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Bedfordshire, Luton and Milton Keynes CCG High Cost Drugs

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BLMK CCG Guidance on prescribing of drugs excluded from the National Tariff 2019/20 in primary care Payment by Results (PbR) is a way of reimbursing hospitals in England for the activity they carry out. It uses a National Tariff of fixed prices that have been set according to the national average cost of providing that activity, (e.g. coronary artery bypass graft; cataract surgery; abdominal hernia). PbR activities are assigned to a Healthcare Resource Group (HRG) – a group consisting of activities that have been judged to consume a similar level of resource. Drugs excluded from the National Tariff (formerly known as PbR excluded drugs), have high cost relative to the rest of the activity within the HRG, or are provided disproportionately by a subset of hospital Trusts. Where drugs (as well as services and procedures) are outside of PbR, commissioners and providers decide whether to commission that drug and if so, agree a local price and arrangement for monitoring activity. There is a nationally agreed list of drugs excluded from the National Tariff, but simply because a drug is on that list does not mean it will automatically be funded by commissioners. The commissioning responsibility of these drugs lies with either Clinical Commissioning Groups (CCGs), NHS England (NHSE) or the Cancer Drug Fund (CDF). Purpose of the table In the most part, drugs excluded from the National Tariff are specialist drugs provided by hospital Trusts and therefore GPs would not be expected to prescribe them. However there are certain circumstances where it might be appropriate for GPs to prescribe and the CCG has developed a number of polices for these, usually with associated shared care guidelines. The Medicines Optimisation Team (MOT) has produced a table that lists drugs excluded from the National Tariff and whether these drugs would be expected to be prescribed by GPs. If a GP is currently prescribing one of the drugs listed in the table, they do not necessarily need to stop prescribing as the drug may be included in a shared care arrangement or there may be plans in place to repatriate the drug to NHSE over the next year. Information relating to these situations are detailed in the table under ‘Additional Notes’, however for clarification GPs should contact the Medicines Optimisation team (MOT) – see contact details below. For circumstances where GPs are expected to prescribe, details are provided in the table along with additional information relating to when the drug should be prescribed. Details regarding prescribing in primary care are outlined as follows: . ‘DO NOT PRESCRIBE’ – new requests for these drugs and patients currently receiving these drugs (issued in primary care) should be referred to the MOT for advice . ‘May be prescribed’ – details for which circumstances and according to which guideline(s) these drugs can be prescribed are provided in the table MOT contact details: For Luton CCG (LCCG): [email protected] For Bedfordshire CCG (BCCG): [email protected] For Milton Keynes CCG (MKCCG): [email protected] Please note: Under shared care guidance, as the GP agrees to take over the prescribing of the drug, the GP as the prescribing clinician has the clinical responsibility for the drug, the monitoring of the drug, and the consequences of its use. Guidance on prescribing of drugs excluded from the National Tariff 2019-20 in primary care Review date: June 2020 Bedfordshire Clinical Commissioning Group Luton Clinical Commissioning Group Milton Keynes Clinical Commissioning Group DRUG NAME COMMISSIONING PRESCRIBING EXPECTED IN ADDITIONAL NOTES RESPONSIBILITY PRIMARY CARE? All hepatitis B & C drugs listed in NHSE NO – DO NOT PRESCRIBE Drugs are also listed individually within this table BNF chapter 6.2a and 6.2b All HIV drugs listed in BNF NHSE NO – DO NOT PRESCRIBE Drugs are also listed individually within this table chapter 6.4 3,4 Diaminopyridine* NHSE NO – DO NOT PRESCRIBE A Abacavir NHSE NO – DO NOT PRESCRIBE Abaloparatide NHSE and CCG (depending on NO – DO NOT PRESCRIBE indication), but not commissioned Abatacept NHSE and CCG (depending on NO – DO NOT PRESCRIBE indication) Abicipar CCG but not commissioned NO – DO NOT PRESCRIBE Abiraterone* NHSE NO – DO NOT PRESCRIBE Actoxumab Commissioning responsibility NO – DO NOT PRESCRIBE unclear, but not commissioned Adalimumab NHSE and CCG (depending on NO – DO NOT PRESCRIBE indication) Adefovir NHSE but not commissioned NO – DO NOT PRESCRIBE Adexanet alfa CCG but not commissioned NO – DO NOT PRESCRIBE Afamelanotide Commissioning responsibility NO – DO NOT PRESCRIBE unclear, but not commissioned Guidance on prescribing of drugs excluded from the National Tariff 2019-20 in primary care Review date: June 2020 