MEDICINES NOT REIMBURSED THROUGH NATIONAL PRICES AND DIRECTLY COMMISSIONED BY NHS ENGLAND

VERSION 11 PUBLISHED DECEMBER 2016

SUITABLE FOR SUITABLE FOR SHARED CARE SPECIALIST SHARED CARE BETWEEN PRIOR CENTRE ONLY WITH PRIMARY SPECIALIST MONITORING/AUDIT APPROVAL (includng outreach CARE (IF DRUG NAME INDICATION COMMISSIONER PBR CATEGORY TA/POLICY STARTING CRITERIA STOPPING CRITERIA AND REQUIREMENTS PROFORMA when delivered as SUPPORTED BY SECONDARY REQUIRED part of a provider LOCAL CARE VIA network) PRESCRIBING NETWORK COMMITTEE) MODEL HIV IN COMBINATION WITH OTHER ANTI- ABACAVIR NHS ENGLAND AIDS/HIV ANTIRETROVIRALS AGREED REGIONALGUIDELINES BHIVA GUIDELINES (8) BHIVA GUIDELINES (8) HARS DATASET √ RETROVIRAL DRUGS

NHS ENGLAND CLINICAL HIV IN COMBINATION WITH OTHER ANTI- NHS ENGLAND AIDS/HIV ANTIRETROVIRALS COMMISSIONING POLICY: BHIVA GUIDELINES (8) BHIVA GUIDELINES (8) HARS DATASET √ ABACAVIR + LAMIVUDINE + RETROVIRAL DRUGS DOLUTEGRAVIR (TRIUMEQ®) B06/P/b/AGREED REGIONAL GUIDELINES HIV IN COMBINATION WITH OTHER ANTI- ABACAVIR + LAMIVUDINE NHS ENGLAND AIDS/HIV ANTIRETROVIRALS AGREED REGIONALGUIDELINES BHIVA GUIDELINES (8) BHIVA GUIDELINES (8) HARS DATASET √ RETROVIRAL DRUGS ABALOPARATIDE DRUGS AFFECTING BONE MALE AND JUVENILE OSTEOPOROSIS NHS ENGLAND NOT ROUTINELY COMMISSIONED AS PER IFR APPROVAL AS PER IFR APPROVAL AS PER IFR APPROVAL √ METABOLISM NHS ENGLAND CLINICAL ABATACEPT JUVENILE ARTHRITIS-PAEDIATRIC NHS ENGLAND CYTOKINE MODULATORS COMMISSIONING POLICY: E03/P/d; TA NHS ENGLAND POLICY NHS ENGLAND POLICY NHS ENGLAND POLICY √ √ 373 PAEDIATRIC INDICATIONS (WHERE ABATACEPT NHS ENGLAND CYTOKINE MODULATORS AS PER ADULT TA'S (TA195, TA280) NICE NICE NICE √ ADULT TA AVAILABLE) TA259, 387 (SEE ALSO SSC1438) NICE/NHS ENGLAND POLICY NICE ABIRATERONE CANCER NHS ENGLAND HORMONE ANTAGONISTS ONLY IN ENZALUTAMIDE NAÏVE SACT √ √ PATIENTS NHS ENGLAND CLINICAL ADALIMUMAB JUVENILE ARTHRITIS-PAEDIATRIC NHS ENGLAND CYTOKINE MODULATORS COMMISSIONING POLICY: E03/P/d; TA NHS ENGLAND POLICY NHS ENGLAND POLICY NHS ENGLAND POLICY √ √ 373 NHS ENGLAND CLINICAL ADALIMUMAB UVEITIS - PAEDIATRIC NHS ENGLAND CYTOKINE MODULATORS NHS ENGLAND POLICY NHS ENGLAND POLICY NHS ENGLAND POLICY √ √ COMMISSIONING POLICY:D12X02 NOT ROUTINELY COMMISSIONED ADALIMUMAB UVEITIS - ADULTS NHS ENGLAND CYTOKINE MODULATORS (NHS ENGLAND CLINICAL AS PER IFR APPROVAL AS PER IFR APPROVAL AS PER IFR APPROVAL √ COMMISSIONING POLICY: D12/P/a) HIGHLY SPECIALISED HIGHLY SPECIALISED ADALIMUMAB BEHCETS SYNDROME NHS ENGLAND CYTOKINE MODULATORS HIGHLY SPECIALISED CRITERIA ONLY HIGHLY SPECIALISED CRITERIA √ CRITERIA ONLY CRITERIA ONLY PAEDIATRIC INDICATIONS (WHERE AS PER ADULT TA'S (TA130, TA143, ADALIMUMAB NHS ENGLAND CYTOKINE MODULATORS NICE NICE NICE AUDIT √ ADULT TA AVAILABLE) TA146, TA187, TA199) ADALIMUMAB HIDRADENITIS SUPPURATIVA NHS ENGLAND CYTOKINE MODULATORS NICE TA 392 NICE NICE NICE AUDIT √ √ VIRAL HEPATITIS (B&C) & NOT ROUTINELY COMMISSIONED ADEFOVIR HEPATITIS B NHS ENGLAND AS PER IFR APPROVAL AS PER IFR APPROVAL AS PER IFR APPROVAL √ RESPIRATORY SYNCYTIAL VIRUS (CG165) AFATINIB CANCER NHS ENGLAND CANCER EXCLUSION TA310 NICE NICE SACT √ NOT ROUTINELY COMMISSIONED AFLIBERCEPT CANCER NHS ENGLAND CANCER EXCLUSION AS PER CDIFR APPROVAL AS PER CDIFR APPROVAL SACT √ (TA307) DRUGS USED IN METABOLIC HIGHLY SPECIALISED HIGHLY SPECIALISED AGALSIDASE ALFA FABRY'S DISEASE NHS ENGLAND NHS ENGLAND SERVICE SPECIFICATION HIGHLY SPECIALISED DATABASE √ DISORDERS CRITERIA ONLY CRITERIA ONLY DRUGS USED IN METABOLIC HIGHLY SPECIALISED HIGHLY SPECIALISED AGALSIDASE BETA FABRY'S DISEASE NHS ENGLAND NHS ENGLAND SERVICE SPECIFICATION HIGHLY SPECIALISED DATABASE √ DISORDERS CRITERIA ONLY CRITERIA ONLY ALBUTREPENONACOG ALFA HAEMOPHILIA B NHS ENGLAND BLOOD-RELATED PRODUCTS SSC 1652 SSC 1652 SSC 1652 PRODUCTS ON CMU FRAMEWORK √ ALBUTROPIN ADULT ONSET GROWTH HORMONE GROWTH HORMONE & GROWTH DEFICIENCY NHS ENGLAND NOT ROUTINELY COMMISSIONED AS PER IFR APPROVAL AS PER IFR APPROVAL AS PER IFR APPROVAL √ HORMONE RECEPTOR ANTAGONIST

ALDESLEUKIN CANCER NHS ENGLAND IMMUNOMODULATING DRUGS NOT ROUTINELY COMMISSIONED AS PER IFR APPROVAL AS PER IFR APPROVAL SACT √ DRUGS AFFECTING THE IMMUNE ALEMTUZUMAB MULTIPLE SCLEROSIS NHS ENGLAND TA312 NICE NICE NICE AUDIT √ √**** RESPONSE TRUST GUIDELINES: ISLET PRE-TRANSPLANT DRUGS AFFECTING THE IMMUNE ALEMTUZUMAB NHS ENGLAND TRANSPLANTATION (ONLY IF PROVIDED TRUST GUIDELINES TRUST GUIDELINES √ IMMUNOSUPPRESSION RESPONSE AT ZERO DRUG COST) DRUGS AFFECTING THE IMMUNE TRUST GUIDELINES: (ONLY IF ALEMTUZUMAB CLL NHS ENGLAND TRUST GUIDELINES TRUST GUIDELINES SACT √ RESPONSE PROVIDED AT ZERO DRUG COST) HIGHLY SPECIALISED CRITERIA ONLY HIGHLY SPECIALISED HIGHLY SPECIALISED ALEMTUZUMAB BEHCETS SYNDROME NHS ENGLAND CYTOKINE MODULATORS (ONLY IF PROVIDED AT ZERO DRUG HIGHLY SPECIALISED CRITERIA √ CRITERIA ONLY CRITERIA ONLY COST) DRUGS USED IN METABOLIC HIGHLY SPECIALISED HIGHLY SPECIALISED ALGLUCOSIDASE ALFA POMPE DISEASE NHS ENGLAND NHS ENGLAND SERVICE SPECIFICATION HIGHLY SPECIALISED DATABASE √ DISORDERS CRITERIA ONLY CRITERIA ONLY DRUGS USED IN METABOLIC ALIPOGENE TIPARVOVEC LIPOPROTEIN LIPASE DEFICIENCY NHS ENGLAND NOT ROUTINELY COMMISSIONED AS PER IFR APPROVAL AS PER IFR APPROVAL AS PER IFR APPROVAL √ DISORDERS VIRAL HEPATITIS (B&C) & ALISPORIVIR HEPATITIS C NHS ENGLAND NOT ROUTINELY COMMISSIONED AS PER IFR APPROVAL AS PER IFR APPROVAL AS PER IFR APPROVAL √ RESPIRATORY SYNCYTIAL VIRUS DRUGS USED IN METABOLIC ALPHA-1 ANTITRYPSIN ALPHA-1 ANTITRYPSIN DEFICIENCY NHS ENGLAND NOT ROUTINELY COMMISSIONED AS PER IFR APPROVAL AS PER IFR APPROVAL AS PER IFR APPROVAL √ DISORDERS ALPHA MANNOSIDASE DRUGS USED IN METABOLIC ALPHA MANNOSIDASE DEFICIENCY NHS ENGLAND NOT ROUTINELY COMMISSIONED AS PER IFR APPROVAL AS PER IFR APPROVAL AS PER IFR APPROVAL √ RECOMBINANT HUMAN DISORDERS VASODILATOR ANTIHYPERTENSIVE PULMONARY ARTERIAL NHS ENGLAND CLINICAL AMBRISENTAN NHS ENGLAND DRUGS/PULMANORY ARTERIAL NHS ENGLAND POLICY NHS ENGLAND POLICY AS PER POLICY √ HYPERTENSION COMMISSIONING POLICY: A11/P/c HYPERTENSION NOT ROUTINELY COMMISSIONED AMIFAMPRIDINE PHOSPHATE LEMS NHS ENGLAND NEUROMUSCULAR DISORDERS AS PER IFR APPROVAL AS PER IFR APPROVAL AS PER IFR APPROVAL √ NHS ENGLAND POLICY: 16009/P

AMIKACIN INHALATION CYSTIC FIBROSIS NHS ENGLAND ANTIBACTERIAL DRUGS NOT ROUTINELY COMMISSIONED AS PER IFR APPROVAL AS PER IFR APPROVAL AS PER IFR APPROVAL √

CYSTIC FIBROSIS AMIKACIN LIPOSOMAL NHS ENGLAND ANTIBACTERIAL DRUGS NOT ROUTINELY COMMISSIONED AS PER IFR APPROVAL AS PER IFR APPROVAL AS PER IFR APPROVAL √ NUMBER OF PATIENTS TREATED AMPHOTERICIN LIPOSOMAL FUNGAL INFECTION NHS ENGLAND ANTIFUNGALS AGREED TRUST GUIDELINES TRUST GUIDELINES TRUST GUIDELINES PROPORTION GIVEN FOR SPC √ INDICATIONS WITHIN POLICY NHS ENGLAND CLINICAL ANAKINRA JUVENILE ARTHRITIS-PAEDIATRIC NHS ENGLAND CYTOKINE MODULATORS NHS ENGLAND POLICY NHS ENGLAND POLICY NHS ENGLAND POLICY √ √ COMMISSIONING POLICY: E03/P/d SPECIALIST AUTOINFLAMMATORY ANAKINRA NHS ENGLAND CYTOKINE MODULATORS NOT ROUTINELY COMMISSIONED AS PER IFR APPROVAL AS PER IFR APPROVAL AS PER IFR APPROVAL √ DISEASE ANAKINRA PAEDIATRIC INDICATIONS NHS ENGLAND CYTOKINE MODULATORS NOT ROUTINELY COMMISSIONED AS PER IFR APPROVAL AS PER IFR APPROVAL AS PER IFR APPROVAL √ CRYOPYRIN ASSOCIATED PERIODIC CRYOPYRIN ASSOCIATED PERIODIC HIGHLY SPECIALISED HIGHLY SPECIALISED ANAKINRA NHS ENGLAND CYTOKINE MODULATORS HIGHLY SPECIALISED DATABASE √ SYNDROME SYNDROME SERVICE SPECIFICATION CRITERIA ONLY CRITERIA ONLY

NHS England drugs-list v11 v4 NHSE Commissioned PbRE Drugv11 1 22/12/2016 SUITABLE FOR SUITABLE FOR SHARED CARE SPECIALIST SHARED CARE BETWEEN PRIOR CENTRE ONLY WITH PRIMARY SPECIALIST MONITORING/AUDIT APPROVAL (includng outreach CARE (IF DRUG NAME INDICATION COMMISSIONER PBR CATEGORY TA/POLICY STARTING CRITERIA STOPPING CRITERIA AND REQUIREMENTS PROFORMA when delivered as SUPPORTED BY SECONDARY REQUIRED part of a provider LOCAL CARE VIA network) PRESCRIBING NETWORK COMMITTEE) MODEL NUMBER OF PATIENTS TREATED ANIDULAFUNGIN FUNGAL INFECTION NHS ENGLAND ANTIFUNGALS AGREED TRUST GUIDELINES TRUST GUIDELINES TRUST GUIDELINES PROPORTION GIVEN FOR SPC √ INDICATIONS WITHIN POLICY ANTIHAEMOPHILIC FACTOR/VON AS PER BCSH GUIDELINES FOR NHS ENGLAND BLOOD-RELATED PRODUCTS BCSH GUIDELINES BCSH GUIDELINES BCSH GUIDELINES PRODUCTS ON CMU FRAMEWORK √ WILLEBRAND FACTOR COMPLEX SPECIALISED INDICATIONS

APLASTIC ANAEMIA DRUGS USED IN HYPOPLASTIC, ANTILYMPHOCYTE GLOBULIN NHS ENGLAND BCSH GUIDELINES BCSH GUIDELINES BCSH GUIDELINES √ ORGAN TRANSPLANT HAEMOLYTIC, AND RENAL ANAEMIAS ANTIPSEUDOMONAS AERUGINOSA CYSTIC FIBROSIS NHS ENGLAND ANTIBACTERIAL DRUGS NOT ROUTINELY COMMISSIONED AS PER IFR APPROVAL AS PER IFR APPROVAL AS PER IFR APPROVAL √ IgY AS PER BCSH GUIDELINES FOR ANTITHROMBIN III NHS ENGLAND BLOOD-RELATED PRODUCTS BCSH GUIDELINES BCSH GUIDELINES BCSH GUIDELINES √ SPECIALISED INDICATIONS ANTITHYMOCYTE APLASTIC ANAEMIA DRUGS USED IN HYPOPLASTIC, NHS ENGLAND BCSH GUIDELINES BCSH GUIDELINES BCSH GUIDELINES √ IMMUNOGLOBULIN ORGAN TRANSPLANT HAEMOLYTIC, AND RENAL ANAEMIAS

