care) Recommended (without shared care) Prescribed by GPs and primary Initially Initially GPs and primary care GP practices are care clinicians. prescribed/administered prescribed/administered clinicians on the advice NOT ROUTINELY by specialists in by specialists in of specialists in FUNDED to CPJPG advises secondary and tertiary secondary and tertiary secondary or tertiary prescribe these that the clinical care with prescribing care with prescribing care. drugs even where case for use of continued by GPs and continued by GPs and initiated in secondary drugs classified primary care clinicians in primary care clinicians care. as Not conjunction with a (no formal shared care Recommended is shared care guideline. guideline not proven. Used in a: Common condition Specific condition Specific condition Specific condition Specific condition that a GP would not judged by have knowledge of CPJPG to be Such drugs will or prior experience suitable for primary not be funded for of treating. care prescribing use in primary or Diagnosis Relatively Specific Specific Or secondary care. Specific straightforward Classified by CPJPG Patient selection Specific to a particular Specific to a particular Specific to a particular not to be highest Easy group group group priority for funding Initiation of May require expertise May require expertise Easy May require expertise treatment May be used in Dose titration Easy Specific Specific Specific exceptional cases Monitoring of but such prescribing Easy Specific Specific Specific treatment effect may be subject to Monitoring of side challenge by CCGs Easy Easy Easy Easy effects in line with BMA Method of guidance on Normal Normal Normal Normal administration Potentially Excessive Discontinuation of Or Inappropriate Easy Complex Complex Complex treatment Prescribing.
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Recommended (with shared care) drugs Shared care drugs are those which are normally initiated, modified or terminated by specialists within secondary care however maintenance prescribing and monitoring can be pursued by the GP. A Shared care arrangement can include a formal written document laying out the GP and hospital prescribers’ responsibilities, prescribing guidance for the GP and hospital prescribers’ or simply a verbal agreement between a GP and hospital prescriber.
The key elements of shared care are – There must be an adequate exchange of information between the GP and hospital prescriber so that prescribing can be carried out safely and effectively. The onus is on the hospital prescriber to liase with the GP. Agreement between the hospital prescriber and GP must be reached before the patient is informed. Patient convenience may be a major factor for GPs wishing to take on prescribing responsibility. The patient’s condition must be stabilised (where possible) prior to transfer of prescribing. The GP must have a sound knowledge of the patient and his/her condition. A GP may decline to prescribe if they cannot realistically be expected to develop the clinical knowledge, experience or facility to monitor and stop therapy. If hospital initiated prescribing is not adopted by the GP, prescribing responsibility will remain within the trust. A clear, direct, workable line of communication must exist between the GP and hospital prescriber.
The above information on shared care and drug classification criteria is taken from the Suffolk Public Health Network document – the introduction of new medication in Suffolk: Re-defining the process in 2003. A report to Primary Care Trusts and Secondary Care Trusts in Suffolk sponsored by the Suffolk Drug and Therapeutics Committee and adopted by Cambridgeshire Joint Prescribing Group 2004.
All enquiries, comments and suggestions relating to the Drug Classification Table are welcomed and should be sent to Prerscribing Partnership mailbox [email protected]
Abbreviations CCG Clinical Commissioning Group CPF Clinical Priorities Forum NICE National Institute for Health and Care Excellence PHN Public Health Network
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Amendments to Document