Bedfordshire Clinical Commissioning Group Luton Clinical Commissioning Group Milton Keynes Clinical Commissioning Group DRUG NAME COMMISSIONING PRESCRIBING EXPECTED IN ADDITIONAL NOTES RESPONSIBILITY PRIMARY CARE? Afatinib NHSE NO – DO NOT PRESCRIBE Aflibercept NHSE and CCG (depending on NO – DO NOT PRESCRIBE indication) Agalsidase alfa NHSE NO – DO NOT PRESCRIBE Agalsidase beta NHSE NO – DO NOT PRESCRIBE Aganirsen CCG but not commissioned NO – DO NOT PRESCRIBE Alafenamide NHSE NO – DO NOT PRESCRIBE Albumin-bound Paclitaxel* NHSE NO – DO NOT PRESCRIBE Albutrepenonacog alfa NHSE NO – DO NOT PRESCRIBE Albutropin NHSE but not commissioned NO – DO NOT PRESCRIBE Aldesleukin NHSE but not commissioned NO – DO NOT PRESCRIBE Alectinib* NHSE NO – DO NOT PRESCRIBE Alemtuzumab NHSE NO – DO NOT PRESCRIBE Alglucosidase alfa NHSE NO – DO NOT PRESCRIBE Alicaforsen CCG but not commissioned NO – DO NOT PRESCRIBE Alipogene tiparvovec NHSE but not commissioned NO – DO NOT PRESCRIBE Guidance on prescribing of drugs excluded from the National Tariff 2019-20 in primary care Review date: June 2020 Bedfordshire Clinical Commissioning Group Luton Clinical Commissioning Group Milton Keynes Clinical Commissioning Group DRUG NAME COMMISSIONING PRESCRIBING EXPECTED IN ADDITIONAL NOTES RESPONSIBILITY PRIMARY CARE? Alirocumab CCG NO – DO NOT PRESCRIBE Alisporivir NHSE but not commissioned NO – DO NOT PRESCRIBE Alitretinoin CCG NO – DO NOT PRESCRIBE Alpha-1 antitrypsin NHSE but not commissioned NO – DO NOT PRESCRIBE Alpha-mannosidase recombinant NHSE but not commissioned NO – DO NOT PRESCRIBE human Ambrisentan NHSE NO – DO NOT PRESCRIBE Amifampridine phosphate NHSE but not commissioned NO – DO NOT PRESCRIBE Amikacin inhalation NHSE and CCG (depending on NO – DO NOT PRESCRIBE . When given as any other form, not excluded from National indication), but not Tariff but secondary care prescribing only – DO NOT commissioned PRESCRIBE Amikacin liposomal NHSE and CCG (depending on NO – DO NOT PRESCRIBE . When given by nebulisation / inhalation – DO NOT indication), but not PRESCRIBE commissioned . When given as any other form, not excluded from National Tariff but secondary care prescribing only – DO NOT PRESCRIBE Amiselimod Commissioning responsibility NO – DO NOT PRESCRIBE unclear, but not commissioned Amphotericin liposomal NHSE NO – DO NOT PRESCRIBE Anabasum NHSE but not commissioned NO – DO NOT PRESCRIBE Anakinra NHSE and CCG (depending on NO – DO NOT PRESCRIBE Guidance on prescribing of drugs excluded from the National Tariff 2019-20 in primary care Review date: June 2020 Bedfordshire Clinical Commissioning Group Luton Clinical Commissioning Group Milton Keynes Clinical Commissioning Group DRUG NAME COMMISSIONING PRESCRIBING EXPECTED IN ADDITIONAL NOTES RESPONSIBILITY PRIMARY CARE? indication) Anidulafungin NHSE NO – DO NOT PRESCRIBE Anifrolumab NHSE but not commissioned NO – DO NOT PRESCRIBE Antilymphocyte globulin NHSE NO – DO NOT PRESCRIBE Anti-pseudomonas aeruginosa NHSE but not commissioned NO – DO NOT PRESCRIBE IgY Antithrombin III NHSE NO – DO NOT PRESCRIBE Antithymocyte immuglobulin NHSE NO – DO NOT PRESCRIBE Apremilast NHSE and CCG (depending on NO – DO NOT PRESCRIBE indication) Arimoclomol NHSE but not commissioned NO – DO NOT PRESCRIBE Arsenic trioxide* NHSE NO – DO NOT PRESCRIBE Asfotase alfa NHSE NO – DO NOT PRESCRIBE Asunaprevir with daclatasvir NHSE but not commissioned NO – DO NOT PRESCRIBE Atacicept NHSE but not commissioned NO – DO NOT PRESCRIBE Ataluren NHSE NO – DO NOT PRESCRIBE Atazanavir NHSE NO – DO NOT PRESCRIBE Guidance on prescribing of drugs excluded from the National Tariff 2019-20 in primary care Review date: June 2020 Bedfordshire Clinical Commissioning Group Luton Clinical Commissioning Group Milton Keynes Clinical Commissioning Group DRUG NAME COMMISSIONING PRESCRIBING EXPECTED IN ADDITIONAL NOTES RESPONSIBILITY PRIMARY CARE? Atezolizumab* NHSE / CDF NO – DO NOT PRESCRIBE Atripla® (Tenofovir +Efavirenz + NHSE NO – DO NOT PRESCRIBE Emtricitabine) Autologous chrondocyte NHSE NO – DO NOT PRESCRIBE implantation* Autologous serum eye drops NHSE but not commissioned NO – DO NOT PRESCRIBE Avacincaptad pegol CCG but not commissioned NO – DO NOT PRESCRIBE Avacopan NHSE but not commissioned NO – DO NOT PRESCRIBE Avatrombopag CCG but not commissioned NO – DO NOT PRESCRIBE Avelumab NHSE / CDF NO – DO NOT PRESCRIBE Axicabtagene ciloleucel CDF NO – DO NOT PRESCRIBE Axitinib NHSE NO – DO NOT PRESCRIBE Azacitidine NHSE NO – DO NOT PRESCRIBE Azathioprine* NHSE when used for DO NOT PRESCRIBE for new . When used for immunosuppression post-transplant in immunosuppression post- transplant patients EXISTING patients, may be prescribed Claw back transplant mechanism in place for BCCG and LCCG . When given for any other indication, not excluded from National Tariff so can be prescribed
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