APREMILAST PAEDIATRIC INDICATIONS NHS ENGLAND CYTOKINE MODULATORS NOT ROUTINELY COMMISSIONED AS PER IFR APPROVAL AS PER IFR APPROVAL AS PER IFR APPROVAL √ CLINICAL GUIDELINES FOR INTRAVENOUS/SUBCUTANEOUS ARAGAM AS PER NATIONAL DMP NHS ENGLAND IMMUNOGLOBULIN USE, SECOND NATIONAL GUIDELINES NATIONAL GUIDELINES QUALITY DASHBOARD √ HUMAN NORMAL IMMUNOGLOBULINS EDITION UPDATE (JULY 2011) DRUGS USED IN METABOLIC ASFOTASE ALFA HYPOPHOSPHATASIA NHS ENGLAND NOT ROUTINELY COMMISSIONED AS PER IFR APPROVAL AS PER IFR APPROVAL AS PER IFR APPROVAL √ DISORDERS VIRAL HEPATITIS (B&C) & ASUNAPREVIR + DACLATASVIR HEPATITIS C NHS ENGLAND NOT ROUTINELY COMMISSIONED AS PER IFR APPROVAL AS PER IFR APPROVAL AS PER IFR APPROVAL √ RESPIRATORY SYNCYTIAL VIRUS DRUGS AFFECTING THE IMMUNE ATACICEPT SLE NHS ENGLAND NOT ROUTINELY COMMISSIONED AS PER IFR APPROVAL AS PER IFR APPROVAL AS PER IFR APPROVAL √ RESPONSE ATALUREN DUCHENNE MUSCULAR DYSTROPHY NHS ENGLAND NEUROMUSCULAR DISORDERS NICE HST3 NICE NICE NORTHSTAR DATABASE √ √ HIV IN COMBINATION WITH OTHER ANTI- ATAZANAVIR NHS ENGLAND AIDS/HIV ANTIRETROVIRALS AGREED REGIONALGUIDELINES BHIVA GUIDELINES (8) BHIVA GUIDELINES (8) HARS DATASET √ RETROVIRAL DRUGS ATAZANAVIR + COBICISTAT HIV IN COMBINATION WITH OTHER ANTI- NHS ENGLAND AIDS/HIV ANTIRETROVIRALS AGREED REGIONALGUIDELINES BHIVA GUIDELINES (8) BHIVA GUIDELINES (8) HARS DATASET √ (EVOTAZ®) RETROVIRAL DRUGS AVORALSTAT HEREDITARY ANGIOEDEMA NHS ENGLAND ALLERGIC EMERGENCIES NOT ROUTINELY COMMISSIONED AS PER IFR APPROVAL AS PER IFR APPROVAL AS PER IFR APPROVAL √ AXITINIB CANCER NHS ENGLAND PROTEIN KINASE INHIBITORS TA333 (also refer to circular SSC1508) NICE NICE SACT √ AZACITIDINE CANCER NHS ENGLAND MYELODYSPLASTIC SYNDROME TA218 NICE NICE SACT √ NHS ENGLAND CLINCAL AZTREONAM LYSINE CYSTIC FIBROSIS NHS ENGLAND ANTIBACTERIAL DRUGS NHS ENGLAND POLICY NHS ENGLAND POLICY NHS ENGLAND POLICY √* √* COMMISSIONING POLICY: A01/P/b NOT ROUTINELY COMMISSIONED AZTREONAM LYSINE CYSTIC FIBROSIS NHS ENGLAND ANTIBACTERIAL DRUGS NHS ENGLAND CLINCAL AS PER IFR APPROVAL AS PER IFR APPROVAL AS PER IFR APPROVAL √ COMMISSIONING POLICY: 16001/P PAEDIATRIC INDICATIONS (WHERE BARICITINIB NHS ENGLAND IMMUNOMODULATING DRUGS NOT ROUTINELY COMMISSIONED AS PER IFR APPROVAL AS PER IFR APPROVAL AS PER IFR APPROVAL √ ADULT TA AVAILABLE) CORTICOSTEROIDS AND OTHER BASILIXIMAB RENAL TRANSPLANT NHS ENGLAND TA85 & TA99 NICE NICE √ IMMUNOSUPPRESSANTS BECLABUVIR HEPATITIS C VIRAL HEPATITIS (B&C) & NHS ENGLAND NOT ROUTINELY COMMISSIONED AS PER IFR APPROVAL AS PER IFR APPROVAL AS PER IFR APPROVAL √ RESPIRATORY SYNCYTIAL VIRUS NHS ENGLAND CLINICAL BEDAQUILINE EXTENSIVELY DRUG RESITANT TB NHS ENGLAND ANTITUBERCULOSIS DRUGS NHS ENGLAND POLICY NHS ENGLAND POLICY NHS ENGLAND POLICY √ √ COMMISSIONING POLICY: F04/P/a NHS ENGLAND CLINICAL BEDAQUILINE MULTI DRUG RESITANT TB NHS ENGLAND ANTITUBERCULOSIS DRUGS NHS ENGLAND POLICY NHS ENGLAND POLICY NHS ENGLAND POLICY √ √ COMMISSIONING POLICY: F04/P/a MALIGNANT DISEASE AND BEGELOMAB GRAFT VERSUS HOST DISEASE NHS ENGLAND NOT ROUTINELY COMMISSIONED AS PER IFR APPROVAL AS PER IFR APPROVAL AS PER IFR APPROVAL √ IMMUNOSUPPRESSION DRUGS AFFECTING THE IMMUNE NOT ROUTINELY COMMISSIONED - NICE BELATACEPT RENAL TRANSPLANT NHS ENGLAND NICE TA IN PROGRESS NICE TA IN PROGRESS NICE TA IN PROGRESS √ RESPONSE TA IN PROGRESS DRUGS AFFECTING THE IMMUNE BELIMUMAB SLE NHS ENGLAND NICE TA 397 NICE NICE NICE AUDIT √ √ RESPONSE BENRALIZUMAB ASTHMA NHS ENGLAND ALLERGEN IMMUNOTHERAPY NOT ROUTINELY COMMISSIONED AS PER IFR APPROVAL AS PER IFR APPROVAL AS PER IFR APPROVAL √ BERACTANT RESPIRATORY DISTRESS SYNDROME NHS ENGLAND PULMONARY SURFACTANTS AGREED TRUST GUIDELINES TRUST GUIDELINES TRUST GUIDELINES √ DRUGS USED IN METABOLIC HIGHLY SPECIALISED HIGHLY SPECIALISED BETAINE HOMOCYSTINURIA NHS ENGLAND NHS ENGLAND SERVICE SPECIFICATION HIGHLY SPECIALISED DATABASE √ DISORDERS CRITERIA ONLY CRITERIA ONLY BEVACIZUMAB CANCER CDF ANTINEOPLASTIC DRUGS CDF POLICY CDF CDF SACT √ AS PER NATIONAL PROTOCOL (SEE NF2 AS PER NATIONAL AS PER NATIONAL BEVACIZUMAB NEUROFIBROMATOSIS NHS ENGLAND ANTINEOPLASTIC DRUGS AS PER NATIONAL PROTOCOL √ SERVICE SPEC) PROTOCOL PROTOCOL BIMAGRUMAB INCLUSION BODY MYOSITIS NHS ENGLAND CYTOKINE MODULATORS NOT ROUTINELY COMMISSIONED AS PER IFR APPROVAL AS PER IFR APPROVAL AS PER IFR APPROVAL √ BIOTIN MULTIPLE SCLEROSIS NHS ENGLAND VITAMINS NOT ROUTINELY COMMISSIONED AS PER IFR APPROVAL AS PER IFR APPROVAL AS PER IFR APPROVAL √ SYSTEMIC LUPUS ERYTHEMATOSUS BLISIBIMOD NHS ENGLAND CYTOKINE MODULATORS NOT ROUTINELY COMMISSIONED AS PER IFR APPROVAL AS PER IFR APPROVAL AS PER IFR APPROVAL √ (SLE) VIRAL HEPATITIS (B&C) & BOCEPREVIR HEPATITIS C NHS ENGLAND TA253 NICE NICE HEPATITIS C MDS √ √ RESPIRATORY SYNCYTIAL VIRUS NOT ROUTINELY COMMISSIONED ORGAN REJECTION POST KIDNEY BORTEZOMIB NHS ENGLAND ANTINEOPLASTIC DRUGS (NHS ENGLAND CLINICAL AS PER IFR APPROVAL AS PER IFR APPROVAL AS PER IFR APPROVAL √ TRANSPLANT COMMISSIONING POLICY: A07/P/c) NHS ENGLAND/ TA129, TA228, TA311, TA 378 NICE NICE BORTEZOMIB CANCER ANTINEOPLASTIC DRUGS SACT √ CDF CDF POLICY CDF CDF VASODILATOR ANTIHYPERTENSIVE NHS ENGLAND CLINICAL BOSENTAN DIGITAL ULCERS NHS ENGLAND DRUGS/PULMANORY ARTERIAL NHS ENGLAND POLICY NHS ENGLAND POLICY NHS ENGLAND POLICY √ √ COMMISSIONING POLICY: A13/P/b HYPERTENSION VASODILATOR ANTIHYPERTENSIVE PULMONARY ARTERIAL NHS ENGLAND CLINICAL BOSENTAN NHS ENGLAND DRUGS/PULMANORY ARTERIAL NHS ENGLAND POLICY NHS ENGLAND POLICY AS PER POLICY √ HYPERTENSION COMMISSIONING POLICY: A11/P/c HYPERTENSION BOSUTINIB CANCER NHS ENGLAND CANCER EXCLUSION TA 401 NICE NICE SACT √ TORSION DYSTONIAS AND OTHER BOTULINUM TOXIN FOCAL SPASTICITY IN CHILDREN NHS ENGLAND AGREED TRUST GUIDELINES TRUST GUIDELINES TRUST GUIDELINES AS PER POLICY √ INVOLUNTARY MOVEMENTS INTRAVESICAL USE IN SPINAL CORD TORSION DYSTONIAS AND OTHER BOTULINUM TOXIN**** NHS ENGLAND AGREED TRUST GUIDELINES TRUST GUIDELINES TRUST GUIDELINES AS PER POLICY √ INJURY INVOLUNTARY MOVEMENTS BRINCIDOFOVIR CYTOMEGALOVIRUS NHS ENGLAND CYTOMEGALOVIRUS INFECTION NOT ROUTINELY COMMISSIONED AS PER IFR APPROVAL AS PER IFR APPROVAL AS PER IFR APPROVAL √ PAEDIATRIC INDICATIONS (WHERE BRODALIMUMAB NHS ENGLAND IMMUNOMODULATING DRUGS NOT ROUTINELY COMMISSIONED AS PER IFR APPROVAL AS PER IFR APPROVAL AS PER IFR APPROVAL √ ADULT TA AVAILABLE) HEREDITARY ANGIOEDEMA - ACUTE NHS ENGLAND CLINICAL C1 ESTERASE INHIBITORS NHS ENGLAND ALLERGIC EMERGENCIES NHS ENGLAND POLICY NHS ENGLAND POLICY AS PER POLICY √ TREATMENT COMMISSIONING POLICY: B09/P/b HEREDUTARY ANGIOEDEMA - NHS ENGLAND CLINICAL C1 ESTERASE INHIBITORS NHS ENGLAND ALLERGIC EMERGENCIES NHS ENGLAND POLICY NHS ENGLAND POLICY AS PER POLICY √ √ PROPHYLACTIC TREATMENT COMMISSIONING POLICY: 16045/P

NHS England drugs-list v11 v4 NHSE Commissioned PbRE Drugv11 2 22/12/2016 SUITABLE FOR SUITABLE FOR SHARED CARE SPECIALIST SHARED CARE BETWEEN PRIOR CENTRE ONLY WITH PRIMARY SPECIALIST MONITORING/AUDIT APPROVAL (includng outreach CARE (IF DRUG NAME INDICATION COMMISSIONER PBR CATEGORY TA/POLICY STARTING CRITERIA STOPPING CRITERIA AND REQUIREMENTS PROFORMA when delivered as SUPPORTED BY SECONDARY REQUIRED part of a provider LOCAL CARE VIA network) PRESCRIBING NETWORK COMMITTEE) MODEL CRYOPYRIN ASSOCIATED PERIODIC CRYOPYRIN ASSOCIATED PERIODIC HIGHLY SPECIALISED HIGHLY SPECIALISED CANAKINUMAB NHS ENGLAND IMMUNOMODULATING DRUGS HIGHLY SPECIALISED DATABASE √ SYNDROME SYNDROME SERVICE SPECIFICATION CRITERIA ONLY CRITERIA ONLY NOT ROUTINELY COMMISSIONED CANAKINUMAB JUVENILE ARTHRITIS-PAEDIATRIC NHS ENGLAND IMMUNOMODULATING DRUGS AS PER IFR APPROVAL AS PER IFR APPROVAL AS PER IFR APPROVAL √ (TA302) DRUGS USED IN METABOLIC HIGHLY SPECIALISED HIGHLY SPECIALISED CARGLUMIC ACID UREA CYCLE DISORDERS NHS ENGLAND NHS ENGLAND SERVICE SPECIFICATION HIGHLY SPECIALISED DATABASE √ DISORDERS CRITERIA ONLY CRITERIA ONLY DRUGS USED IN METABOLIC HIGHLY SPECIALISED HIGHLY SPECIALISED CARNITINE CARNITINE DEFICIENCY NHS ENGLAND NHS ENGLAND SERVICE SPECIFICATION HIGHLY SPECIALISED DATABASE √ DISORDERS CRITERIA ONLY CRITERIA ONLY NUMBER OF PATIENTS TREATED CASPOFUNGIN FUNGAL INFECTION NHS ENGLAND ANTIFUNGALS AGREED TRUST GUIDELINES TRUST GUIDELINES TRUST GUIDELINES PROPORTION GIVEN FOR SPC √ INDICATIONS WITHIN POLICY

CONGENITAL FACTOR XIII A-SUBUNIT CATRIDECACOG NHS ENGLAND BLOOD-RELATED PRODUCTS NOT ROUTINELY COMMISSIONED AS PER IFR APPROVAL AS PER IFR APPROVAL AS PER IFR APPROVAL √ DEFICIENCY

CERALIFIMOD MULTIPLE SCLEROSIS NHS ENGLAND IMMUNOMODULATING DRUGS NOT ROUTINELY COMMISSIONED AS PER IFR APPROVAL AS PER IFR APPROVAL AS PER IFR APPROVAL √ LYSOSOMAL STORAGE DISORDER CERLIPONASE ALFA NEURONAL CEROID LIPOFUSCINOSIS NHS ENGLAND NOT ROUTINELY COMMISSIONED AS PER IFR APPROVAL AS PER IFR APPROVAL AS PER IFR APPROVAL √ DRUGS CERTOLIZUMAB PEGOL PAEDIATRIC INDICATIONS NHS ENGLAND CYTOKINE MODULATORS NOT ROUTINELY COMMISSIONED AS PER IFR APPROVAL AS PER IFR APPROVAL AS PER IFR APPROVAL √ NHS ENGLAND/ TA145, TA176 NICE NICE CETUXIMAB CANCER ANTINEOPLASTIC DRUGS SACT √ CDF CDF POLICY CDF CDF CEREBROTENDINOUS DRUGS USED IN METABOLIC CHENODEOXYCHOLIC ACID NHS ENGLAND NOT ROUTINELY COMMISSIONED AS PER IFR APPROVAL AS PER IFR APPROVAL AS PER IFR APPROVAL √ XANTHOMATOSIS (CTX) DISORDERS DRUGS USED IN METABOLIC CHENODEOXYCHOLIC ACID PRIMARY BILIARY CIRRHOSIS NHS ENGLAND NOT ROUTINELY COMMISSIONED AS PER IFR APPROVAL AS PER IFR APPROVAL AS PER IFR APPROVAL √ DISORDERS INBORN ERRORS IN PRIMARY BILE DRUGS USED IN METABOLIC CHOLIC ACID NHS ENGLAND NOT ROUTINELY COMMISSIONED AS PER IFR APPROVAL AS PER IFR APPROVAL AS PER IFR APPROVAL √ ACID SYNTHESIS DISORDERS NUMBER OF PATIENTS TREATED CIDOFOVIR CYTOMEGALOVIRUS NHS ENGLAND CYTOMEGALOVIRUS INFECTION AGREED TRUST GUIDELINES TRUST GUIDELINES TRUST GUIDELINES PROPORTION GIVEN FOR SPC √ INDICATIONS WITHIN POLICY CIPROFLOXACIN INHALATION CYSTIC FIBROSIS NHS ENGLAND ANTIBACTERIAL DRUGS NOT ROUTINELY COMMISSIONED AS PER IFR APPROVAL AS PER IFR APPROVAL AS PER IFR APPROVAL √ CIPROFLOXACIN LIPOSOMAL CYSTIC FIBROSIS NHS ENGLAND ANTIBACTERIAL DRUGS NOT ROUTINELY COMMISSIONED AS PER IFR APPROVAL AS PER IFR APPROVAL AS PER IFR APPROVAL √ (INHALED) CLADRIBINE MULTIPLE SCLEROSIS NHS ENGLAND IMMUNOMODULATING DRUGS NOT ROUTINELY COMMISSIONED AS PER IFR APPROVAL AS PER IFR APPROVAL AS PER IFR APPROVAL √**** PULMONARY LANGERHANS CLADRIBINE NHS ENGLAND IMMUNOMODULATING DRUGS NOT ROUTINELY COMMISSIONED AS PER IFR APPROVAL AS PER IFR APPROVAL AS PER IFR APPROVAL √ HISTIOCYTOSIS

NHS ENGLAND CLINICAL HIV IN COMBINATION WITH OTHER ANTI- COBICISTAT NHS ENGLAND AIDS/HIV ANTIRETROVIRALS COMMISSIONING POLICY: NHS ENGLAND POLICY NHS ENGLAND POLICY HARS DATASET √ RETROVIRAL DRUGS F03/P/b/AGREED REGIONAL GUIDELINES PAEDIATRIC INDICATIONS (WHERE DRUGS AFFECTING THE IMMUNE COBITOLIMOD NHS ENGLAND NOT ROUTINELY COMMISSIONED AS PER IFR APPROVAL AS PER IFR APPROVAL AS PER IFR APPROVAL √ ADULT TA AVAILABLE) RESPONSE NHS ENGLAND CLINICAL CO-CARELDOPA INTESTINAL GEL PARKINSON'S DISEASE NHS ENGLAND NEURODEGENERATIVE CONDITIONS NHS ENGLAND POLICY NHS ENGLAND POLICY NHS ENGLAND POLICY √ √ COMMISSIONING POLICY: D04/P/e NHS ENGLAND CLINICAL NHS ENGLAND POLICY NHS ENGLAND POLICY NHS ENGLAND POLICY COLISTIMETHATE SODIUM CYSTIC FIBROSIS NHS ENGLAND ANTIBACTERIAL DRUGS COMMISSIONING POLICY: A01/P/b √* √* NICE NICE NICE AUDIT TA276 HEREDITARY ANGIOEDEMA - ACUTE NHS ENGLAND CLINICAL CONESTAT ALFA NHS ENGLAND ALLERGIC EMERGENCIES NHS ENGLAND POLICY NHS ENGLAND POLICY AS PER POLICY √ TREATMENT ONLY COMMISSIONING POLICY: B09/P/b CRIZOTINIB CANCER NHS ENGLAND PROTEIN KINASE INHIBITORS NICE TA 406, 422 NICE NICE SACT √ DRUGS USED IN METABOLIC HIGHLY SPECIALISED HIGHLY SPECIALISED CYSTEAMINE (MERCAPTAMINE) NEPHROPATHIC CYSTINOSIS NHS ENGLAND NHS ENGLAND SERVICE SPECIFICATION HIGHLY SPECIALISED DATABASE √ DISORDERS CRITERIA ONLY CRITERIA ONLY DABRAFENIB CANCER NHS ENGLAND PROTEIN KINASE INHIBITORS TA321, 396 NICE NICE SACT √ (TA396) √ VIRAL HEPATITIS (B&C) & DACLATASIVIR HEPATITIS C NHS ENGLAND TA 364 AS PER RUN RATE CARD AS PER RUN RATE CARD HEPATITIS C MDS √ √ RESPIRATORY SYNCYTIAL VIRUS DACLIZUMAB MULTIPLE SCLEROSIS NHS ENGLAND IMMUNOMODULATING DRUGS NOT ROUTINELY COMMISSIONED AS PER IFR APPROVAL AS PER IFR APPROVAL AS PER IFR APPROVAL √ HIV IN COMBINATION WITH OTHER ANTI- DARUNAVIR NHS ENGLAND AIDS/HIV ANTIRETROVIRALS AGREED REGIONALGUIDELINES BHIVA GUIDELINES (8) BHIVA GUIDELINES (8) HARS DATASET √ RETROVIRAL DRUGS DARUNAVIR + HIV IN COMBINATION WITH OTHER ANTI- NHS ENGLAND AIDS/HIV ANTIRETROVIRALS AGREED REGIONALGUIDELINES BHIVA GUIDELINES (8) BHIVA GUIDELINES (8) HARS DATASET √ COBICISTAT (REZOLSTA®) RETROVIRAL DRUGS VIRAL HEPATITIS (B&C) & DASABUVIR HEPATITIS C NHS ENGLAND NOT ROUTINELY COMMISSIONED AS PER IFR APPROVAL AS PER IFR APPROVAL AS PER IFR APPROVAL √ RESPIRATORY SYNCYTIAL VIRUS NHS ENGLAND/ NICE TA 425, 426 NICE NICE DASATINIB CANCER PROTEIN KINASE INHIBITORS SACT √ CDF CDF POLICY CDF CDF NOT ROUTINELY COMMISSIONED DECITABINE CANCER NHS ENGLAND MYELODYSPLASTIC SYNDROME AS PER IFR APPROVAL AS PER IFR APPROVAL SACT √ (TA270) DRUGS USED IN HYPOPLASTIC, IRON CHELATION IN THALASSAEMIA NHS ENGLAND CLINICAL QUALITY DASHBOARD/ NATIONAL DEFERASIROX NHS ENGLAND HAEMOLYTIC, AND RENAL ANAEMIAS - NHS ENGLAND POLICY NHS ENGLAND POLICY √ AND SICKLE CELL COMMISSIONING POLICY 16070/P HAEMOGLOBINOPATHY REGISTRY IRON OVERLOAD DRUGS USED IN HYPOPLASTIC, IRON CHELATION IN THALASSAEMIA NHS ENGLAND CLINICAL QUALITY DASHBOARD/ NATIONAL DEFERIPRONE** NHS ENGLAND HAEMOLYTIC, AND RENAL ANAEMIAS - NHS ENGLAND POLICY NHS ENGLAND POLICY √ AND SICKLE CELL COMMISSIONING POLICY 16070/P HAEMOGLOBINOPATHY REGISTRY IRON OVERLOAD NHS ENGLAND CLINICAL DEFIBROTIDE HEPATIC VENO-OCCLUSIVE DISEASE NHS ENGLAND BLOOD-RELATED PRODUCTS NHS ENGLAND POLICY NHS ENGLAND POLICY NHS ENGLAND POLICY √ √ COMMISSIONING POLICY: B04/P/c NHS ENGLAND CLINICAL DELAMANID EXTENSIVELY DRUG RESITANT TB NHS ENGLAND ANTITUBERCULOSIS DRUGS NHS ENGLAND POLICY NHS ENGLAND POLICY NHS ENGLAND POLICY √ √ COMMISSIONING POLICY: F04/P/a NHS ENGLAND CLINICAL DELAMANID MULTI DRUG RESITANT TB NHS ENGLAND ANTITUBERCULOSIS DRUGS NHS ENGLAND POLICY NHS ENGLAND POLICY NHS ENGLAND POLICY √ √ COMMISSIONING POLICY: F04/P/a DRUGS USED IN HYPOPLASTIC, IRON CHELATION IN THALASSAEMIA NHS ENGLAND CLINICAL QUALITY DASHBOARD/ NATIONAL DESFERRIOXAMINE** NHS ENGLAND HAEMOLYTIC, AND RENAL ANAEMIAS - NHS ENGLAND POLICY NHS ENGLAND POLICY √ AND SICKLE CELL COMMISSIONING POLICY 16070/P HAEMOGLOBINOPATHY REGISTRY IRON OVERLOAD