Date of Page number and Amendment Detail Amended By Checked By Amendment 15/10/2013 Page 79 Rotigotine (Neupro) reference to Shared Care Guidance document updated KD JW 11/11/2013 Page 93 Ulipristal brand names amended for different indications KD JW 26/11/2013 Page 45 Gluten Free New link to website added KD SM 28/11/2013 Page 70 Retigabine text amended to Funded in accordance to NICE criteria and implementation plan from secondary care /tertiary KD JW care clinical leads 28/11/2013 Page 49 Lacosamide text amended to consultant initiation and funded in Primary and Secondary KD JW care 17/04/14 Medication now included in the primary care formulary removed from classification table. Decision MC N/A from March CPJPG meeting. 05/06/14 Decisions from May CPJPG meeting included. Duplicate dipipanone entry removed. Hyperlink for VG MC N-acetylcysteine SCG removed as document under review. Shared care still in place. 21/07/14 Decisions from July CPJPG meeting added. Subfertility drug section amended. VG MC Separate new entry created for clomifene. Classification table updated. 28/08/14 Classification table included in new format. Drugs with shared care removed and included in formulary. Dornase alfa removed. Specialist initiated drugs removed and included in formulary (rufinamide, rotigotine for PD, Derma MC KD , pimecrolimus) Link to resources for travel vaccines updated 02/09/14 Correction page 20 – commissioning responsibility changed from CCG to NHSE for MC KD epoetins,epoetins beta (Eprex, NeoRecormon) for cancer related anaemia. 22/09/14 Decisions from September CPJPG added. Gluten Free Foods entry amended in line with CPJPG decision. VG MC Recommendations for LMWHs and link to guidance added. Bemiparin removed as discontinued. 08/10/2014 Rifaximin entry updated. VG MC
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Current Commissioning Indication Last date Relevant Approved name Classification and Responsibility Rationale for Next Review Covered by this classified by NICE (Brand Name) Priority Funding Decision Due Classification CPJPG Guidance Position NHSE CCG
23/10/2014 Gluten free fresh bread added to Not Recommended Gluten Free Foods VG MC 20/11/2014 Back to contents link removed from footer for technical reasons Depuytren’s amended to correct spelling of Dupuytren’s Rivaroxaban for VTE – classification amended to make clearer. Botulinum toxin for facial palsy or following stroke or head trauma – link to Prior Approval Document removed as not recommended and GPA does not exist. Updated with decisions from November JPG: Gluten Free Fresh bread reclassified as RECOMMENDED. Alogliptin reclassified as RECOMMENDED VG MC Isotretinoin gel added as RECOMMENDED Lipid Modification CG181: Do not do recommendations added. Nalmefene classification changed to Recommended Specialist Advice from Local drug and alcohol treatment service Entry for eptotermin – alfa (Osigraft) removed as product discontinued. Rituximab for autoimmune haemolytic anaemia – Prior Approval Document link added. Entries removed for Fostair, Goserelin and triptorelin as included in the Formulary for > 6months. 21/01/2015 C&PCCG HCD commissioning intentions for National Tariff excluded drugs included (where applicable). Remicade brand removed from infliximab entries. Lipid Modification CG181: clarified why rosuvastatin continues to be not recommended (omitted from last update in error). Link to GF guidance amended to link to dedicated Nutrition section. Anticoagulant Test Strips – Policy currently under review added. Dronedarone recommendation updated. VG MC Fentanyl Immediate release. Additional entry created for non-palliative care pain Carvedilol added for the prophylaxis of variceal bleeding due to portal hypotension (CUHFT Business case). Sodium hyaluronate bladder irrigation added Hospital only Alemtuzumab (Lemtrada) for multiple sclerosis added Alemtuzumab (MabCampath) removed as discontinued. Saxagliptin, sitagliptin and poetins e added. Quetiapine XL (Biquelle® XL, Ebesque® XL) added recommended – specialist initiation. 09/02/15 Correction to bosentan commissioning responsibility and classification to improve clarity over VG MC Page 90 of 97
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Current Commissioning Indication Last date Relevant Approved name Classification and Responsibility Rationale for Next Review Covered by this classified by NICE (Brand Name) Priority Funding Decision Due Classification CPJPG Guidance Position NHSE CCG
which conditions are not recommended. 19/02/15 Commissioning responsibility for epoetins and darbepoetin for anaemia in those with cancer MC JW having chemotherapy was clarified by NHSE and amended within table. 18/03/15 Updated with decisions from March JPG (subject to Governing Body approval & ratification):
Aspirin for SGA fetus Infliximab, adalimumab and golimumab for moderate to severe UC (NICE TA329) Inflectra is biosimilar of choice for new patients included for all infliximab entries.
The following entries amended: Gluten free foods that can be prescribed updated to include multipurpose and bread mixes flour products. MC VG Commissioning responsibility for epoetinsand octreotide (acromegaly) changed to NHSE and palliative care (without chemotherapy) remains with CCG from 1st April 2015. Commissioning responsibility for epoetins changed to NHSE from 1st April 2015. Reference to awaiting implementation plan removed from lubiprostone (now received and place in therapy included in CCG formulary).