DEXRAZOXANE ANTHRACYCLINE EXTRAVASATION NHS ENGLAND IMMUNOMODULATING DRUGS AGREED TRUST GUIDELINES TRUST GUIDELINES TRUST GUIDELINES √

DEXRAZOXANE ANTHRACYCLINE CARDIOTOXICITY NHS ENGLAND IMMUNOMODULATING DRUGS NOT ROUTINELY COMMISSIONED AS PER IFR APPROVAL AS PER IFR APPROVAL AS PER IFR APPROVAL √ NHS ENGLAND CLINICAL DIBOTERMIN ALFA COMPLEX SPINAL SURGERY NHS ENGLAND BONE MORPHOGENETIC PROTEIN NHS ENGLAND POLICY NHS ENGLAND POLICY AUDIT, BSR REGISTRY √ COMMISSIONING POLICY 16063/P HIV IN COMBINATION WITH OTHER ANTI- DIDANOSINE NHS ENGLAND AIDS/HIV ANTIRETROVIRALS AGREED REGIONALGUIDELINES BHIVA GUIDELINES (8) BHIVA GUIDELINES (8) HARS DATASET √ RETROVIRAL DRUGS DIMETHYL FUMARATE MULTIPLE SCLEROSIS NHS ENGLAND IMMUNOMODULATING DRUGS TA320 NICE NICE NICE AUDIT √ √****

NHS England drugs-list v11 v4 NHSE Commissioned PbRE Drugv11 3 22/12/2016 SUITABLE FOR SUITABLE FOR SHARED CARE SPECIALIST SHARED CARE BETWEEN PRIOR CENTRE ONLY WITH PRIMARY SPECIALIST MONITORING/AUDIT APPROVAL (includng outreach CARE (IF DRUG NAME INDICATION COMMISSIONER PBR CATEGORY TA/POLICY STARTING CRITERIA STOPPING CRITERIA AND REQUIREMENTS PROFORMA when delivered as SUPPORTED BY SECONDARY REQUIRED part of a provider LOCAL CARE VIA network) PRESCRIBING NETWORK COMMITTEE) MODEL

NHS ENGLAND CLINICAL HIV IN COMBINATION WITH OTHER ANTI- DOLUTEGRAVIR NHS ENGLAND AIDS/HIV ANTIRETROVIRALS COMMISSIONING POLICY: NHS ENGLAND POLICY NHS ENGLAND POLICY HARS DATASET √ RETROVIRAL DRUGS B06/P/b/AGREED REGIONAL GUIDELINES HIV iN COMBINATION WITH OTHER ANTI- DORAVIRINE NHS ENGLAND AIDS/HIV ANTIRETROVIRALS NOT ROUTINELY COMMISSIONED AS PER IFR APPROVAL AS PER IFR APPROVAL AS PER IFR APPROVAL √ RETROVIRAL DRUGS NOT ROUTINELY COMMISSIONED DORNASE ALFA PRIMARY CILIARY DYSKINESIA NHS ENGLAND MUCOLYTICS AS PER IFR APPROVAL AS PER IFR APPROVAL AS PER IFR APPROVAL √ NHS ENGLAND POLICY 16029/P NHS ENGLAND CLINICAL DORNASE ALFA CYSTIC FIBROSIS NHS ENGLAND MUCOLYTICS NHS ENGLAND POLICY NHS ENGLAND POLICY NHS ENGLAND POLICY √* √* COMMISSIONING POLICY: A01/P/b DRISAPERSEN DUCHENNE MUSCULAR DYSTROPHY NHS ENGLAND NEUROMUSCULAR DISORDERS NOT ROUTINELY COMMISSIONED AS PER IFR APPROVAL AS PER IFR APPROVAL AS PER IFR APPROVAL √ DRUGS AFFECTING THE IMMUNE DUPILUMAB ASTHMA NHS ENGLAND NOT ROUTINELY COMMISSIONED AS PER IFR APPROVAL AS PER IFR APPROVAL AS PER IFR APPROVAL √ RESPONSE HEREDITARY ANGIOEDEMA - ACUTE ECALLANTIDE NHS ENGLAND ALLERGIC EMERGENCIES NOT ROUTINELY COMMISSIONED AS PER IFR APPROVAL AS PER IFR APPROVAL AS PER IFR APPROVAL √ TREATMENT ONLY ORGAN REJECTION POST KIDNEY PAROXYSMAL NOCTURNAL NOT ROUTINELY COMMISSIONED ECULIZUMAB NHS ENGLAND AS PER IFR APPROVAL AS PER IFR APPROVAL AS PER IFR APPROVAL √ TRANSPLANT HAEMOGLOBINURIA NHS ENGLAND POLICY: A07/P/b C3 GLOMERULOPATHY (POST PAROXYSMAL NOCTURNAL NOT ROUTINELY COMMISSIONED ECULIZUMAB NHS ENGLAND AS PER IFR APPROVAL AS PER IFR APPROVAL AS PER IFR APPROVAL √ TRANSPLANT) HAEMOGLOBINURIA NHS ENGLAND POLICY: 16054/P

NHS ENGLAND CLINICAL PAROXYSMAL NOCTURNAL NHS ENGLAND POLICY NHS ENGLAND POLICY NHS ENGLAND POLICY ECULIZUMAB AHUS NHS ENGLAND COMMISSIONING POLICY: E03/PS(HSS)/A √ HAEMOGLOBINURIA NICE NICE NICE NICE HST1

NHS NATIONAL SPECIALISED PAROXYSMAL NOCTURNAL PAROXYSMAL NOCTURNAL ECULIZUMAB NHS ENGLAND COMMISSIONING TEAM SERVICE NSCT SERVICE SPEC NSCT SERVICE SPEC NSCT SERVICE SPEC √ HAEMOGLOBINURIA HAEMOGLOBINURIA SPECIFICATION DRUGS AFFECTING THE IMMUNE EDRATIDE SLE NHS ENGLAND NOT ROUTINELY COMMISSIONED AS PER IFR APPROVAL AS PER IFR APPROVAL AS PER IFR APPROVAL √ RESPONSE HIV IN COMBINATION WITH OTHER ANTI- EFAVIRENZ NHS ENGLAND AIDS/HIV ANTIRETROVIRALS AGREED REGIONALGUIDELINES BHIVA GUIDELINES (8) BHIVA GUIDELINES (8) HARS DATASET √ RETROVIRAL DRUGS

EFRALOCTOCOG ALFA / EFMOROCTOCOG ALFA / FACTOR HAEMOPHILIA A NHS ENGLAND BLOOD-RELATED PRODUCTS SSC 1652 SSC 1652 SSC 1652 PRODUCTS ON CMU FRAMEWORK √ VIII FC FUSION PROTEIN (Elocta®)

EFTRENONACOG ALFA (Alprolix®) HAEMOPHILIA B NHS ENGLAND BLOOD-RELATED PRODUCTS SSC 1652 SSC 1652 SSC 1652 PRODUCTS ON CMU FRAMEWORK √ VIRAL HEPATITIS (B&C) & ELBASVIR HEPATITIS C NHS ENGLAND TA 413 AS PER RUN RATE CARD AS PER RUN RATE CARD HEPATITIS C MDS √ √ RESPIRATORY SYNCYTIAL VIRUS DRUGS USED IN METABOLIC ELIGLUSTAT GAUCHER'S DISEASE NHS ENGLAND NOT ROUTINELY COMMISSIONED AS PER IFR APPROVAL AS PER IFR APPROVAL AS PER IFR APPROVAL √ DISORDERS LYSOSOMAL STORAGE DISORDER MANAGED ACCESS MANAGED ACCESS ELOSULFASE ALFA MUCOPOLYSACCHARIDOSIS IV TYPE A NHS ENGLAND NICE HST2 MANAGED ACCESS AGREEMENT √ √ DRUGS AGREEMENT AGREEMENT ELTROMBOPAG ITP IN CHILDREN NHS ENGLAND PLATELET DISORDER DRUGS AS PER ADULT TA 293 NICE NICE NICE AUDIT √ HIV IN COMBINATION WITH OTHER ANTI- ELVITEGRAVIR NHS ENGLAND AIDS/HIV ANTIRETROVIRALS AGREED REGIONALGUIDELINES NHS ENGLAND POLICY NHS ENGLAND POLICY HARS DATASET √ RETROVIRAL DRUGS HIV IN COMBINATION WITH OTHER ANTI- ELVUCITABINE NHS ENGLAND AIDS/HIV ANTIRETROVIRALS NOT ROUTINELY COMMISSIONED AS PER IFR APPROVAL AS PER IFR APPROVAL AS PER IFR APPROVAL √ RETROVIRAL DRUGS NON-ALCOHOLIC STEATOHEPATITIS DRUGS USED IN METABOLIC EMRICASAN NHS ENGLAND NOT ROUTINELY COMMISSIONED AS PER IFR APPROVAL AS PER IFR APPROVAL AS PER IFR APPROVAL √ (NASH) FIBROSIS DISORDERS HIV IN COMBINATION WITH OTHER ANTI- EMTRICITABINE NHS ENGLAND AIDS/HIV ANTIRETROVIRALS AGREED REGIONALGUIDELINES BHIVA GUIDELINES (8) BHIVA GUIDELINES (8) HARS DATASET √ RETROVIRAL DRUGS HIV IN COMBINATION WITH OTHER ANTI- EMTRICITABINE +TENOFOVIR NHS ENGLAND AIDS/HIV ANTIRETROVIRALS AGREED REGIONALGUIDELINES BHIVA GUIDELINES (8) BHIVA GUIDELINES (8) HARS DATASET √ RETROVIRAL DRUGS EMTRICITABINE + TENOFOVIR HIV IN COMBINATION WITH OTHER ANTI- NHS ENGLAND CLINICAL NHS ENGLAND AIDS/HIV ANTIRETROVIRALS NHS ENGLAND POLICY NHS ENGLAND POLICY HARS DATASET √ ALAFENAMIDE DESCOVY® RETROVIRAL DRUGS COMMISSIONING POLICY: 16043/P EMTRICITABINE + RILPIVIRINE + HIV IN COMBINATION WITH OTHER ANTI- NHS ENGLAND CLINICAL TENOFOVIR ALAFENAMIDE NHS ENGLAND AIDS/HIV ANTIRETROVIRALS NHS ENGLAND POLICY NHS ENGLAND POLICY HARS DATASET √ RETROVIRAL DRUGS COMMISSIONING POLICY: 16043/P (ODEFSEY®) HIV IN COMBINATION WITH OTHER ANTI- ENFUVIRTIDE NHS ENGLAND AIDS/HIV ANTIRETROVIRALS AGREED REGIONALGUIDELINES BHIVA GUIDELINES (8) BHIVA GUIDELINES (8) HARS DATASET √ RETROVIRAL DRUGS VIRAL HEPATITIS (B&C) & ENTECAVIR HEPATITIS B NHS ENGLAND TA153 & IN PROGRESS NICE NICE NICE AUDIT √ RESPIRATORY SYNCYTIAL VIRUS TA316, TA 377 (SEE ALSO SSC1439) NICE/NHS ENGLAND POLICY NICE ENZALUTAMIDE CANCER NHS ENGLAND HORMONE ANTAGONISTS BOTH: ONLY IN ABIRATERONE NAÏVE SACT √ PATIENTS VASODILATOR ANTIHYPERTENSIVE PULMONARY ARTERIAL NHS ENGLAND CLINICAL EPOPROSTENOL (5) NHS ENGLAND DRUGS/PULMANORY ARTERIAL NHS ENGLAND POLICY NHS ENGLAND POLICY AS PER POLICY √ HYPERTENSION COMMISSIONING POLICY: A11/P/c HYPERTENSION EPRATUZUMAB SLE NHS ENGLAND CYTOKINE MODULATORS NOT ROUTINELY COMMISSIONED AS PER IFR APPROVAL AS PER IFR APPROVAL AS PER IFR APPROVAL √ EPRODISATE AMYLOIDOSIS NHS ENGLAND BLOOD-RELATED PRODUCTS NOT ROUTINELY COMMISSIONED AS PER IFR APPROVAL AS PER IFR APPROVAL AS PER IFR APPROVAL √ EPTOTERMIN ALFA COMPLEX SPINAL SURGERY NHS ENGLAND BONE MORPHOGENETIC PROTEIN NOT ROUTINELY COMMISSIONED AS PER IFR APPROVAL AS PER IFR APPROVAL AS PER IFR APPROVAL √ TA162, TA227, TA 374& IN PROGRESS ERLOTINIB CANCER NHS ENGLAND PROTEIN KINASE INHIBITORS NICE NICE SACT √ NHSE LETTER NHS ENGLAND CLINICAL ETANERCEPT JUVENILE ARTHRITIS-PAEDIATRIC NHS ENGLAND CYTOKINE MODULATORS COMMISSIONING POLICY: E03/P/d; TA NHS ENGLAND POLICY NHS ENGLAND POLICY NHS ENGLAND POLICY √ √ 373 PAEDIATRIC INDICATIONS (WHERE AS PER ADULT TA'S (TA103, TA130, ETANERCEPT NHS ENGLAND CYTOKINE MODULATORS NICE NICE NICE AUDIT √ ADULT TA AVAILABLE) TA143, TA199) ETEPLIRSEN DUCHENNE MUSCULAR DYSTROPHY NHS ENGLAND NEUROMUSCULAR DISORDERS NOT ROUTINELY COMMISSIONED AS PER IFR APPROVAL AS PER IFR APPROVAL AS PER IFR APPROVAL √ HIV IN COMBINATION WITH OTHER ANTI- ETRAVIRINE NHS ENGLAND AIDS/HIV ANTIRETROVIRALS AGREED REGIONALGUIDELINES BHIVA GUIDELINES (8) BHIVA GUIDELINES (8) HARS DATASET √ RETROVIRAL DRUGS PAEDIATRIC INDICATIONS (WHERE DRUGS AFFECTING THE IMMUNE ETROLIZUMAB NHS ENGLAND NOT ROUTINELY COMMISSIONED AS PER IFR APPROVAL AS PER IFR APPROVAL AS PER IFR APPROVAL √ ADULT TA AVAILABLE) RESPONSE NHS ENGLAND/ TA421 NICE NICE EVEROLIMUS (AFINITOR®) CANCER PROTEIN KINASE INHIBITORS SACT √ CDF CDF POLICY CDF CDF PREVENTING ORGAN REJECTION IN NOT ROUTINELY COMMISSIONED EVEROLIMUS (CERTICAN®) NHS ENGLAND PROTEIN KINASE INHIBITORS AS PER IFR APPROVAL AS PER IFR APPROVAL AS PER IFR APPROVAL √ LIVER TRANSPLANTATION (TA348) PREVENTING ORGAN REJECTION IN NOT ROUTINELY COMMISSIONED NHS EVEROLIMUS (CERTICAN®) NHS ENGLAND PROTEIN KINASE INHIBITORS AS PER IFR APPROVAL AS PER IFR APPROVAL AS PER IFR APPROVAL √ HEART TRANSPLANTATION ENGLAND POLICY 16016/P

NHS England drugs-list v11 v4 NHSE Commissioned PbRE Drugv11 4 22/12/2016 SUITABLE FOR SUITABLE FOR SHARED CARE SPECIALIST SHARED CARE BETWEEN PRIOR CENTRE ONLY WITH PRIMARY SPECIALIST MONITORING/AUDIT APPROVAL (includng outreach CARE (IF DRUG NAME INDICATION COMMISSIONER PBR CATEGORY TA/POLICY STARTING CRITERIA STOPPING CRITERIA AND REQUIREMENTS PROFORMA when delivered as SUPPORTED BY SECONDARY REQUIRED part of a provider LOCAL CARE VIA network) PRESCRIBING NETWORK COMMITTEE) MODEL SUBEPENDYMAL GIANT CELL NHS ENGLAND CLINICAL EVEROLIMUS (VOTUBIA®) ASTROCYTOMA (SEGA) ASSOCIATED NHS ENGLAND PROTEIN KINASE INHIBITORS NHS ENGLAND POLICY NHS ENGLAND POLICY NHS ENGLAND POLICY √ √ COMMISSIONING POLICY: 16066/P WITH TUBULAR SCLEROSIS RENAL ANGIOMYOLIPOMA NHS ENGLAND CLINICAL EVEROLIMUS (VOTUBIA®) ASSOCIATED WITH TUBULAR NHS ENGLAND PROTEIN KINASE INHIBITORS COMMISSIONING POLICY STATEMENT NHS ENGLAND POLICY NHS ENGLAND POLICY NHS ENGLAND POLICY √ √ SCLEROSIS B14X09L AS NICE TA 394 HOMOZYGOUS FAMILIAL EVOLOCUMAB NHS ENGLAND LIPID-REGULATING DRUGS (FOLLOW GUIDANCE FOR NICE NICE NICE AUDIT √ HYPERCHOLESTEROLAEMIA HETEROZYGOUS FH)

TREATMENT OF ADULT PATIENTS WITH EX-VIVO EXPANDED AUTOLOGOUS MODERATE TO SEVERE LIMBAL STEM HUMAN CORNEAL EPITHELIAL CELL DEFICIENCY (LSCD), UNILATERAL NHS ENGLAND NOT ROUTINELY COMMISSIONED AS PER IFR APPROVAL AS PER IFR APPROVAL AS PER IFR APPROVAL √ CELLS CONTAINING STEM CELLS OR BILATERAL, DUE TO PHYSICAL OR CHEMICAL OCULAR BURNS

AS PER BCSH GUIDELINES FOR FACTOR IX NHS ENGLAND BLOOD-RELATED PRODUCTS BCSH GUIDELINES BCSH GUIDELINES BCSH GUIDELINES PRODUCTS ON CMU FRAMEWORK √ SPECIALISED INDICATIONS AS PER BCSH GUIDELINES FOR FACTOR VII NHS ENGLAND BLOOD-RELATED PRODUCTS BCSH GUIDELINES BCSH GUIDELINES BCSH GUIDELINES √ SPECIALISED INDICATIONS AS PER BCSH GUIDELINES FOR FACTOR VIIA NHS ENGLAND BLOOD-RELATED PRODUCTS BCSH GUIDELINES BCSH GUIDELINES BCSH GUIDELINES PRODUCTS ON CMU FRAMEWORK √ SPECIALISED INDICATIONS AS PER BCSH GUIDELINES FOR FACTOR VIII NHS ENGLAND BLOOD-RELATED PRODUCTS BCSH GUIDELINES BCSH GUIDELINES BCSH GUIDELINES PRODUCTS ON CMU FRAMEWORK √ SPECIALISED INDICATIONS FACTOR VIII INHIBITOR BYPASSING AS PER BCSH GUIDELINES FOR NHS ENGLAND BLOOD-RELATED PRODUCTS BCSH GUIDELINES BCSH GUIDELINES BCSH GUIDELINES PRODUCTS ON CMU FRAMEWORK √ FACTOR (FEIBA) SPECIALISED INDICATIONS AS PER BCSH GUIDELINES FOR FACTOR XIII NHS ENGLAND BLOOD-RELATED PRODUCTS BCSH GUIDELINES BCSH GUIDELINES BCSH GUIDELINES PRODUCTS ON CMU FRAMEWORK √ SPECIALISED INDICATIONS NOT ROUTINELY COMMISSIONED FAMPRIDINE MULTIPLE SCLEROSIS NHS ENGLAND NEUROMUSCULAR DISORDERS AS PER IFR APPROVAL AS PER IFR APPROVAL AS PER IFR APPROVAL √**** NHS ENGLAND POLICY: 16010/P AS PER BCSH GUIDELINES FOR FIBRINOGEN NHS ENGLAND BLOOD-RELATED PRODUCTS BCSH GUIDELINES BCSH GUIDELINES BCSH GUIDELINES √ SPECIALISED INDICATIONS FIBROBLAST GROWTH FACTOR 1 SOMATOSTATIN ANALOGUE NHS ENGLAND SOMATOSTATIN ANALOGUES NOT ROUTINELY COMMISSIONED AS PER IFR APPROVAL AS PER IFR APPROVAL AS PER IFR APPROVAL √ GENE THERAPY PAEDIATRIC INDICATIONS (WHERE DRUGS AFFECTING THE IMMUNE FILGOTINIB NHS ENGLAND NOT ROUTINELY COMMISSIONED AS PER IFR APPROVAL AS PER IFR APPROVAL AS PER IFR APPROVAL √ ADULT TA AVAILABLE) RESPONSE HIGHLY SPECIALISED HIGHLY SPECIALISED FILGRASTIM BARTH SYNDROME NHS ENGLAND DRUGS USED IN NEUTROPENIA HIGHLY SPECIALISED CRITERIA ONLY √ CRITERIA ONLY CRITERIA ONLY NUMBER OF PATIENTS TREATED PROPORTION GIVEN FOR SPC FILGRASTIM NEUTROPENIA NHS ENGLAND DRUGS USED IN NEUTROPENIA SPC TRUST GUIDELINES TRUST GUIDELINES INDICATIONS WITHIN POLICY √ PRODUCT WITH LOWEST ACQUISITION COST TO BE USED VIRAL HEPATITIS (B&C) & FILIBUVIR HEPATITIS C NHS ENGLAND NOT ROUTINELY COMMISSIONED AS PER IFR APPROVAL AS PER IFR APPROVAL AS PER IFR APPROVAL √ RESPIRATORY SYNCYTIAL VIRUS TA254 FINGOLIMOD MULTIPLE SCLEROSIS NHS ENGLAND IMMUNOMODULATING DRUGS NHS ENGLAND POLICY NHS ENGLAND POLICY NICE AUDIT √ √**** NHS ENGLAND POLICY: D04/P/b ANAEMIAS AND SOME OTHER BLOOD FITUSIRAN HAEMOPHILIA A AND B NHS ENGLAND NOT ROUTINELY COMMISSIONED AS PER IFR APPROVAL AS PER IFR APPROVAL AS PER IFR APPROVAL √ DISORDERS CLINICAL GUIDELINES FOR INTRAVENOUS/SUBCUTANEOUS FLEBOGAMMA AS PER NATIONAL DMP NHS ENGLAND IMMUNOGLOBULIN USE, SECOND NATIONAL GUIDELINES NATIONAL GUIDELINES QUALITY DASHBOARD √ HUMAN NORMAL IMMUNOGLOBULINS EDITION UPDATE (JULY 2011) CLINICAL GUIDELINES FOR INTRAVENOUS/SUBCUTANEOUS FLEBOGAMMADIF AS PER NATIONAL DMP NHS ENGLAND IMMUNOGLOBULIN USE, SECOND NATIONAL GUIDELINES NATIONAL GUIDELINES QUALITY DASHBOARD √ HUMAN NORMAL IMMUNOGLOBULINS EDITION UPDATE (JULY 2011) FORIGERIMOD ACETATE SLE NHS ENGLAND CYTOKINE MODULATORS NOT ROUTINELY COMMISSIONED AS PER IFR APPROVAL AS PER IFR APPROVAL AS PER IFR APPROVAL √ HIV IN COMBINATION WITH OTHER ANTI- FOSAMPRENAVIR NHS ENGLAND AIDS/HIV ANTIRETROVIRALS AGREED REGIONALGUIDELINES BHIVA GUIDELINES (8) BHIVA GUIDELINES (8) HARS DATASET √ RETROVIRAL DRUGS NUMBER OF PATIENTS TREATED FOSCARNET CYTOMEGALOVIRUS NHS ENGLAND CYTOMEGALOVIRUS INFECTION AGREED TRUST GUIDELINES TRUST GUIDELINES TRUST GUIDELINES PROPORTION GIVEN FOR SPC √ INDICATIONS WITHIN POLICY HIV iN COMBINATION WITH OTHER ANTI- FOSTEMSAVIR NHS ENGLAND AIDS/HIV ANTIRETROVIRALS NOT ROUTINELY COMMISSIONED AS PER IFR APPROVAL AS PER IFR APPROVAL AS PER IFR APPROVAL √ RETROVIRAL DRUGS DRUGS USED IN METABOLIC HIGHLY SPECIALISED HIGHLY SPECIALISED GALSULFASE MUCOPOLYSACCHARIDOSIS NHS ENGLAND NHS ENGLAND SERVICE SPECIFICATION HIGHLY SPECIALISED DATABASE √ DISORDERS CRITERIA ONLY CRITERIA ONLY CLINICAL GUIDELINES FOR INTRAVENOUS/SUBCUTANEOUS GAMMAGARD AS PER NATIONAL DMP NHS ENGLAND IMMUNOGLOBULIN USE, SECOND NATIONAL GUIDELINES NATIONAL GUIDELINES QUALITY DASHBOARD √ HUMAN NORMAL IMMUNOGLOBULINS EDITION UPDATE (JULY 2011) CLINICAL GUIDELINES FOR INTRAVENOUS/SUBCUTANEOUS GAMMANORM AS PER NATIONAL DMP NHS ENGLAND IMMUNOGLOBULIN USE, SECOND NATIONAL GUIDELINES NATIONAL GUIDELINES QUALITY DASHBOARD √ HUMAN NORMAL IMMUNOGLOBULINS EDITION UPDATE (JULY 2011) CLINICAL GUIDELINES FOR INTRAVENOUS/SUBCUTANEOUS GAMMAPLEX AS PER NATIONAL DMP NHS ENGLAND IMMUNOGLOBULIN USE, SECOND NATIONAL GUIDELINES NATIONAL GUIDELINES QUALITY DASHBOARD √ HUMAN NORMAL IMMUNOGLOBULINS EDITION UPDATE (JULY 2011) CLINICAL GUIDELINES FOR INTRAVENOUS/SUBCUTANEOUS GAMUNEX AS PER NATIONAL DMP NHS ENGLAND IMMUNOGLOBULIN USE, SECOND NATIONAL GUIDELINES NATIONAL GUIDELINES QUALITY DASHBOARD √ HUMAN NORMAL IMMUNOGLOBULINS EDITION UPDATE (JULY 2011) NUMBER OF PATIENTS TREATED GANCICLOVIR CYTOMEGALOVIRUS NHS ENGLAND CYTOMEGALOVIRUS INFECTION AGREED TRUST GUIDELINES TRUST GUIDELINES TRUST GUIDELINES PROPORTION GIVEN FOR SPC √ INDICATIONS WITHIN POLICY DRUGS AFFECTING THE IMMUNE GANETESPIB CANCER NHS ENGLAND NOT ROUTINELY COMMISSIONED AS PER IFR APPROVAL AS PER IFR APPROVAL SACT √ RESPONSE GEFITINIB CANCER NHS ENGLAND PROTEIN KINASE INHIBITORS TA192 NICE NICE SACT √ GEVOKIZUMAB UVEITIS NHS ENGLAND CYTOKINE MODULATORS NOT ROUTINELY COMMISSIONED AS PER IFR APPROVAL AS PER IFR APPROVAL AS PER IFR APPROVAL √ GLATIRAMER MULTIPLE SCLEROSIS NHS ENGLAND IMMUNOMODULATING DRUGS TA32 & NHS ENGLAND POLICY: D04/P/b NHS ENGLAND POLICY NHS ENGLAND POLICY AS PER NHSE POLICY √ √**** VIRAL HEPATITIS (B&C) & GLECAPREVIR HEPATITIS C NHS ENGLAND NOT ROUTINELY COMMISSIONED AS PER IFR APPROVAL AS PER IFR APPROVAL AS PER IFR APPROVAL √ RESPIRATORY SYNCYTIAL VIRUS METHOTREXATE INDUCED RENAL NHS ENGLAND CLINICAL GLUCARPIDASE NHS ENGLAND POISONING NHS ENGLAND POLICY NHS ENGLAND POLICY NHS ENGLAND POLICY √ DYSFUNCTION COMMISSIONING POLICY: B15/P/a DRUGS USED IN METABOLIC GLYCEROL PHENYLBUTYRATE UREA CYCLE DISORDERS NHS ENGLAND NOT ROUTINELY COMMISSIONED AS PER IFR APPROVAL AS PER IFR APPROVAL AS PER IFR APPROVAL √ DISORDERS GLYCOPEGYLATED FACTOR IX HAEMOPHILIA A NHS ENGLAND BLOOD-RELATED PRODUCTS NOT ROUTINELY COMMISSIONED AS PER IFR APPROVAL AS PER IFR APPROVAL AS PER IFR APPROVAL √ GOLIMUMAB PAEDIATRIC INDICATIONS NHS ENGLAND CYTOKINE MODULATORS AS PER ADULTS TA'S (TA220, TA233) NICE NICE NICE AUDIT √

NHS England drugs-list v11 v4 NHSE Commissioned PbRE Drugv11 5 22/12/2016 SUITABLE FOR SUITABLE FOR SHARED CARE SPECIALIST SHARED CARE BETWEEN PRIOR CENTRE ONLY WITH PRIMARY SPECIALIST MONITORING/AUDIT APPROVAL (includng outreach CARE (IF DRUG NAME INDICATION COMMISSIONER PBR CATEGORY TA/POLICY STARTING CRITERIA STOPPING CRITERIA AND REQUIREMENTS PROFORMA when delivered as SUPPORTED BY SECONDARY REQUIRED part of a provider LOCAL CARE VIA network) PRESCRIBING NETWORK COMMITTEE) MODEL GRANULOCYTE-MACROPHAGE ANTIBODY-POSITIVE PULMONARY COLONY-STIMULATING FACTOR NHS ENGLAND DRUGS USED IN NEUTROPENIA NOT ROUTINELY COMMISSIONED AS PER IFR APPROVAL AS PER IFR APPROVAL AS PER IFR APPROVAL √ ALVEOLAR PROTEINOSIS (LEUKINE® - IMPORT) GRAZOPREVIR VIRAL HEPATITIS (B&C) & HEPATITIS C NHS ENGLAND TA 413 AS PER RUN RATE CARD AS PER RUN RATE CARD HEPATITIS C MDS √ √ RESPIRATORY SYNCYTIAL VIRUS HIV VACCINE HIV INFECTION PROPHYLAXIS NHS ENGLAND VACCINES AND ANTISERA NOT ROUTINELY COMMISSIONED AS PER IFR APPROVAL AS PER IFR APPROVAL AS PER IFR APPROVAL √ CLINICAL GUIDELINES FOR INTRAVENOUS/SUBCUTANEOUS HIZENTRA AS PER NATIONAL DMP NHS ENGLAND IMMUNOGLOBULIN USE, SECOND NATIONAL GUIDELINES NATIONAL GUIDELINES QUALITY DASHBOARD √ HUMAN NORMAL IMMUNOGLOBULINS EDITION UPDATE (JULY 2011) DRUGS USED IN METABOLIC HIGHLY SPECIALISED HIGHLY SPECIALISED HUMAN (HAEM) ARGINATE HEPATIC PORPHYRIA NHS ENGLAND NHS ENGLAND SERVICE SPECIFICATION HIGHLY SPECIALISED DATABASE √ DISORDERS CRITERIA ONLY CRITERIA ONLY HUMAN HETEROLOGOUS LIVER DRUGS USED IN METABOLIC UREA CYCLE DISORDERS NHS ENGLAND NOT ROUTINELY COMMISSIONED AS PER IFR APPROVAL AS PER IFR APPROVAL AS PER IFR APPROVAL √ CELLS DISORDERS HUMAN PARATHYROID HORMONE- MALE AND JUVENILE OSTEOPOROSIS DRUGS AFFECTING BONE NHS ENGLAND NOT ROUTINELY COMMISSIONED AS PER IFR APPROVAL AS PER IFR APPROVAL AS PER IFR APPROVAL √ RELATED PROTEIN ANALOGUE HYPOPARATHYROIDISM METABOLISM

INTRAVENOUS/SUBCUTANEOUS HYQVIA AS PER NATIONAL DMP NHS ENGLAND NOT ROUTINELY COMMISSIONED AS PER IFR APPROVAL AS PER IFR APPROVAL AS PER IFR APPROVAL √ HUMAN NORMAL IMMUNOGLOBULINS HIV iN COMBINATION WITH OTHER ANTI- IBALIZUMAB NHS ENGLAND AIDS/HIV ANTIRETROVIRALS NOT ROUTINELY COMMISSIONED AS PER IFR APPROVAL AS PER IFR APPROVAL AS PER IFR APPROVAL √ RETROVIRAL DRUGS HEREDITARY ANGIOEDEMA - ACUTE NHS ENGLAND CLINICAL ICATIBANT NHS ENGLAND ALLERGIC EMERGENCIES NHS ENGLAND POLICY NHS ENGLAND POLICY AS PER POLICY √ TREATMENT ONLY COMMISSIONING POLICY: B09/P/b HEREDUTARY ANGIOEDEMA - NHS ENGLAND CLINICAL ICATIBANT NHS ENGLAND ALLERGIC EMERGENCIES NHS ENGLAND POLICY NHS ENGLAND POLICY AS PER POLICY √ √ PROPHYLACTIC TREATMENT COMMISSIONING POLICY: 16045/P IDEBENONE DUCHENNE MUSCULAR DYSTROPHY NHS ENGLAND NEUROMUSCULAR DISORDERS NOT ROUTINELY COMMISSIONED AS PER IFR APPROVAL AS PER IFR APPROVAL AS PER IFR APPROVAL √ DRUGS USED IN METABOLIC HIGHLY SPECIALISED HIGHLY SPECIALISED IDURSULFASE MUCOPOLYSACCHARIDOSIS NHS ENGLAND NHS ENGLAND SERVICE SPECIFICATION HIGHLY SPECIALISED DATABASE √ DISORDERS CRITERIA ONLY CRITERIA ONLY VASODILATOR ANTIHYPERTENSIVE PULMONARY ARTERIAL NHS ENGLAND CLINICAL ILOPROST (5) NHS ENGLAND DRUGS/PULMANORY ARTERIAL NHS ENGLAND POLICY NHS ENGLAND POLICY AS PER POLICY √ HYPERTENSION COMMISSIONING POLICY: A11/P/c HYPERTENSION IMATINIB CANCER NHS ENGLAND PROTEIN KINASE INHIBITORS TA70, TA86, TA251, TA326 NICE NICE SACT √ IMATINIB GRAFT VERSUS HOST DISEASE NHS ENGLAND CYTOKINE MODULATORS NOT ROUTINELY COMMISSIONED AS PER IFR APPROVAL AS PER IFR APPROVAL AS PER IFR APPROVAL √ DRUGS USED IN METABOLIC HIGHLY SPECIALISED HIGHLY SPECIALISED IMIGLUCERASE GAUCHER'S DISEASE NHS ENGLAND NHS ENGLAND SERVICE SPECIFICATION HIGHLY SPECIALISED DATABASE √ DISORDERS CRITERIA ONLY CRITERIA ONLY HIV IN COMBINATION WITH OTHER ANTI- INDINAVIR NHS ENGLAND AIDS/HIV ANTIRETROVIRALS AGREED REGIONALGUIDELINES BHIVA GUIDELINES (8) BHIVA GUIDELINES (8) HARS DATASET √ RETROVIRAL DRUGS NHS ENGLAND CLINICAL INFLIXIMAB JUVENILE ARTHRITIS-PAEDIATRIC NHS ENGLAND CYTOKINE MODULATORS NHS ENGLAND POLICY NHS ENGLAND POLICY NHS ENGLAND POLICY √ √ COMMISSIONING POLICY: E03/P/d NOT ROUTINELY COMMISSIONED (NHS ENGLAND CLINICAL INFLIXIMAB UVEITIS NHS ENGLAND CYTOKINE MODULATORS AS PER IFR APPROVAL AS PER IFR APPROVAL AS PER IFR APPROVAL √ COMMISSIONING POLICY: D12/P/a & D12/P/a) PAEDIATRIC INDICATIONS (WHERE AS PER ADULT TA'S (TA130, TA134, INFLIXIMAB NHS ENGLAND CYTOKINE MODULATORS NICE NICE NICE AUDIT √ ADULT TA AVAILABLE) TA140, TA143, TA163, TA199) CONNECTIVE TISSUE DISEASE - NOT ROUTINELY COMMISSIONED - INFLIXIMAB NHS ENGLAND CYTOKINE MODULATORS AS PER IFR APPROVAL AS PER IFR APPROVAL AS PER IFR APPROVAL √ INTERSTITAL LUNG DISEASE POLICY IN PROGRESS INFLIXIMAB CROHN'S DISEASE IN CHILDREN NHS ENGLAND CYTOKINE MODULATORS TA187 NICE NICE NICE AUDIT √ INFLIXIMAB GRAFT VERSUS HOST DISEASE NHS ENGLAND CYTOKINE MODULATORS NOT ROUTINELY COMMISSIONED AS PER IFR APPROVAL AS PER IFR APPROVAL AS PER IFR APPROVAL √ INFLIXIMAB RENAL NHS ENGLAND CYTOKINE MODULATORS NOT ROUTINELY COMMISSIONED AS PER IFR APPROVAL AS PER IFR APPROVAL AS PER IFR APPROVAL √ INFLIXIMAB SARCOIDOSIS NHS ENGLAND CYTOKINE MODULATORS NOT ROUTINELY COMMISSIONED AS PER IFR APPROVAL AS PER IFR APPROVAL AS PER IFR APPROVAL √ NOT ROUTINELY COMMISSIONED - NHS INFLIXIMAB HIDRADENITIS SUPPURATIVA NHS ENGLAND CYTOKINE MODULATORS AS PER IFR APPROVAL AS PER IFR APPROVAL AS PER IFR APPROVAL √ ENGLAND POLICY 16018/P HIGHLY SPECIALISED HIGHLY SPECIALISED INFLIXIMAB BEHCETS SYNDROME NHS ENGLAND CYTOKINE MODULATORS HIGHLY SPECIALISED CRITERIA ONLY HIGHLY SPECIALISED CRITERIA √ CRITERIA ONLY CRITERIA ONLY INTERFERON ALFA HEPATITIS B AND C NHS ENGLAND IMMUNOMODULATING DRUGS TA75 NICE NICE NICE AUDIT √ TA32 INTERFERON BETA MULTIPLE SCLEROSIS NHS ENGLAND IMMUNOMODULATING DRUGS NHS ENGLAND POLICY NHS ENGLAND POLICY AS PER NHSE POLICY √ √**** NHS ENGLAND POLICY: D04/P/b CLINICAL GUIDELINES FOR INTRAVENOUS/SUBCUTANEOUS INTRATECT AS PER NATIONAL DMP NHS ENGLAND IMMUNOGLOBULIN USE, SECOND NATIONAL GUIDELINES NATIONAL GUIDELINES QUALITY DASHBOARD √ HUMAN NORMAL IMMUNOGLOBULINS EDITION UPDATE (JULY 2011) NUMBER OF PATIENTS TREATED FUNGAL INFECTION (LICENSED ISAVUCONAZOLE NHS ENGLAND ANTIFUNGALS AGREED TRUST GUIDELINES TRUST GUIDELINES TRUST GUIDELINES PROPORTION GIVEN FOR SPC √ INDICATIONS) INDICATIONS WITHIN POLICY NHS ENGLAND CLINICAL IVACAFTOR CYSTIC FIBROSIS NHS ENGLAND MUCOLYTICS COMMISSIONING POLICY: A01/P/c, NHS ENGLAND POLICY NHS ENGLAND POLICY NHS ENGLAND POLICY √ 16049/P IXAZOMIB AMYLOIDOSIS/ MULTIPLE MYELOMA NHS ENGLAND BLOOD-RELATED PRODUCTS NOT ROUTINELY COMMISSIONED AS PER IFR APPROVAL AS PER IFR APPROVAL AS PER IFR APPROVAL √ CLINICAL GUIDELINES FOR INTRAVENOUS/SUBCUTANEOUS KIOVIG AS PER NATIONAL DMP NHS ENGLAND IMMUNOGLOBULIN USE, SECOND NATIONAL GUIDELINES NATIONAL GUIDELINES QUALITY DASHBOARD √ HUMAN NORMAL IMMUNOGLOBULINS EDITION UPDATE (JULY 2011) VIRAL HEPATITIS (B&C) & LAMIVUDINE HEPATITIS B NHS ENGLAND CG165 NICE NICE NICE AUDIT √ RESPIRATORY SYNCYTIAL VIRUS HIV IN COMBINATION WITH OTHER ANTI- LAMIVUDINE NHS ENGLAND AIDS/HIV ANTIRETROVIRALS AGREED REGIONALGUIDELINES BHIVA GUIDELINES (8) BHIVA GUIDELINES (8) HARS DATASET √ RETROVIRAL DRUGS PRODUCT WITH LOWEST LANREOTIDE CANCER NHS ENGLAND SOMATOSTATIN ANALOGUES AGREED TRUST GUIDELINES TRUST GUIDELINES TRUST GUIDELINES √ PROCUREMENT COST TO BE USED HIGHLY SPECIALISED HIGHLY SPECIALISED LANREOTIDE CONGENITAL HYPERINSULINISM NHS ENGLAND SOMATOSTATIN ANALOGUES HIGHLY SPECIALISED CRITERIA ONLY √ CRITERIA ONLY CRITERIA ONLY PRODUCT WITH LOWEST LANREOTIDE*** ACROMEGALY NHS ENGLAND SOMATOSTATIN ANALOGUES AGREED TRUST GUIDELINES TRUST GUIDELINES TRUST GUIDELINES √ √ PROCUREMENT COST TO BE USED LAPATINIB CANCER CDF PROTEIN KINASE INHIBITORS NOT ROUTINELY COMMISSIONED CDIFR CDIFR SACT √ LAQUINIMOD MULTIPLE SCLEROSIS NHS ENGLAND IMMUNOMODULATING DRUGS NOT ROUTINELY COMMISSIONED AS PER IFR APPROVAL AS PER IFR APPROVAL AS PER IFR APPROVAL √**** DRUGS USED IN METABOLIC HIGHLY SPECIALISED HIGHLY SPECIALISED LARONIDASE MUCOPOLYSACCHARIDOSIS NHS ENGLAND NHS ENGLAND SERVICE SPECIFICATION HIGHLY SPECIALISED DATABASE √ DISORDERS CRITERIA ONLY CRITERIA ONLY LEBRIKIZUMAB ASTHMA NHS ENGLAND ALLERGEN IMMUNOTHERAPY NOT ROUTINELY COMMISSIONED AS PER IFR APPROVAL AS PER IFR APPROVAL AS PER IFR APPROVAL √ NHS ENGLAND/ TA171, TA322 NICE NICE LENALIDOMIDE CANCER IMMUNOMODULATING DRUGS SACT √ CDF CDF POLICY CDF CDF