The following entries removed: Local commissioning intention – infliximab for ulcerative colitis (acute exacerbations) Links to CCG LMWH Prescribing Guidance updated. 02/06/15 Updated with decisions from May JPG ( subject to Governing Body approval and ratification) Sativex® (Cannabis extract) spray. Pirfenidone (Esbriet®) Beclomethasone/formoterol DPI (Fostair NEXThaler) Denosumab (Prolia) Lidocaine Patches/Plasters (Versatis) VG MC Doublebase Dayleve gel DuoResp Spiromax (Budesonide + formoterol DPI) Epimax cream Zerocream, Zeroderm and Zerodouble gel Sudocrem
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Current Commissioning Indication Last date Relevant Approved name Classification and Responsibility Rationale for Next Review Covered by this classified by NICE (Brand Name) Priority Funding Decision Due Classification CPJPG Guidance Position NHSE CCG
Correction to rituximab for acquired haemophilia commissioning responsibility. Historic information no longer relevant removed from poetins for pre-dialysis patients. Where appropriate, recommendations made at least 6 months ago have been removed (can be found in the CCG Formulary) including Epiduo and Duac (see acne pathway) Various web and hyperlinks updated. 22/07/2015 The following classifications were added or updated:
Aclidinium plus formoterol (Duaklir Genuair). Linaclotide Humalog Kwik pen 200units/ml Fenofibrate Ciprofibrate VG KB Rivaroxaban for prevention of adverse outcomes after acute management of acute coronary syndrome (NICE TA335) Empagliflozin (NICE TA337)
Ustekinumab for active psoriatic arthritis in adults – GPA link added. Rituximab for severe refractory vasculitis-GPA link added. Pirfenidone for IPF Shared care link added. 14/08/2015 Commissioning responsibility for Tolvaptan amended to NHS England KB JW 02/09/2015 Ustekinumab for active psoriatic arthritis in adults – changed to hospital only and TA reference updated Rifaximin for hepatic encephalopathy entry updated with hospital only and TA reference KB VG Entry added for vedolizumab for ulcerative colitis Hospital only
24/09/2015 Entries for Fluticasone + salmeterol MDI (Sirdupla®) and Juxta CURES compression system added. Rifaximin reclassified to Recommended-Specialist initiation VG KB Entries added for all indications and prescribing classification for apixaban, dabigatran and rivaroxaban Rituximab for haemophilia- wording added to clarify commissioning status 19/10/2015 Entries added for NICE Tas: VG KB NICE TA 345 : Naloxegol Page 92 of 97
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Current Commissioning Indication Last date Relevant Approved name Classification and Responsibility Rationale for Next Review Covered by this classified by NICE (Brand Name) Priority Funding Decision Due Classification CPJPG Guidance Position NHSE CCG
NICE TA 346 Aflibercept for DMO NICE TA 359 Dexamethasone Intravitreal for DMO NICE TA 350 Secukinumab for moderate to severe plaque psoriasis
19/11/2015 Entries added for NICE Tas NICE TA 354 Edoxaban for treatment or prevention of deep vein thrombosis or pulmonary VG KB/JW embolism NICE TA 352 Vedolizumab for moderate to severely active Crohn’s disease after prior therapy 25/11/2015 Updated with decisions from the C & P Joint Prescribing Group held 18th November 2015 Avanafil changed to RECOMMENDED. Tadalafil entries updated. New entry added for tadalafil post prostate surgery. Ulipristal for pre-operative treatment of Uterine Fibroids. Decisions updated for Jaw Rehabilitation device, Vaginal trainers, Vacuum Pumps for ED. The following classification decisions were added; VG KB Meningococool Group B vaccine Neutrogenia Dermatological Cream Sacubitril/valsartan (Entresto) Edoxaban (Lixiana for AF Omalizumab (Xolair) for previously treated chronic spontaneous urticaria 22/01/2016 Entries added or amended for new or amended NICE Tas and minor housekeeping amendments. Tolvaptan for autosomal dominant polycystic kidney disease (TA358) Omalizumab for spontaneous idiopathic urticarial (TA339) VG KB Apremilast for plaque psoriasis (TA368) Apremilast for psoriatic arthritis (TA373 Minor amendment made to hyperlink in Grazax (grass pollen vaccine ) entry. 29/01/2016 Dornase alfa and Tobramycin added to classification table as Hospital only, as management of Cystic Fibrosis patients repatriated to Secondary Care at request of NHS England. Link to VG KB Dornase alfa shared care removed from formulary. 23/02/2016 Vortioxetine added (NICE TA 367) VG KB 08/03/2016 Ciclosporin eye drops added (NICE TA 369) KB VG Tadalafil for Pulmonary Arterial Hypertension (NHS England commissioned) 18/03/2016 Following added or updated VG KB
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Current Commissioning Indication Last date Relevant Approved name Classification and Responsibility Rationale for Next Review Covered by this classified by NICE (Brand Name) Priority Funding Decision Due Classification CPJPG Guidance Position NHSE CCG