NHS England drugs-list v11 v4 NHSE Commissioned PbRE Drugv11 6 22/12/2016 SUITABLE FOR SUITABLE FOR SHARED CARE SPECIALIST SHARED CARE BETWEEN PRIOR CENTRE ONLY WITH PRIMARY SPECIALIST MONITORING/AUDIT APPROVAL (includng outreach CARE (IF DRUG NAME INDICATION COMMISSIONER PBR CATEGORY TA/POLICY STARTING CRITERIA STOPPING CRITERIA AND REQUIREMENTS PROFORMA when delivered as SUPPORTED BY SECONDARY REQUIRED part of a provider LOCAL CARE VIA network) PRESCRIBING NETWORK COMMITTEE) MODEL NUMBER OF PATIENTS TREATED PROPORTION GIVEN FOR SPC LENOGRASTIM NEUTROPENIA NHS ENGLAND DRUGS USED IN NEUTROPENIA SPC TRUST GUIDELINES TRUST GUIDELINES INDICATIONS WITHIN POLICY √ PRODUCT WITH LOWEST ACQUISITION COST TO BE USED HIGHLY SPECIALISED HIGHLY SPECIALISED LENOGRASTIM BARTH SYNDROME NHS ENGLAND DRUGS USED IN NEUTROPENIA HIGHLY SPECIALISED CRITERIA ONLY √ CRITERIA ONLY CRITERIA ONLY LETERMOVIR CYTOMEGALOVIRUS NHS ENGLAND CYTOMEGALOVIRUS INFECTION NOT ROUTINELY COMMISSIONED AS PER IFR APPROVAL AS PER IFR APPROVAL AS PER IFR APPROVAL √ LEVOFLOXACIN (INHALED) CYSTIC FIBROSIS NHS ENGLAND ANTIBACTERIAL DRUGS NOT ROUTINELY COMMISSIONED AS PER IFR APPROVAL AS PER IFR APPROVAL AS PER IFR APPROVAL √ NOT ROUTINELY COMMISSIONED - LIPEGFILGRASTIM NEUTROPENIA NHS ENGLAND DRUGS USED IN NEUTROPENIA AS PER IFR APPROVAL AS PER IFR APPROVAL AS PER IFR APPROVAL √ POLICY IN PROGRESS HYPONATRAEMIA AND OTHER POSTERIOR PITUITARY HORMONES LIXIVAPTAN NHS ENGLAND NOT ROUTINELY COMMISSIONED AS PER IFR APPROVAL AS PER IFR APPROVAL AS PER IFR APPROVAL √ ENDOCRINE USES AND ANTAGONISTS HOMOZYGOUS FAMILIAL LOMITAPIDE NHS ENGLAND LIPID-REGULATING DRUGS NOT ROUTINELY COMMISSIONED AS PER IFR APPROVAL AS PER IFR APPROVAL AS PER IFR APPROVAL √ HYPERCHOLESTEROLEMIA LONAFARNIB CANCER NHS ENGLAND PROTEIN KINASE INHIBITORS NOT ROUTINELY COMMISSIONED AS PER IFR APPROVAL AS PER IFR APPROVAL AS PER IFR APPROVAL √ HIV IN COMBINATION WITH OTHER ANTI- LOPINAVIR + RITONAVIR NHS ENGLAND AIDS/HIV ANTIRETROVIRALS AGREED REGIONALGUIDELINES BHIVA GUIDELINES (8) BHIVA GUIDELINES (8) HARS DATASET √ RETROVIRAL DRUGS NOT ROUTINELY COMMISSIONED LUMACAFTOR AND IVACAFTOR CYSTIC FIBROSIS NHS ENGLAND MUCOLYTICS AS PER IFR APPROVAL AS PER IFR APPROVAL AS PER IFR APPROVAL √ TA IN PROGRESS GROWTH HORMONE & GROWTH MACIMORELIN GROWTH FAILURE NHS ENGLAND NOT ROUTINELY COMMISSIONED AS PER IFR APPROVAL AS PER IFR APPROVAL AS PER IFR APPROVAL √ HORMONE RECEPTOR ANTAGONIST

VASODILATOR ANTIHYPERTENSIVE PULMONARY ARTERIAL NHS ENGLAND CLINICAL MACITENTAN NHS ENGLAND DRUGS/PULMANORY ARTERIAL AS PER IFR APPROVAL AS PER IFR APPROVAL AS PER IFR APPROVAL √ HYPERTENSION COMMISSIONING POLICY: A11/P/c HYPERTENSION NHS ENGLAND CLINICAL NHS ENGLAND POLICY NHS ENGLAND POLICY NHS ENGLAND POLICY MANNITOL CYSTIC FIBROSIS NHS ENGLAND MUCOLYTICS COMMISSIONING POLICY: A01/P/b √ NICE NICE NICE AUDIT TA266 HIV IN COMBINATION WITH OTHER ANTI- MARAVIROC NHS ENGLAND AIDS/HIV ANTIRETROVIRALS AGREED REGIONALGUIDELINES BHIVA GUIDELINES (8) BHIVA GUIDELINES (8) HARS DATASET √ RETROVIRAL DRUGS MASITINIB PANCREATIC CANCER/GIST NHS ENGLAND PROTEIN KINASE INHIBITORS NOT ROUTINELY COMMISSIONED AS PER IFR APPROVAL AS PER IFR APPROVAL AS PER IFR APPROVAL √ PAEDIATRIC INDICATIONS (WHERE DRUGS AFFECTING THE IMMUNE MAVRILIMUMAB NHS ENGLAND NOT ROUTINELY COMMISSIONED AS PER IFR APPROVAL AS PER IFR APPROVAL AS PER IFR APPROVAL √ ADULT TA AVAILABLE) RESPONSE GROWTH HORMONE & GROWTH NHS ENGLAND CLINICAL MECASERMIN GROWTH FAILURE NHS ENGLAND NHS ENGLAND POLICY NHS ENGLAND POLICY AS PER POLICY √ HORMONE RECEPTOR ANTAGONIST COMMISSIONING POLICY: EO3/P/a NOT ROUTINELY COMMISSIONED MEPOLIZUMAB ASTHMA NHS ENGLAND ALLERGEN IMMUNOTHERAPY AS PER IFR APPROVAL AS PER IFR APPROVAL AS PER IFR APPROVAL √ TA IN PROGRESS METRELEPTIN DYSLIPIDAEMIA NHS ENGLAND OTHER ENDOCRINE DRUGS NOT ROUTINELY COMMISSIONED AS PER IFR APPROVAL AS PER IFR APPROVAL AS PER IFR APPROVAL √ NUMBER OF PATIENTS TREATED MICAFUNGIN FUNGAL INFECTION NHS ENGLAND ANTIFUNGALS AGREED TRUST GUIDELINES TRUST GUIDELINES TRUST GUIDELINES PROPORTION GIVEN FOR SPC √ INDICATIONS WITHIN POLICY DRUGS USED IN METABOLIC HIGHLY SPECIALISED HIGHLY SPECIALISED MIGALASTAT FABRY'S DISEASE NHS ENGLAND NHS ENGLAND SERVICE SPECIFICATION HIGHLY SPECIALISED DATABASE √ DISORDERS CRITERIA ONLY CRITERIA ONLY DRUGS USED IN METABOLIC HIGHLY SPECIALISED HIGHLY SPECIALISED MIGLUSTAT GAUCHER'S DISEASE/ NIEMANN-PICK NHS ENGLAND NHS ENGLAND SERVICE SPECIFICATION HIGHLY SPECIALISED DATABASE √ DISORDERS CRITERIA ONLY CRITERIA ONLY MOMELOTINIB CANCER NHS ENGLAND PROTEIN KINASE INHIBITORS NOT ROUTINELY COMMISSIONED AS PER IFR APPROVAL AS PER IFR APPROVAL AS PER IFR APPROVAL √ VIRAL HEPATITIS (B&C) & MOTAVIZUMAB RSV PROPHYLAXIS NHS ENGLAND NOT ROUTINELY COMMISSIONED AS PER IFR APPROVAL AS PER IFR APPROVAL AS PER IFR APPROVAL √ RESPIRATORY SYNCYTIAL VIRUS TA127 NATALIZUMAB MULTIPLE SCLEROSIS NHS ENGLAND IMMUNOMODULATING DRUGS NHS ENGLAND POLICY NHS ENGLAND POLICY NICE AUDIT √ √**** NHS ENGLAND POLICY: D04/P/b HIV IN COMBINATION WITH OTHER ANTI- NELFINAVIR NHS ENGLAND AIDS/HIV ANTIRETROVIRALS AGREED REGIONALGUIDELINES BHIVA GUIDELINES (8) BHIVA GUIDELINES (8) HARS DATASET √ RETROVIRAL DRUGS HIV IN COMBINATION WITH OTHER ANTI- NEVIRAPINE NHS ENGLAND AIDS/HIV ANTIRETROVIRALS AGREED REGIONALGUIDELINES BHIVA GUIDELINES (8) BHIVA GUIDELINES (8) HARS DATASET √ RETROVIRAL DRUGS NILOTINIB CANCER NHS ENGLAND PROTEIN KINASE INHIBITORS TA241, TA251 NICE NICE SACT √ NINTEDANIB OVARIAN CANCER NHS ENGLAND IMMUNOMODULATING DRUGS NOT ROUTINELY COMMISSIONED CDIFR CDIFR SACT √ NINTEDANIB (OFEV®) IDIOPATHIC PULMONARY FIBROSIS NHS ENGLAND IMMUNOMODULATING DRUGS TA 379 NICE NICE NICE AUDIT √ √ NINTEDANIB (VARGATEF®) NON-SMALL-CELL LUNG CANCER NHS ENGLAND IMMUNOMODULATING DRUGS TA347 NICE NICE SACT √ VIRAL HEPATITIS (B&C) & NITAZOXANIDE HEPATITIS C NHS ENGLAND NOT ROUTINELY COMMISSIONED AS PER IFR APPROVAL AS PER IFR APPROVAL AS PER IFR APPROVAL √ RESPIRATORY SYNCYTIAL VIRUS DRUGS USED IN METABOLIC HIGHLY SPECIALISED HIGHLY SPECIALISED NITISINONE ALKAPTONURIA NHS ENGLAND NHS ENGLAND SERVICE SPECIFICATION HIGHLY SPECIALISED DATABASE √ DISORDERS CRITERIA ONLY CRITERIA ONLY DRUGS USED IN METABOLIC HIGHLY SPECIALISED HIGHLY SPECIALISED NITISINONE TYROSINAEMIA NHS ENGLAND NHS ENGLAND SERVICE SPECIFICATION HIGHLY SPECIALISED DATABASE √ DISORDERS CRITERIA ONLY CRITERIA ONLY VASODILATOR ANTIHYPERTENSIVE PULMONARY ARTERIAL NITRIC OXIDE NHS ENGLAND DRUGS/PULMANORY ARTERIAL AGREED TRUST GUIDELINES TRUST GUIDELINES TRUST GUIDELINES √ HYPERTENSION HYPERTENSION NONACOG ALPHA (BeneFIX) HAEMOPHILIA B NHS ENGLAND BLOOD-RELATED PRODUCTS BCSH GUIDELINES BCSH GUIDELINES BCSH GUIDELINES √ NONACOG BETA PEGOL HAEMOPHILIA B NHS ENGLAND BLOOD-RELATED PRODUCTS NOT ROUTINELY COMMISSIONED AS PER IFR APPROVAL AS PER IFR APPROVAL AS PER IFR APPROVAL √ CLINICAL GUIDELINES FOR INTRAVENOUS/SUBCUTANEOUS NORMAL IMMUNOGLOBULIN AS PER NATIONAL DMP NHS ENGLAND IMMUNOGLOBULIN USE, SECOND NATIONAL GUIDELINES NATIONAL GUIDELINES QUALITY DASHBOARD √ HUMAN NORMAL IMMUNOGLOBULINS EDITION UPDATE (JULY 2011) DRUGS USED IN METABOLIC OBETICHOLIC ACID PRIMARY BILIARY CIRRHOSIS NHS ENGLAND NOT ROUTINELY COMMISSIONED AS PER IFR APPROVAL AS PER IFR APPROVAL AS PER IFR APPROVAL √ DISORDERS DRUGS AFFECTING THE IMMUNE OCRELIZUMAB MULTIPLE SCLEROSIS NHS ENGLAND NOT ROUTINELY COMMISSIONED AS PER IFR APPROVAL AS PER IFR APPROVAL AS PER IFR APPROVAL √ RESPONSE CLINICAL GUIDELINES FOR INTRAVENOUS/SUBCUTANEOUS OCTAGAM AS PER NATIONAL DMP NHS ENGLAND IMMUNOGLOBULIN USE, SECOND NATIONAL GUIDELINES NATIONAL GUIDELINES QUALITY DASHBOARD √ HUMAN NORMAL IMMUNOGLOBULINS EDITION UPDATE (JULY 2011) OCTOCOG ALFA HAEMOPHILIA A NHS ENGLAND BLOOD-RELATED PRODUCTS NOT ROUTINELY COMMISSIONED AS PER IFR APPROVAL AS PER IFR APPROVAL AS PER IFR APPROVAL √

GROWTH HORMONE & GROWTH OCTREOLIN ACROMEGALY NHS ENGLAND NOT ROUTINELY COMMISSIONED AS PER IFR APPROVAL AS PER IFR APPROVAL AS PER IFR APPROVAL √ HORMONE RECEPTOR ANTAGONIST

PRODUCT WITH LOWEST OCTREOTIDE CANCER NHS ENGLAND SOMATOSTATIN ANALOGUES AGREED TRUST GUIDELINES TRUST GUIDELINES TRUST GUIDELINES √ PROCUREMENT COST TO BE USED HIGHLY SPECIALISED HIGHLY SPECIALISED OCTREOTIDE CONGENITAL HYPERINSULINISM NHS ENGLAND SOMATOSTATIN ANALOGUES HIGHLY SPECIALISED CRITERIA ONLY √ CRITERIA ONLY CRITERIA ONLY PRODUCT WITH LOWEST OCTREOTIDE*** ACROMEGALY NHS ENGLAND SOMATOSTATIN ANALOGUES AGREED TRUST GUIDELINES TRUST GUIDELINES TRUST GUIDELINES √ PROCUREMENT COST TO BE USED

NHS England drugs-list v11 v4 NHSE Commissioned PbRE Drugv11 7 22/12/2016 SUITABLE FOR SUITABLE FOR SHARED CARE SPECIALIST SHARED CARE BETWEEN PRIOR CENTRE ONLY WITH PRIMARY SPECIALIST MONITORING/AUDIT APPROVAL (includng outreach CARE (IF DRUG NAME INDICATION COMMISSIONER PBR CATEGORY TA/POLICY STARTING CRITERIA STOPPING CRITERIA AND REQUIREMENTS PROFORMA when delivered as SUPPORTED BY SECONDARY REQUIRED part of a provider LOCAL CARE VIA network) PRESCRIBING NETWORK COMMITTEE) MODEL OFATUMUMAB CANCER NHS ENGLAND IMMUNOMODULATING DRUGS TA344 NICE NICE SACT √ OFATUMUMAB PEMPHIGUS VULGARIS NHS ENGLAND CYTOKINE MODULATORS NOT ROUTINELY COMMISSIONED AS PER IFR APPROVAL AS PER IFR APPROVAL AS PER IFR APPROVAL √ OLESOXIME SPINAL MUSCULAR ATROPHY NHS ENGLAND NEUROMUSCULAR DISORDERS NOT ROUTINELY COMMISSIONED AS PER IFR APPROVAL AS PER IFR APPROVAL AS PER IFR APPROVAL √ OMALIZUMAB ASTHMA NHS ENGLAND ALLERGEN IMMUNOTHERAPY TA278 NICE NICE NICE AUDIT √ √ OMBITASVIR/PARITAPREVIR/RITON VIRAL HEPATITIS (B&C) & HEPATITIS C NHS ENGLAND TA 365 AS PER RUN RATE CARD AS PER RUN RATE CARD HEPATITIS C MDS √ √ AVIR + DASABUVIR + RIBAVIRIN RESPIRATORY SYNCYTIAL VIRUS OSILODROSTAT CUSHING'S DISEASE NHS ENGLAND OTHER ENDOCRINE DRUGS NOT ROUTINELY COMMISSIONED AS PER IFR APPROVAL AS PER IFR APPROVAL AS PER IFR APPROVAL √ OZANIMOD MULTIPLE SCLEROSIS NHS ENGLAND IMMUNOMODULATING DRUGS NOT ROUTINELY COMMISSIONED AS PER IFR APPROVAL AS PER IFR APPROVAL AS PER IFR APPROVAL √ PACRITINIB MYELOFIBROSIS NHS ENGLAND PROTEIN KINASE INHIBITORS NOT ROUTINELY COMMISSIONED AS PER IFR APPROVAL AS PER IFR APPROVAL AS PER IFR APPROVAL √ VIRAL HEPATITIS (B&C) & JCVI GUIDELINES PALIVIZUMAB RSV PROPHYLAXIS NHS ENGLAND AS PER SPECIFICATION AS PER SPECIFICATION √ √ RESPIRATORY SYNCYTIAL VIRUS PHE SPECIFICATION PARA-AMINOSALICYLIC ACID TB NHS ENGLAND ANTITUBERCULOSIS DRUGS NOT ROUTINELY COMMISSIONED AS PER IFR APPROVAL AS PER IFR APPROVAL AS PER IFR APPROVAL √ SPECIALIST ENDOCRINOLOGY PARATHYROID HORMONE NHS ENGLAND PARATHYROID HORMONE AGREED TRUST GUIDELINES TRUST GUIDELINES TRUST GUIDELINES √ CONDITIONS PARENTERAL NUTRITION (HOME INTESTINAL FAILURE NHS ENGLAND PARENTERAL NUTRITION AS PER BLUETEQ FORM AS PER BLUETEQ FORM AS PER BLUETEQ FORM AUDIT √ √ USE)

ONLY WHEN DURATION OF PN IS > 14 DAYS OR INITIATED PRIOR TO PARENTERAL NUTRITION INTESTINAL FAILURE; INADEQUATE/ NHS ENGLAND PARENTERAL NUTRITION ADMISSION. ADULTS; SEE ALSO CG32. TRUST GUIDELINES TRUST GUIDELINES √ (INPATIENT USE) UNSAFE ENTERAL FEEDING SEE ALSO 'MANUAL FOR PRESCRIBED SPECIALISED SERVICES'

VIRAL HEPATITIS (B&C) & PARITAPREVIR HEPATITIS C NHS ENGLAND NOT ROUTINELY COMMISSIONED AS PER IFR APPROVAL AS PER IFR APPROVAL AS PER IFR APPROVAL √ RESPIRATORY SYNCYTIAL VIRUS NOT ROUTINELY COMMISSIONED PASIREOTIDE ACROMEGALY NHS ENGLAND SOMATOSTATIN ANALOGUES AS PER IFR APPROVAL AS PER IFR APPROVAL AS PER IFR APPROVAL √ NHS ENGLAND POLICY 16003/P NHS ENGLAND CLINICAL PASIREOTIDE CUSHING'S DISEASE NHS ENGLAND SOMATOSTATIN ANALOGUES NHS ENGLAND POLICY NHS ENGLAND POLICY NHS ENGLAND POLICY √ COMMISSIONING POLICY: 16052/P PAZOPANIB CANCER NHS ENGLAND PROTEIN KINASE INHIBITORS TA215 NICE NICE SACT √ NHS ENGLAND CLINICAL VIRAL HEPATITIS (B&C) & COMMISSIONING POLICY: B07/P/a; TA75, PEG INTERFERON ALFA HEPATITIS B AND C NHS ENGLAND NICE NICE NICE AUDIT √ RESPIRATORY SYNCYTIAL VIRUS TA96, TA106, TA200, TA 300 CG165 NOT ROUTINELY COMMISSIONED - PEGFILGRASTIM NEUTROPENIA NHS ENGLAND DRUGS USED IN NEUTROPENIA AS PER IFR APPROVAL AS PER IFR APPROVAL AS PER IFR APPROVAL √ POLICY IN PROGRESS

ROUTINELY COMMISSIONED AS PER PEGINTERFERON BETA-1A MULTIPLE SCLEROSIS NHS ENGLAND IMMUNOMODULATING DRUGS SSC1534: MULTIPLE SCLEROSIS FIRST NHS ENGLAND POLICY NHS ENGLAND POLICY NICE AUDIT √ √**** LINE DISEASE MODIFYING AGENTS PEGINTERFERON LAMBDA-1A HEPATITIS C NHS ENGLAND IMMUNOMODULATING DRUGS NOT ROUTINELY COMMISSIONED AS PER IFR APPROVAL AS PER IFR APPROVAL AS PER IFR APPROVAL √ HYPOTHALMIC & ANTERIOR NHS ENGLAND CLINICAL PEGVISOMANT ACROMEGALY NHS ENGLAND PITUITARY HORMONES & ANTI- NHS ENGLAND POLICY NHS ENGLAND POLICY NHS ENGLAND POLICY √ COMMISSIONING POLICY: 16050/P OESTROGENS MELANOMA (UNRESECTABLE, PEMBROLIZUMAB NHS ENGLAND CANCER EXCLUSION TA 357 NICE NICE SACT √ METASTATIC) TREATMENT NAÏVE MELANOMA PEMBROLIZUMAB NHS ENGLAND CANCER EXCLUSION TA 366 NICE NICE SACT √ (UNRESECTABLE, METASTATIC) PIRFENIDONE IDIOPATHIC PULMONARY FIBROSIS NHS ENGLAND PULMONARY FIBROSIS TA282 (SPECIALIST CENTRE ONLY) NICE NICE NICE AUDIT √ √ NUMBER OF PATIENTS TREATED NHS ENGLAND CLINICAL DRUGS AFFECTING THE IMMUNE NUMBER OF PATIENTS PLERIXAFOR STEM CELL MOBILISATION NHS ENGLAND COMMISSIONING POLICY: B04/P/b, NHS ENGLAND POLICY NHS ENGLAND POLICY √ √ RESPONSE SUCCESSFULLY TRANSPLANTED 16064/P STAGE DRUG UTILISED POMALIDOMIDE CANCER CDF IMMUNOMODULATING DRUGS CDF POLICY CDF CDF SACT √ POMALIDOMIDE MYELOFIBROSIS NHS ENGLAND IMMUNOMODULATING DRUGS NOT ROUTINELY COMMISSIONED AS PER IFR APPROVAL AS PER IFR APPROVAL AS PER IFR APPROVAL √ PONATINIB CANCER CDF PROTEIN KINASE INHIBITORS CDF POLICY CDF CDF SACT √ DRUGS USED FOR NEUROMUSCULAR PONESIMOD MULTIPLE SCLEROSIS NHS ENGLAND NOT ROUTINELY COMMISSIONED AS PER IFR APPROVAL AS PER IFR APPROVAL AS PER IFR APPROVAL √ DISORDERS PRODUCT WITH LOWEST PORACTANT ALFA RESPIRATORY DISTRESS SYNDROME NHS ENGLAND PULMONARY SURFACTANTS AGREED TRUST GUIDELINES TRUST GUIDELINES TRUST GUIDELINES √ PROCUREMENT COST TO BE USED

NUMBER OF PATIENTS TREATED POSACONAZOLE FUNGAL INFECTION NHS ENGLAND ANTIFUNGALS AGREED TRUST GUIDELINES TRUST GUIDELINES TRUST GUIDELINES PROPORTION GIVEN FOR SPC √ INDICATIONS WITHIN POLICY PRETOMANID MULTI DRUG RESITANT TB NHS ENGLAND ANTITUBERCULOSIS DRUGS NOT ROUTINELY COMMISSIONED AS PER IFR APPROVAL AS PER IFR APPROVAL AS PER IFR APPROVAL √ CLINICAL GUIDELINES FOR INTRAVENOUS/SUBCUTANEOUS PRIVIGEN AS PER NATIONAL DMP NHS ENGLAND IMMUNOGLOBULIN USE, SECOND NATIONAL GUIDELINES NATIONAL GUIDELINES QUALITY DASHBOARD √ HUMAN NORMAL IMMUNOGLOBULINS EDITION UPDATE (JULY 2011) AS PER BCSH GUIDELINES FOR PROTEIN C NHS ENGLAND BLOOD-RELATED PRODUCTS BCSH GUIDELINES BCSH GUIDELINES BCSH GUIDELINES PRODUCTS ON CMU FRAMEWORK √ SPECIALISED INDICATIONS AS PER BCSH GUIDELINES FOR PROTHROMBIN COMPLEX NHS ENGLAND BLOOD-RELATED PRODUCTS BCSH GUIDELINES BCSH GUIDELINES BCSH GUIDELINES PRODUCTS ON CMU FRAMEWORK √ SPECIALISED INDICATIONS HIV IN COMBINATION WITH OTHER ANTI- RALTEGRAVIR NHS ENGLAND AIDS/HIV ANTIRETROVIRALS AGREED REGIONALGUIDELINES BHIVA GUIDELINES (8) BHIVA GUIDELINES (8) HARS DATASET √ RETROVIRAL DRUGS GOUT AND CYTOTOXIC-INDUCED RASBURICASE HYPERURICAEMIA NHS ENGLAND AGREED TRUST GUIDELINES TRUST GUIDELINES TRUST GUIDELINES √ HYPERURICAEMIA REGORAFENIB CANCER CDF PROTEIN KINASE INHIBITORS CDF POLICY CDF CDF SACT √ RESLIZUMAB ASTHMA NHS ENGLAND ALLERGEN IMMUNOTHERAPY NOT ROUTINELY COMMISSIONED AS PER IFR APPROVAL AS PER IFR APPROVAL AS PER IFR APPROVAL √ LYSOSOMAL STORAGE DISORDER REVEGLUCOSIDASE ALFA POMPE DISEASE NHS ENGLAND NOT ROUTINELY COMMISSIONED AS PER IFR APPROVAL AS PER IFR APPROVAL AS PER IFR APPROVAL √ DRUGS

NHS ENGLAND CLINICAL NICE AUDIT VIRAL HEPATITIS (B&C) & RIBAVIRIN HEPATITIS C NHS ENGLAND COMMISSIONING POLICY: B07/P/a; TA75, NICE NICE PRODUCT WITH LOWEST √ RESPIRATORY SYNCYTIAL VIRUS TA106, TA200 PROCUREMENT COST TO BE USED RIGOSERTIB MDS/PANCREATIC CANCER NHS ENGLAND MYELODYSPLASTIC SYNDROME NOT ROUTINELY COMMISSIONED AS PER IFR APPROVAL AS PER IFR APPROVAL AS PER IFR APPROVAL √ CRYOPYRIN-ASSOCIATED PERIODIC RILONACEPT NHS ENGLAND IMMUNOMODULATING DRUGS NOT ROUTINELY COMMISSIONED AS PER IFR APPROVAL AS PER IFR APPROVAL AS PER IFR APPROVAL √ SYNDROMES HIV IN COMBINATION WITH OTHER ANTI- RILPIVIRINE NHS ENGLAND AIDS/HIV ANTIRETROVIRALS AGREED REGIONALGUIDELINES BHIVA GUIDELINES (8) BHIVA GUIDELINES (8) HARS DATASET √ RETROVIRAL DRUGS VASODILATOR ANTIHYPERTENSIVE PULMONARY ARTERIAL NHS ENGLAND CLINICAL RIOCIGUAT NHS ENGLAND DRUGS/PULMANORY ARTERIAL NHS ENGLAND POLICY NHS ENGLAND POLICY NHS ENGLAND POLICY √ HYPERTENSION (CTEPH) COMMISSIONING POLICY: A11/P/c HYPERTENSION VASODILATOR ANTIHYPERTENSIVE PULMONARY ARTERIAL NOT ROUTINELY COMMISSIONED RIOCIGUAT NHS ENGLAND DRUGS/PULMANORY ARTERIAL AS PER IFR APPROVAL AS PER IFR APPROVAL AS PER IFR APPROVAL √ HYPERTENSION NHS ENGLAND POLICY: 16055/P HYPERTENSION

NHS England drugs-list v11 v4 NHSE Commissioned PbRE Drugv11 8 22/12/2016 SUITABLE FOR SUITABLE FOR SHARED CARE SPECIALIST SHARED CARE BETWEEN PRIOR CENTRE ONLY WITH PRIMARY SPECIALIST MONITORING/AUDIT APPROVAL (includng outreach CARE (IF DRUG NAME INDICATION COMMISSIONER PBR CATEGORY TA/POLICY STARTING CRITERIA STOPPING CRITERIA AND REQUIREMENTS PROFORMA when delivered as SUPPORTED BY SECONDARY REQUIRED part of a provider LOCAL CARE VIA network) PRESCRIBING NETWORK COMMITTEE) MODEL HIV IN COMBINATION WITH OTHER ANTI- RITONAVIR NHS ENGLAND AIDS/HIV ANTIRETROVIRALS AGREED REGIONALGUIDELINES BHIVA GUIDELINES (8) BHIVA GUIDELINES (8) HARS DATASET √ RETROVIRAL DRUGS STEROID SENSITIVE NEPHROTIC NHS ENGLAND CLINICAL RITUXIMAB NHS ENGLAND CYTOKINE MODULATORS NHS ENGLAND POLICY NHS ENGLAND POLICY NHS ENGLAND POLICY √ SYNDROME COMMISSIONING POLICY: E03/P/b STEROID RESISTANT NEPHROTIC NHS ENGLAND CLINICAL RITUXIMAB NHS ENGLAND CYTOKINE MODULATORS NHS ENGLAND POLICY NHS ENGLAND POLICY NHS ENGLAND POLICY √ SYNDROME COMMISSIONING POLICY: E03/P/c NOT ROUTINELY COMMISSIONED - RITUXIMAB PRIMARY SJOGREN'S SYNDROME (PSS) NHS ENGLAND CYTOKINE MODULATORS AS PER IFR APPROVAL AS PER IFR APPROVAL AS PER IFR APPROVAL √ POLICY IN PROGRESS CHRONIC INFLAMMATORY NOT ROUTINELY COMMISSIONED - RITUXIMAB NHS ENGLAND CYTOKINE MODULATORS AS PER IFR APPROVAL AS PER IFR APPROVAL AS PER IFR APPROVAL √ DEMYELINATING POLYNEUROPATHY POLICY IN PROGRESS NHS ENGLAND CLINICAL RITUXIMAB JUVENILE ARTHRITIS-PAEDIATRIC NHS ENGLAND CYTOKINE MODULATORS NHS ENGLAND POLICY NHS ENGLAND POLICY NHS ENGLAND POLICY √ √ COMMISSIONING POLICY: E03/P/d NHS ENGLAND CLINICAL RITUXIMAB ACQUIRED HAEMOPHILIA NHS ENGLAND CYTOKINE MODULATORS NHS ENGLAND POLICY NHS ENGLAND POLICY NHS ENGLAND POLICY √ COMMISSIONING POLICY: F02/P/a TA308 NICE/ NHS ENGLAND NICE/ NHS ENGLAND RITUXIMAB ANCA-POSITIVE VASCULITIS NHS ENGLAND CYTOKINE MODULATORS NICE/ NHS ENGLAND POLICY √ NHS ENGLAND POLICY: A13/P/a POLICY POLICY CONNECTIVE TISSUE DISEASE - NOT ROUTINELY COMMISSIONED - RITUXIMAB NHS ENGLAND CYTOKINE MODULATORS AS PER IFR APPROVAL AS PER IFR APPROVAL AS PER IFR APPROVAL √ INTERSTITIAL LUNG DISEASE POLICY IN PROGRESS CYTOPENIA COMPLICATING PRIMARY NHS ENGLAND CLINICAL RITUXIMAB NHS ENGLAND CYTOKINE MODULATORS NHS ENGLAND POLICY NHS ENGLAND POLICY NHS ENGLAND POLICY √ IMMUNODEFICIENCY COMMISSIONING POLICY:16044/P RITUXIMAB GRAFT VERSUS HOST DISEASE NHS ENGLAND CYTOKINE MODULATORS NOT ROUTINELY COMMISSIONED AS PER IFR APPROVAL AS PER IFR APPROVAL AS PER IFR APPROVAL √ NHS ENGLAND CLINICAL RITUXIMAB SLE NHS ENGLAND CYTOKINE MODULATORS NHS ENGLAND POLICY NHS ENGLAND POLICY NHS ENGLAND POLICY √ COMMISSIONING POLICY: A13/PS/a NHS ENGLAND CLINICAL RITUXIMAB MYOSITIS NHS ENGLAND CYTOKINE MODULATORS NHS ENGLAND POLICY NHS ENGLAND POLICY NHS ENGLAND POLICY √ COMMISSIONING POLICY:16035/P RITUXIMAB NEPHRITIS NHS ENGLAND CYTOKINE MODULATORS NOT ROUTINELY COMMISSIONED AS PER IFR APPROVAL AS PER IFR APPROVAL AS PER IFR APPROVAL √ RITUXIMAB NEUROMYELITIS OPTICA NHS ENGLAND CYTOKINE MODULATORS AS PER SPECIFICATION AS PER SPECIFICATION AS PER SPECIFICATION AS PER SPECIFICATION √ ABO-INCOMPATIBLE KIDNEY RITUXIMAB NHS ENGLAND CYTOKINE MODULATORS AS PER SPECIFICATION AS PER SPECIFICATION AS PER SPECIFICATION AS PER SPECIFICATION √ TRANSPLANTS PEMPHIGUS VULGARIS AND NHS ENGLAND CLINICAL RITUXIMAB NHS ENGLAND CYTOKINE MODULATORS NHS ENGLAND POLICY NHS ENGLAND POLICY NHS ENGLAND POLICY √ PEMPHIGOID DISEASE COMMISSIONING POLICY:16035/P NHS ENGLAND CLINICAL RITUXIMAB IMMUNOGLOBIN G4 RELATED DISEASE NHS ENGLAND CYTOKINE MODULATORS NHS ENGLAND POLICY NHS ENGLAND POLICY NHS ENGLAND POLICY √ COMMISSIONING POLICY:16057/P TA65, TA137, TA174, TA193, TA65, TA137, TA174, TA193, TA65, TA137, TA174, TA193, TA226, TA243 TA226, TA243 RITUXIMAB IV CANCER NHS ENGLAND CYTOKINE MODULATORS TA226, TA243 SACT √ NHS ENGLAND CDF LETTER NHS ENGLAND CDF NHS ENGLAND CDF LETTER LETTER

AS PER CIRCULAR IE ONLY RITUXIMAB SUBCUTANEOUS CANCER NHS ENGLAND CYTOKINE MODULATORS COMMISSIONED FOR FOLLICULAR AS PER CIRCULAR AS PER CIRCULAR SACT √ FORMULATION LYMPHOMA MAINTENANCE TREATMENT VIRAL HEPATITIS (B&C) & ROPEGINTERFERON ALFA-2b HEPATITIS C NHS ENGLAND NOT ROUTINELY COMMISSIONED AS PER IFR APPROVAL AS PER IFR APPROVAL AS PER IFR APPROVAL √ RESPIRATORY SYNCYTIAL VIRUS DRUGS USED IN HYPOPLASTIC, ROXADUSTAT DIALYSIS-INDUCED ANAEMIA NHS ENGLAND NOT ROUTINELY COMMISSIONED AS PER IFR APPROVAL AS PER IFR APPROVAL AS PER IFR APPROVAL √ HAEMOLYTIC, AND RENAL ANAEMIAS RUXOLITINIB CANCER NHS ENGLAND PROTEIN KINASE INHIBITORS TA 386 NICE NICE SACT √ CLINICAL GUIDELINES FOR INTRAVENOUS/SUBCUTANEOUS SANDOGLOBULIN AS PER NATIONAL DMP NHS ENGLAND IMMUNOGLOBULIN USE, SECOND NATIONAL GUIDELINES NATIONAL GUIDELINES QUALITY DASHBOARD √ HUMAN NORMAL IMMUNOGLOBULINS EDITION UPDATE (JULY 2011) NOT ROUTINELY COMMISSIONED DRUGS USED IN METABOLIC SAPROPTERIN CHILDREN WITH PHENYLKETONURIA NHS ENGLAND (NHS ENGLAND CLINICAL AS PER IFR APPROVAL AS PER IFR APPROVAL AS PER IFR APPROVAL √ DISORDERS COMMISSIONING POLICY: E06/P/a) DRUGS USED IN METABOLIC NHS ENGLAND CLINICAL SAPROPTERIN MATERNAL PHENYLKETONURIA NHS ENGLAND NHS ENGLAND POLICY NHS ENGLAND POLICY HIGHLY SPECIALISED DATABASE √ DISORDERS COMMISSIONING POLICY: E12/P/a HIV IN COMBINATION WITH OTHER ANTI- SAQUINAVIR NHS ENGLAND AIDS/HIV ANTIRETROVIRALS AGREED REGIONALGUIDELINES BHIVA GUIDELINES (8) BHIVA GUIDELINES (8) HARS DATASET √ RETROVIRAL DRUGS PAEDIATRIC INDICATIONS (WHERE SARILUMAB NHS ENGLAND CYTOKINE MODULATORS NOT ROUTINELY COMMISSIONED AS PER IFR APPROVAL AS PER IFR APPROVAL AS PER IFR APPROVAL √ ADULT TA AVAILABLE) DRUGS USED IN METABOLIC NOT ROUTINELY COMMISSIONED SEBELIPASE ALFA LYSOSOMAL ACID LIPASE DEFICIENCY NHS ENGLAND AS PER IFR APPROVAL AS PER IFR APPROVAL AS PER IFR APPROVAL √ DISORDERS NICE HST IN PROGRESS SECUKINUMAB PAEDIATRIC INDICATIONS NHS ENGLAND CYTOKINE MODULATORS NOT ROUTINELY COMMISSIONED AS PER IFR APPROVAL AS PER IFR APPROVAL AS PER IFR APPROVAL √ VASODILATOR ANTIHYPERTENSIVE PULMONARY ARTERIAL NOT ROUTINELY COMMISSIONED SELEXIPAG NHS ENGLAND DRUGS/PULMANORY ARTERIAL AS PER IFR APPROVAL AS PER IFR APPROVAL AS PER IFR APPROVAL √ HYPERTENSION NHS ENGLAND POLICY 160017/P HYPERTENSION VIRAL HEPATITIS (B&C) & SETROBUVIR HEPATITIS C NHS ENGLAND NOT ROUTINELY COMMISSIONED AS PER IFR APPROVAL AS PER IFR APPROVAL AS PER IFR APPROVAL √ RESPIRATORY SYNCYTIAL VIRUS DRUGS USED IN METABOLIC SIALIC ACID MYOPATHY NHS ENGLAND NOT ROUTINELY COMMISSIONED AS PER IFR APPROVAL AS PER IFR APPROVAL AS PER IFR APPROVAL √ DISORDERS