Liothyronine Specialist Advice Insulin degludec + liraglutide Insulin glargine (Toujeo) Spiolto Respimat added Ultibro updated AirFluSAL Spiriva Respimat for Asthma Alirocumab and Evolocumab Oxycodone e-VOKE devices (Nicotine replacement) Nortriptyline Tolvaptan Dexamfetamine
Links to NICE guidance added or updated where appropriate 18/05/2016 Following added or updated; Insulin Degludec Rasagiline Vortioxetine Quetiapine XL Stoma underwear VG KB Nintendanib Doselupin Immediate release fentanyl Sacubitril/valsartan (Entresto
06/07/2016 Updated following CCG Governing Body meeting 05/07/2016 Gluten Free classification updated VG KB Baby Milk classification updated 22/07/2016 Updated with housekeeping changes. VG MD Oxycodone entry amended 03/08/2016 Updated with changes following Joint Prescribing Group 20th July 2016 VG KB Dymista entry updated Page 94 of 97
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Current Commissioning Indication Last date Relevant Approved name Classification and Responsibility Rationale for Next Review Covered by this classified by NICE (Brand Name) Priority Funding Decision Due Classification CPJPG Guidance Position NHSE CCG
Ulipristal for Medical treatment of fibroids added Nicorandil added Rifaximin for Chronic Gastro indications added Not recommended Botulinum Entries updated in line with EoE PAC Review
24/08/2016 Entries for Pregabalin added to clarify brand prescribing. VG KB Liothyronine entry amended to improve clarity of JPG decision 14/08/2016 Entries for Alirocumab and Evolocumab updated to reflect published NICE TAs NICE TA 393 Alirocumab for treating primary hypercholesterolaemia and mixed dyslipidaemia CH VG NICE TA 394 Evolocumab for treating primary hypercholesterolaemia and mixed dyslipidaemia 08/12/2016 Removal of requirement for prior approval for Insulin Degludec KB VG 13/12/2016 Following added or updated: Link to Quetiapine XL review guidance Toujeo – Specialist advice from a consultant Teriparatide – GPA for male patients KB VG Xultophy – Specialist advice from a consultant NICE TA404 Degarelix for treating advanced hormone –dependent prostate cancer
28/12/2016 Entry for tadalafil (BPH) – date of decision updated AisFluSal – entries removed as some practices are supported to prescribe to provide audit data Brivaracetam added – specialist initiation Entry updated for abatacept, adalimumab, etanercept & tocilizumab for JIA (TA373) – adult KB CM patients Secukinumab – NICE TA407 added Aflibercept – NICE TA409 added 16/03/2017 Lidocaine plasters – date of decision updated Entresto amended to Specialist Initiation(Consultant Cardiologist) with Prescribing Support Teriparatide for men amended to NHSE commissioned Addition of Espranor KB VG Apremilast for Plaque Psoriasis amended to Hospital Only Certolizumab pegol NICE TA415 added Empagliflozin entry removed – listed in main formulary. Page 95 of 97
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Current Commissioning Indication Last date Relevant Approved name Classification and Responsibility Rationale for Next Review Covered by this classified by NICE (Brand Name) Priority Funding Decision Due Classification CPJPG Guidance Position NHSE CCG
18/04/2017 Minor correction to Bexsero entry to align dose interval recommendations with secondary care ( VG JW does interval changed from 4 to 8 weeks as per CUHFT guidance) 28/04/2017 Freestyle Libre addition Saxenda (liraglutide) addition Mysimba (bupropion / naltrexone) addition Hydroxychloroquine with prescribing support Recommendations added inline with PrescQIPP Medical Devices DROP-List (excluding lymphedema garments) KB VG Salbutamol for Neuromuscular Conditions Dupilumab added (IFR) Somatropin – link to prior approval removed Onexila XL not recommended Apremilast for psoriatic arthritis added 25/09/2017 Omega 3 not recommended (update) Rubefacients not recommended Trimipramine not recommended Dicycloverine not recommended Fiasp Insulin not recommended Baricitinib added (TA466) KB AG Lesinurad not recommended Sub-fertility drug treatments updated Ixekizumab added (TA442) Certolizumab & Secukinumab added (TA445) Ustekinumab added (TA456) Nebulised amikacin, ceftazidime & meropenem added - Hospital only (via Homecare) (Papworth) 02/11/2017 Amendment to classification of pregabalin including prescribing generically KB AG 21/11/2017 Ferric maltol added Botox added for hypersalivation Collagenase clostridium histolyticum entry updated Dexamethasone and adalimumab for non-infections uveitis added KB AG Roflumilast entry updated Eluxadoline entry NICE TA471 Methylnaltrexone bromide added (TA468)
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Current Commissioning Indication Last date Relevant Approved name Classification and Responsibility Rationale for Next Review Covered by this classified by NICE (Brand Name) Priority Funding Decision Due Classification CPJPG Guidance Position NHSE CCG
Dimethyl fumarate (TA475) Ibandronic acid and Zolendronic acid entries updated (TA464)
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