VASODILATOR ANTIHYPERTENSIVE AS PER POLICY PULMONARY ARTERIAL NHS ENGLAND CLINICAL SILDENAFIL NHS ENGLAND DRUGS/PULMANORY ARTERIAL NHS ENGLAND POLICY NHS ENGLAND POLICY PRODUCT WITH LOWEST √ HYPERTENSION COMMISSIONING POLICY: A11/P/c HYPERTENSION PROCUREMENT COST TO BE USED SIMEPREVIR/PEGINTERFERON + VIRAL HEPATITIS (B&C) & HEPATITIS C NHS ENGLAND TA 331 NICE NICE HEPATITIS C MDS √ √ RIBAVIRIN RESPIRATORY SYNCYTIAL VIRUS

PAEDIATRIC INDICATIONS (WHERE DRUGS AFFECTING THE IMMUNE SIRUKUMAB NHS ENGLAND NOT ROUTINELY COMMISSIONED AS PER IFR APPROVAL AS PER IFR APPROVAL AS PER IFR APPROVAL √ ADULT TA AVAILABLE) RESPONSE

DRUGS USED IN METABOLIC SODIUM BENZOATE UREA CYCLE DISORDERS NHS ENGLAND NOT ROUTINELY COMMISSIONED AS PER IFR APPROVAL AS PER IFR APPROVAL AS PER IFR APPROVAL √ DISORDERS NARCOLEPSY - PEADIATRIC SERVICES NHS ENGLAND CLINICAL SODIUM OXYBATE NHS ENGLAND HYPNOTICS & ANXIOLYTICS NHS ENGLAND POLICY NHS ENGLAND POLICY NHS ENGLAND POLICY √ √ ONLY COMMISSIONING POLICY: 16065/P DRUGS USED IN METABOLIC HIGHLY SPECIALISED HIGHLY SPECIALISED SODIUM PHENYLBUTYRATE UREA CYCLE DISORDERS NHS ENGLAND NHS ENGLAND SERVICE SPECIFICATION HIGHLY SPECIALISED DATABASE √ DISORDERS CRITERIA ONLY CRITERIA ONLY SOFOSBUVIR/DACLATASVIR + VIRAL HEPATITIS (B&C) & HEPATITIS C NHS ENGLAND TA 364 AS PER RUN RATE CARD AS PER RUN RATE CARD HEPATITIS C MDS √ √ RIBAVIRIN RESPIRATORY SYNCYTIAL VIRUS SOFOSBUVIR/LEDIPASVIR +/- VIRAL HEPATITIS (B&C) & HEPATITIS C NHS ENGLAND TA 363 AS PER RUN RATE CARD AS PER RUN RATE CARD HEPATITIS C MDS √ √ RIBAVIRIN RESPIRATORY SYNCYTIAL VIRUS SOFOSBUVIR/PEGINTERFERON+ VIRAL HEPATITIS (B&C) & HEPATITIS C NHS ENGLAND TA 330 AS PER RUN RATE CARD AS PER RUN RATE CARD HEPATITIS C MDS √ √ RIBAVIRIN RESPIRATORY SYNCYTIAL VIRUS SORAFENIB CANCER CDF PROTEIN KINASE INHIBITORS CDF POLICY CDF CDF SACT √

NHS England drugs-list v11 v4 NHSE Commissioned PbRE Drugv11 9 22/12/2016 SUITABLE FOR SUITABLE FOR SHARED CARE SPECIALIST SHARED CARE BETWEEN PRIOR CENTRE ONLY WITH PRIMARY SPECIALIST MONITORING/AUDIT APPROVAL (includng outreach CARE (IF DRUG NAME INDICATION COMMISSIONER PBR CATEGORY TA/POLICY STARTING CRITERIA STOPPING CRITERIA AND REQUIREMENTS PROFORMA when delivered as SUPPORTED BY SECONDARY REQUIRED part of a provider LOCAL CARE VIA network) PRESCRIBING NETWORK COMMITTEE) MODEL HIV IN COMBINATION WITH OTHER ANTI- STAVUDINE NHS ENGLAND AIDS/HIV ANTIRETROVIRALS AGREED REGIONALGUIDELINES BHIVA GUIDELINES (8) BHIVA GUIDELINES (8) HARS DATASET √ RETROVIRAL DRUGS CLINICAL GUIDELINES FOR INTRAVENOUS/SUBCUTANEOUS SUBCUVIA AS PER NATIONAL DMP NHS ENGLAND IMMUNOGLOBULIN USE, SECOND NATIONAL GUIDELINES NATIONAL GUIDELINES QUALITY DASHBOARD √ HUMAN NORMAL IMMUNOGLOBULINS EDITION UPDATE (JULY 2011)

CLINICAL GUIDELINES FOR INTRAVENOUS/SUBCUTANEOUS SUBGAM AS PER NATIONAL DMP NHS ENGLAND IMMUNOGLOBULIN USE, SECOND NATIONAL GUIDELINES NATIONAL GUIDELINES QUALITY DASHBOARD √ HUMAN NORMAL IMMUNOGLOBULINS EDITION UPDATE (JULY 2011)

NHS ENGLAND/ TA169, TA179 NICE NICE SUNITINIB CANCER PROTEIN KINASE INHIBITORS SACT √ CDF CDF POLICY CDF CDF SUSOCTOCOG ALFA (OBIZUR) HAEMOPHILIA A NHS ENGLAND BLOOD-RELATED PRODUCTS NOT ROUTINELY COMMISSIONED AS PER IFR APPROVAL AS PER IFR APPROVAL AS PER IFR APPROVAL √ TABALUMAB SLE NHS ENGLAND CYTOKINE MODULATORS NOT ROUTINELY COMMISSIONED AS PER IFR APPROVAL AS PER IFR APPROVAL AS PER IFR APPROVAL √ VASODILATOR ANTIHYPERTENSIVE PULMONARY ARTERIAL NHS ENGLAND CLINICAL TADALAFIL NHS ENGLAND DRUGS/PULMANORY ARTERIAL NHS ENGLAND POLICY NHS ENGLAND POLICY AS PER POLICY √ HYPERTENSION COMMISSIONING POLICY: A11/P/c HYPERTENSION DRUGS USED IN METABOLIC HIGHLY SPECIALISED HIGHLY SPECIALISED TALIGLUCERASE ALFA GAUCHER'S DISEASE NHS ENGLAND NHS ENGLAND SERVICE SPECIFICATION HIGHLY SPECIALISED DATABASE √ DISORDERS CRITERIA ONLY CRITERIA ONLY VIRAL HEPATITIS (B&C) & TARIBAVIRIN HEPATITIS C NHS ENGLAND NOT ROUTINELY COMMISSIONED AS PER IFR APPROVAL AS PER IFR APPROVAL AS PER IFR APPROVAL √ RESPIRATORY SYNCYTIAL VIRUS TEDUGLUTIDE SHORT BOWEL SYNDROME NHS ENGLAND CYTOKINE MODULATORS NOT ROUTINELY COMMISSIONED AS PER IFR APPROVAL AS PER IFR APPROVAL AS PER IFR APPROVAL √ VIRAL HEPATITIS (B&C) & TELAPREVIR HEPATITIS C NHS ENGLAND TA252 NICE NICE HEPATITIS C MDS √ √ RESPIRATORY SYNCYTIAL VIRUS VIRAL HEPATITIS (B&C) & NOT ROUTINELY COMMISSIONED TELBIVUDINE HEPATITIS B NHS ENGLAND AS PER IFR APPROVAL AS PER IFR APPROVAL AS PER IFR APPROVAL √ RESPIRATORY SYNCYTIAL VIRUS (TA154) TEMSIROLIMUS CANCER CDF PROTEIN KINASE INHIBITORS CDF POLICY CDF CDF SACT √ HIV IN COMBINATION WITH OTHER ANTI- RETROVIRAL DRUGS TA173 (FOR HEPATITIS B)/AGREED BHIVA GUIDELINES (8) BHIVA GUIDELINES (8) TENOFOVIR NHS ENGLAND AIDS/HIV ANTIRETROVIRALS HARS DATASET √ HEPATITIS B +/- OTHER ANTI- REGIONAL GUIDELINES FOR HIV NICE NICE RETROVIRAL DRUGS TENOFOVIR ALAFENAMIDE HEPATITIS B NHS ENGLAND AIDS/HIV ANTIRETROVIRALS NOT ROUTINELY COMMISSIONED AS PER IFR APPROVAL AS PER IFR APPROVAL AS PER IFR APPROVAL √ HIV IN COMBINATION WITH OTHER ANTI- NHS ENGLAND CLINICAL TENOFOVIR ALAFENAMIDE NHS ENGLAND AIDS/HIV ANTIRETROVIRALS NHS ENGLAND POLICY NHS ENGLAND POLICY HARS DATASET √ RETROVIRAL DRUGS COMMISSIONING POLICY: 16043/P TENOFOVIR ALAFENAMIDE + HIV IN COMBINATION WITH OTHER ANTI- NHS ENGLAND CLINICAL COBICISTAT + ELVITEGRAVIR + NHS ENGLAND AIDS/HIV ANTIRETROVIRALS NHS ENGLAND POLICY NHS ENGLAND POLICY HARS DATASET √ RETROVIRAL DRUGS COMMISSIONING POLICY: 16043/P EMTRICITABINE (GENVOYA®) TENOFOVIR DISOPROXIL + NHS ENGLAND CLINICAL HIV IN COMBINATION WITH OTHER ANTI- COBICISTAT + ELVITEGRAVIR + NHS ENGLAND AIDS/HIV ANTIRETROVIRALS COMMISSIONING POLICY: NHS ENGLAND POLICY NHS ENGLAND POLICY HARS DATASET √ RETROVIRAL DRUGS EMTRICITABINE (STRIBILD®) F03/P/b/AGREED REGIONAL GUIDELINES TENOFOVIR + EMTRICITABINE + HIV IN COMBINATION WITH OTHER ANTI- NHS ENGLAND AIDS/HIV ANTIRETROVIRALS AGREED REGIONALGUIDELINES BHIVA GUIDELINES (8) BHIVA GUIDELINES (8) HARS DATASET √ EFAVIRENZ RETROVIRAL DRUGS TENOFOVIR + EMTRICITABINE + HIV IN COMBINATION WITH OTHER ANTI- NHS ENGLAND AIDS/HIV ANTIRETROVIRALS AGREED REGIONALGUIDELINES BHIVA GUIDELINES (8) BHIVA GUIDELINES (8) HARS DATASET √ RILPIVIRINE RETROVIRAL DRUGS TA303 TERIFLUNOMIDE MULTIPLE SCLEROSIS NHS ENGLAND IMMUNOMODULATING DRUGS NICE NICE NICE AUDIT √ √**** NHS ENGLAND POLICY: D04/P/b DRUGS AFFECTING BONE NOT ROUTINELY COMMISSIONED TERIPARATIDE OSTEOGENESIS IMPERFECTA NHS ENGLAND AS PER IFR APPROVAL AS PER IFR APPROVAL AS PER IFR APPROVAL √ METABOLISM NHS ENGLAND POLICY: 16002/P DRUGS AFFECTING BONE TERIPARATIDE MALE AND JUVENILE OSTEOPOROSIS NHS ENGLAND NOT ROUTINELY COMMISSIONED AS PER IFR APPROVAL AS PER IFR APPROVAL AS PER IFR APPROVAL √ METABOLISM DRUGS USED IN METABOLIC HIGHLY SPECIALISED HIGHLY SPECIALISED TETRAHYDROBIOPTERIN PHENYLKETONURIA NHS ENGLAND NHS ENGLAND SERVICE SPECIFICATION HIGHLY SPECIALISED DATABASE √ DISORDERS CRITERIA ONLY CRITERIA ONLY TEZACAFTOR CYSTIC FIBROSIS NHS ENGLAND MUCOLYTICS NOT ROUTINELY COMMISSIONED AS PER IFR APPROVAL AS PER IFR APPROVAL AS PER IFR APPROVAL √ THALIDOMIDE CANCER NHS ENGLAND IMMUNOMODULATING DRUGS TA228 NICE NICE SACT √

THROMBIN PSEUDOANEURYSM NHS ENGLAND BLOOD-RELATED PRODUCTS IPG060 IPG060 NICE √

HIV IN COMBINATION WITH OTHER ANTI- TIPRANAVIR NHS ENGLAND AIDS/HIV ANTIRETROVIRALS AGREED REGIONALGUIDELINES BHIVA GUIDELINES (8) BHIVA GUIDELINES (8) HARS DATASET √ RETROVIRAL DRUGS NHS ENGLAND CLINICAL NHS ENGLAND POLICY NHS ENGLAND POLICY NHS ENGLAND POLICY TOBRAMYCIN CYSTIC FIBROSIS NHS ENGLAND ANTIBACTERIAL DRUGS COMMISSIONING POLICY: A01/P/b √* √* NICE NICE NICE AUDIT TA276 NHS ENGLAND CLINICAL TOCILIZUMAB IV JUVENILE ARTHRITIS-PAEDIATRIC NHS ENGLAND CYTOKINE MODULATORS COMMISSIONING POLICY: E03/P/d; TA NHS ENGLAND POLICY NHS ENGLAND POLICY NHS ENGLAND POLICY √ √ 373 NHS ENGLAND CLINICAL TOCILIZUMAB IV TAKAYASU ARTERITIS NHS ENGLAND CYTOKINE MODULATORS NHS ENGLAND POLICY NHS ENGLAND POLICY NHS ENGLAND POLICY √ COMMISSIONING POLICY 16056/P NOT ROUTINELY COMMISSIONED NHS TOCILIZUMAB IV GIANT CELL ARTERITIS NHS ENGLAND CYTOKINE MODULATORS AS PER IFR APPROVAL AS PER IFR APPROVAL AS PER IFR APPROVAL √ ENGLAND POLICY 16019/P PAEDIATRIC INDICATIONS (WHERE TOCILIZUMAB IV NHS ENGLAND CYTOKINE MODULATORS AS PER ADULT TA'S (TA247 and TA375) NICE NICE NICE AUDIT √ ADULT TA AVAILABLE) PAEDIATRIC INDICATIONS (WHERE TOFACITINIB NHS ENGLAND CYTOKINE MODULATORS NOT ROUTINELY COMMISSIONED AS PER IFR APPROVAL AS PER IFR APPROVAL AS PER IFR APPROVAL √ ADULT TA AVAILABLE) POSTERIOR PITUITARY HORMONES NHS ENGLAND CLINICAL TOLVAPTAN HYPONATRAEMIA IN CANCER NHS ENGLAND NHS ENGLAND POLICY NHS ENGLAND POLICY NHS ENGLAND POLICY √ AND ANTAGONISTS COMMISSIONING POLICY 16051/P TRALOKINUMAB ASTHMA NHS ENGLAND ALLERGEN IMMUNOTHERAPY NOT ROUTINELY COMMISSIONED AS PER IFR APPROVAL AS PER IFR APPROVAL AS PER IFR APPROVAL √ TRENONACOG ALPHA HAEMOPHILIA B NHS ENGLAND BLOOD-RELATED PRODUCTS NOT ROUTINELY COMMISSIONED AS PER IFR APPROVAL AS PER IFR APPROVAL AS PER IFR APPROVAL √ VASODILATOR ANTIHYPERTENSIVE PULMONARY ARTERIAL TREPROSTINIL DIETHANOLAMINE NHS ENGLAND DRUGS/PULMANORY ARTERIAL NOT ROUTINELY COMMISSIONED AS PER IFR APPROVAL AS PER IFR APPROVAL AS PER IFR APPROVAL √ HYPERTENSION HYPERTENSION NOT ROUTINELY COMMISSIONED FOR VASODILATOR ANTIHYPERTENSIVE PULMONARY ARTERIAL NEW PATIENTS - NHS ENGLAND TREPROSTINIL SODIUM NHS ENGLAND DRUGS/PULMANORY ARTERIAL AS PER IFR APPROVAL AS PER IFR APPROVAL AS PER IFR APPROVAL √ HYPERTENSION CLINICAL COMMISSIONING POLICY: HYPERTENSION A11/P/c DRUGS USED IN METABOLIC TRIENTENE WILSONS DISEASE NHS ENGLAND NOT ROUTINELY COMMISSIONED AS PER IFR APPROVAL AS PER IFR APPROVAL AS PER IFR APPROVAL √ DISORDERS AS PER BCSH GUIDELINES FOR TUROCTOCOG ALFA (NovoEight) NHS ENGLAND BLOOD-RELATED PRODUCTS BCSH GUIDELINES BCSH GUIDELINES BCSH GUIDELINES √ SPECIALISED INDICATIONS DRUGS AFFECTING IMMUNE USTEKINUMAB PAEDIATRIC INDICATIONS NHS ENGLAND AS PER ADULT TA180 NICE NICE NICE √ RESPONSE

DRUGS USED IN HYPOPLASTIC, VADADUSTAT DIALYSIS-INDUCED ANAEMIA NHS ENGLAND NOT ROUTINELY COMMISSIONED AS PER IFR APPROVAL AS PER IFR APPROVAL AS PER IFR APPROVAL √ HAEMOLYTIC, AND RENAL ANAEMIAS

NHS England drugs-list v11 v4 NHSE Commissioned PbRE Drugv11 10 22/12/2016 SUITABLE FOR SUITABLE FOR SHARED CARE SPECIALIST SHARED CARE BETWEEN PRIOR CENTRE ONLY WITH PRIMARY SPECIALIST MONITORING/AUDIT APPROVAL (includng outreach CARE (IF DRUG NAME INDICATION COMMISSIONER PBR CATEGORY TA/POLICY STARTING CRITERIA STOPPING CRITERIA AND REQUIREMENTS PROFORMA when delivered as SUPPORTED BY SECONDARY REQUIRED part of a provider LOCAL CARE VIA network) PRESCRIBING NETWORK COMMITTEE) MODEL NUMBER OF PATIENTS TREATED VALGANCICLOVIR CYTOMEGALOVIRUS NHS ENGLAND CYTOMEGALOVIRUS INFECTION AGREED TRUST GUIDELINES TRUST GUIDELINES TRUST GUIDELINES PROPORTION GIVEN FOR SPC √ INDICATIONS WITHIN POLICY SACT VANDETANIB THYROID CANCER CDF PROTEIN KINASE INHIBITORS CDF POLICY CDF CDF √ CDF NATIONAL AUDIT VEDOLIZUMAB IBD IN CHILDREN NHS ENGLAND CYTOKINE MODULATORS AS PER ADULT TAs - TA 342, TA 352 NICE NICE NICE AUDIT √

DRUGS USED IN METABOLIC HIGHLY SPECIALISED HIGHLY SPECIALISED VELAGLUCERASE ALFA GAUCHER'S DISEASE NHS ENGLAND NHS ENGLAND SERVICE SPECIFICATION HIGHLY SPECIALISED DATABASE √ DISORDERS CRITERIA ONLY CRITERIA ONLY

DRUGS AFFECTING BONE VELCALCETIDE HYPERPARATHYROIDISM NHS ENGLAND NOT ROUTINELY COMMISSIONED AS PER IFR APPROVAL AS PER IFR APPROVAL AS PER IFR APPROVAL √ METABOLISM VEMURAFENIB MELANOMA NHS ENGLAND PROTEIN KINASE INHIBITORS TA269 NICE NICE NICE AUDIT √ CLINICAL GUIDELINES FOR INTRAVENOUS/SUBCUTANEOUS VIGAM AS PER NATIONAL DMP NHS ENGLAND IMMUNOGLOBULIN USE, SECOND NATIONAL GUIDELINES NATIONAL GUIDELINES QUALITY DASHBOARD √ HUMAN NORMAL IMMUNOGLOBULINS EDITION UPDATE (JULY 2011) CLINICAL GUIDELINES FOR INTRAVENOUS/SUBCUTANEOUS VIVAGLOBIN AS PER NATIONAL DMP NHS ENGLAND IMMUNOGLOBULIN USE, SECOND NATIONAL GUIDELINES NATIONAL GUIDELINES QUALITY DASHBOARD √ HUMAN NORMAL IMMUNOGLOBULINS EDITION UPDATE (JULY 2011) VON WILLEBRAND FACTOR, VON WILLEBRAND DEFICIENCY NHS ENGLAND BLOOD-RELATED PRODUCTS NOT ROUTINELY COMMISSIONED AS PER IFR APPROVAL AS PER IFR APPROVAL AS PER IFR APPROVAL √ RECOMBINANT NUMBER OF PATIENTS TREATED VORICONAZOLE FUNGAL INFECTION NHS ENGLAND ANTIFUNGALS AGREED TRUST GUIDELINES TRUST GUIDELINES TRUST GUIDELINES PROPORTION GIVEN FOR SPC √ INDICATIONS WITHIN POLICY CHRONIC PULMONARY HIGHLY SPECIALISED HIGHLY SPECIALISED VORICONAZOLE NHS ENGLAND ANTIFUNGALS HIGHLY SPECIALISED CRITERIA ONLY √ ASPERGILLOSIS CRITERIA ONLY CRITERIA ONLY NOT ROUTINELY COMMISSIONED - NHS ZICONOTIDE INTRATHECAL ANALGESIA NHS ENGLAND NON-OPIOID ANALGESICS AS PER IFR APPROVAL AS PER IFR APPROVAL AS PER IFR APPROVAL √ ENGLAND POLICY 16011/P HIV IN COMBINATION WITH OTHER ANTI- ZIDOVUDINE NHS ENGLAND AIDS/HIV ANTIRETROVIRALS AGREED REGIONALGUIDELINES BHIVA GUIDELINES (8) BHIVA GUIDELINES (8) HARS DATASET √ RETROVIRAL DRUGS HIV IN COMBINATION WITH OTHER ANTI- ZIDOVUDINE + LAMIVUDINE NHS ENGLAND AIDS/HIV ANTIRETROVIRALS AGREED REGIONALGUIDELINES BHIVA GUIDELINES (8) BHIVA GUIDELINES (8) HARS DATASET √ RETROVIRAL DRUGS ZIDOVUDINE + LAMIVUDINE + HIV IN COMBINATION WITH OTHER ANTI- NHS ENGLAND AIDS/HIV ANTIRETROVIRALS AGREED REGIONALGUIDELINES BHIVA GUIDELINES (8) BHIVA GUIDELINES (8) HARS DATASET √ ABACAVIR RETROVIRAL DRUGS OTHER DRUGS NOT LISTED UNDER PBR EXCLUSIONS LAMBERT EATON MYASTHENIC 3,4 DIAMINOPYRIDINE NHS ENGLAND AGREED TRUST GUIDELINES TRUST GUIDELINES TRUST GUIDELINES √ SYNDROME AFLIBERCEPT CANCER NHS ENGLAND CANCER EXCLUSION NOT ROUTINELY COMMISSIONED AS PER CDIFR APPROVAL AS PER CDIFR APPROVAL SACT √ TREATMENT OF BREAST CANCER NHS ENGLAND ROUTINELY NHS ENGLAND ROUTINELY NHS ENGLAND ROUTINELY ALBUMIN BOUND PACLITAXEL PATIENTS WITH DOCUMENTED NHS ENGLAND CANCER EXCLUSION SACT √ COMMISSIONED LETTER COMMISSIONED LETTER COMMISSIONED LETTER TAXANE HYPERSENSITIVITY TRANSPLANT IMMUNOSUPPRESSION NEW PATIENTS ONLY UNTIL FORMAL AZATHIOPRINE NHS ENGLAND TRUST GUIDELINES TRUST GUIDELINES √* √* ONLY REPATRIATION AGREED NHS ENGLAND/ TA216 NICE NICE BENDAMUSTINE CANCER CANCER EXCLUSION SACT √ CDF CDF POLICY CDF CDF BRENTUXIMAB CANCER CDF CANCER EXCLUSION CDF POLICY CDF CDF SACT √ CABAZITAXEL CANCER NHS ENGLAND CANCER EXCLUSION TA 391 NICE NICE SACT √ √ CABOZANTINIB CANCER CDF CANCER EXCLUSION CDF POLICY CDF CDF SACT √ CERITINIB CANCER NHS ENGLAND CANCER EXCLUSION TA 395 NICE NICE SACT √ √ NHS ENGLAND/ TRUST GUIDELINES/ NICE/ TRUST GUIDELINES/ NICE/ CHEMOTHERAPY CANCER - (NOT SPECIFICALLY LISTED) CANCER EXCLUSION TRUST GUIDELINES/ NICE/ CDF POLICY SACT √ CDF CDF POLICY CDF POLICY TRANSPLANT IMMUNOSUPPRESSION NEW PATIENTS ONLY UNTIL FORMAL PRODUCT WITH LOWEST CICLOSPORIN NHS ENGLAND TRUST GUIDELINES TRUST GUIDELINES √* √* ONLY REPATRIATION AGREED PROCUREMENT COST TO BE USED HYPERPARATHYROIDISM - DIALYSIS DRUGS FOR MINERAL BONE CINACALCET NHS ENGLAND TA117 NICE NICE √ PATIENTS ONLY DISORDERS CLOFARABINE CANCER CDF CANCER EXCLUSION CDF POLICY CDF CDF SACT √ DRUGS FOR MINERAL BONE COLESTILAN ADULT RENAL DIALYSIS ONLY NHS ENGLAND TRUST GUIDELINES TRUST GUIDELINES TRUST GUIDELINES √ DISORDERS RENAL DIALYSIS ONLY, INCLUDING VIA PRODUCT WITH LOWEST DARBEPOETIN DIALYSIS-INDUCED ANAEMIA NHS ENGLAND ERYTHROPOETINS OUTPATIENTS, AND ONLY AS PER NICE TRUST GUIDELINES TRUST GUIDELINES √ PROCUREMENT COST TO BE USED CG114 RENAL DIALYSIS ONLY, INCLUDING VIA NICE NICE PRODUCT WITH LOWEST EPOETIN (ALL VARIANTS) DIALYSIS-INDUCED ANAEMIA NHS ENGLAND ERYTHROPOETINS OUTPATIENTS, AND ONLY AS PER NICE TRUST GUIDELINES (RENAL TRUST GUIDELINES (RENAL PROCUREMENT COST TO BE USED √ CG114 USE ONLY) USE ONLY) (NICE CG114) NHS ENGLAND/ NICE TA 423 NICE NICE ERIBULIN CANCER CANCER EXCLUSION SACT √ CDF CDF POLICY CDF CDF IBRUTINIB CANCER CDF PROTEIN KINASE INHIBITORS CDF POLICY CDF CDF SACT √ IDELALISIB CANCER NHS ENGLAND PROTEIN KINASE INHIBITORS NICE TA 359 NICE NICE SACT √ IPILIMUMAB CANCER NHS ENGLAND CANCER EXCLUSION TA268, TA319, 400 NICE NICE SACT √ DRUGS FOR MINERAL BONE LANTHANUM ADULT RENAL DIALYSIS ONLY NHS ENGLAND TRUST GUIDELINES TRUST GUIDELINES √ DISORDERS MESENCHYMAL STEM CELLS (E.G. ACUTE GVHD AND OTHER NHS ENGLAND NOT ROUTINELY COMMISSIONED AS PER IFR APPROVAL AS PER IFR APPROVAL AS PER IFR APPROVAL √ PROCHYMAL®) INDICATIONS (BCSH) TRANSPLANT IMMUNOSUPPRESSION NEW PATIENTS ONLY UNTIL FORMAL PRODUCT WITH LOWEST MYCOPHENOLATE MOFETIL NHS ENGLAND TRUST GUIDELINES TRUST GUIDELINES √* √* ONLY REPATRIATION AGREED PROCUREMENT COST TO BE USED

TRANSPLANT IMMUNOSUPPRESSION NEW PATIENTS ONLY UNTIL FORMAL PRODUCT WITH LOWEST MYCOPHENOLIC ACID NHS ENGLAND TRUST GUIDELINES TRUST GUIDELINES √* √* ONLY REPATRIATION AGREED PROCUREMENT COST TO BE USED NELARABINE CANCER CDF CANCER EXCLUSION CDF POLICY CDF CDF SACT √ NIVOLUMAB CANCER NHS ENGLAND CANCER EXCLUSION TA 384, 400, 417 NICE NICE SACT √ OBINUTUZUMAB CANCER NHS ENGLAND CANCER EXCLUSION TA343 NICE NICE SACT √ OLAPARIB CANCER NHS ENGLAND CANCER EXCLUSION TA 381 NICE NICE SACT √ OSIMERTINIB CANCER CDF CANCER EXCLUSION TA 416 CDF CDF SACT √ PANITUMUMAB CANCER CDF CANCER EXCLUSION CDF POLICY CDF CDF SACT √

PANOBINOSTAT CANCER NHS ENGLAND CANCER EXCLUSION TA 380 NICE NICE SACT √

PEGASPARGASE CANCER NHS ENGLAND CANCER EXCLUSION TA 408 NICE NICE SACT √ PEGYLATED LIPOSOMAL NHS ENGLAND/ TA91 NICE NICE CANCER CANCER EXCLUSION SACT √ DOXORUBICIN CDF CDF POLICY CDF CDF NHS ENGLAND/ TA135, TA181, TA190, TA 402 NICE NICE PEMETREXED CANCER CANCER EXCLUSION SACT √ CDF CDF CDF

NHS England drugs-list v11 v4 NHSE Commissioned PbRE Drugv11 11 22/12/2016 SUITABLE FOR SUITABLE FOR SHARED CARE SPECIALIST SHARED CARE BETWEEN PRIOR CENTRE ONLY WITH PRIMARY SPECIALIST MONITORING/AUDIT APPROVAL (includng outreach CARE (IF DRUG NAME INDICATION COMMISSIONER PBR CATEGORY TA/POLICY STARTING CRITERIA STOPPING CRITERIA AND REQUIREMENTS PROFORMA when delivered as SUPPORTED BY SECONDARY REQUIRED part of a provider LOCAL CARE VIA network) PRESCRIBING NETWORK COMMITTEE) MODEL PEPTIDE RECEPTOR CANCER CDF NOT ROUTINELY COMMISSIONED AS PER IFR APPROVAL AS PER IFR APPROVAL AS PER IFR APPROVAL √ RADIONUCLEOTIDE THERAPY NHS ENGLAND/ NICE TA 424 NICE NICE PERTUZUMAB CANCER CANCER EXCLUSION SACT √ CDF CDF POLICY CDF CDF

PIXANTRONE CANCER NHS ENGLAND CANCER EXCLUSION TA306 NICE NICE SACT √

POMALIDOMIDE CANCER CDF CANCER EXCLUSION NOT ROUTINELY COMMISSIONED AS PER IFR APPROVAL AS PER IFR APPROVAL AS PER IFR APPROVAL √

ENDOCRINOLOGY; NON-MALIGNANT PROTEIN KINASE INHIBITORS NHS ENGLAND NOT ROUTINELY COMMISSIONED AS PER IFR APPROVAL AS PER IFR APPROVAL AS PER IFR APPROVAL √ CONDITIONS NHS ENGLAND/ NICE NICE RADIUM-223 DICHLORIDE CANCER CANCER EXCLUSION NICE TA 376, TA 412 SACT √ CDF CDF CDF NOT ROUTINELY COMMISSIONED - RAMUCIRUMAB CANCER NHS ENGLAND CANCER EXCLUSION CDIFR CDIFR AS PER IFR APPROVAL √ TA 378 DRUGS FOR MINERAL BONE SEVELAMER ADULT RENAL DIALYSIS ONLY NHS ENGLAND TRUST GUIDELINES TRUST GUIDELINES √ DISORDERS TRANSPLANT IMMUNOSUPPRESSION NEW PATIENTS ONLY UNTIL FORMAL PRODUCT WITH LOWEST SIROLIMUS (RAPAMUNE) NHS ENGLAND TRUST GUIDELINES TRUST GUIDELINES √* √* ONLY REPATRIATION AGREED PROCUREMENT COST TO BE USED CONTROL OF SERUM PHOSPHORUS SUCROFERRIC OXYHDROXIDE NHS ENGLAND PHOSPHATE BINDING AGENTS AGREED TRUST GUIDELINES TRUST GUIDELINES TRUST GUIDELINES √ LEVELS IN DIALYSIS PATIENTS TRANSPLANT IMMUNOSUPPRESSION NEW PATIENTS ONLY UNTIL FORMAL PRODUCT WITH LOWEST TACROLIMUS NHS ENGLAND TRUST GUIDELINES TRUST GUIDELINES √* √* ONLY REPATRIATION AGREED PROCUREMENT COST TO BE USED TALIMOGENE LAHERPAREPVEC CANCER NHS ENGLAND CANCER EXCLUSION TA 410 NICE NICE SACT √ ENDOCRINOLOGY; NON-MALIGNANT TEMOZOLOMIDE NHS ENGLAND CANCER EXCLUSION NOT ROUTINELY COMMISSIONED AS PER IFR APPROVAL AS PER IFR APPROVAL AS PER IFR APPROVAL √ CONDITIONS TRABECTEDIN CANCER NHS ENGLAND ANTINEOPLASTIC DRUGS TA185 NICE NICE SACT √ TRAMETINIB CANCER NHS ENGLAND CANCER EXCLUSION TA 396 NICE NICE SACT √ √ TRASTUZUMAB CANCER NHSE ENGLAND CANCER EXCLUSION TA 34, 107, 208 NICE NICE SACT √ TRASTUZUMAB EMTANSINE CANCER CDF CANCER EXCLUSION CDF POLICY CDF CDF SACT √ TRIFLURIDINE–TIPIRACIL CANCER NHS ENGLAND CANCER EXCLUSION TA 405 NICE NICE SACT √ VISMODEGIB CANCER CDF CANCER EXCLUSION CDF POLICY CDF CDF SACT √

* DRUG IS BEING REPATRIATED FROM PRIMARY TO SECONDARY CARE THEREFORE SUPPLY ROUTE MAY VARY AT PRESENT

** ROUTINELY COMMISSIONED IN COMBINATION WHEN DUAL THERAPY REQUIRED

*** ONLY WHEN PRESCRIBED IN A SPECIALIST CENTRE **** ONLY WHERE IT IS A RECOGNISED MS CENTRE WITH SPECIALIST NURSE SUPPORT

NEW DRUGS ADDED TO 2017/2018 EXCLUSIONS' LIST CHANGES TO 16/17 LIST

ADDITIONAL NOTES: 1. WHERE THE FUNDED INDICATION IS FOR PAEDIATRIC USE THE CCG WILL BECOME THE RESPONSIBLE COMMISSIONER WHEN THE PATIENT IS TRANSFERRED TO THE ADULT SERVICE 2. CCGS ARE THE RESPONSIBLE COMMISSIONER FOR RITUXIMAB IN NON CANCEROUS HAEMOTOLOGICAL CONDITIONS (EG ITP) AND NON SPECIALIST AUTO-INFLAMMATORY CONDITIONS (EG RA) 3. ELTROMBOPAG AND ROMIPLOSTIM ARE THE RESPONSIBILTY OF CCGS REGARDLESS OF THE CAUSE OF THE THROMBOCYTOPENIA IN ADULTS (PAEDIATRICS ARE NHS ENGLAND RESPONSIBILITY) 4. IT IS A MANDATED REQUIREMENT THAT ALL USE OF CHEMOTHERAPY IS RECORDED IN THE SACT DATABASE INCLUDING THOSE TREATMENTS FUNDED THROUGH THE CDF 5. USE IN VASCULAR DISEASE IS COMMISSIONED BY NHS ENGLAND WITHIN SPECIALIST CENTRES - ALL OTHER INDICATIONS ARE CCG COMMISSIONED 6. NHS ENGLAND IS THE RESPONSIBLE COMMISSIONER WHEN SOMATROPIN ANALOGUES (GROWTH HORMONE) ARE PRESCRIBED IN SPECIALIST CENTRES FOR INDICATIONS FALLING OUTSIDE NICE GUIDANCE 7. A DERROGATION LIST CAN BE FOUND UNDER EACH PROGRAMME OF CARE - PLEASE REFER TO THIS LINK - HTTPS://WWW.ENGLAND.NHS.UK/COMMISSIONING/SPEC-SERVICES/NPC-CRG/ 8. NHS ENGLAND COMMISSIONS ARVS AS PER PUBLISHED POLICIES, FOR THE TREATMENT OF PEOPLE WITH DIAGNOSED HIV INFECTION AND FOR THOSE THOUGHT TO BE HIV POSITIVE (POST EXPOSURE PROPHYLAXIS). NHS ENGLAND DOES NOT ROUTINELY COMMISSION PRE-EXPOSURE PROPHYLAXIS AND THIS IS ONLY AVAILABLE TO 9.DRUGS APPROVED BY NICE FOR ADULT CONDITIONS WILL BE COMMISSIONED IN CHILDREN AT SPECIALISED PAEDIATRIC CENTRES IF THE PATIENT MEETS THE NICE CRITERIA AND THERE IS EVIDENCE TO SUGGEST THAT THE DRUG IS SAFE AND CLINICALLY APPROPRIATE TO USE IN CHILDREN. A PRESCRIBING POLICY IS IN DEVELOPMENT TO CLARIFY THESE ARRANGEMENTS”. THIS WILL APPLY TO ANY DRUG WHERE WE HAVE STATED “AS PER ADULT TA” AS THE TA/ POLICY. A PRIOR APPROVAL SYSTEM WILL BE IMPLEMENTED ALONG SIDE THE POLICY. 10. CINACALCET FOR COMPLEX PRIMARY PARATHYROIDISM IS IN TARIFF

NHS England drugs-list v11 v4 NHSE Commissioned PbRE Drugv11 12 22/12/2016