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 Aztreonam lysine NHSE and CCG (depending on NO – DO NOT PRESCRIBE . When given by nebulisation / inhalation for cystic fibrosis / indication) bronchiectasis – 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? . When given as any other form, not excluded from National Tariff but secondary care prescribing only – DO NOT PRESCRIBE B Bardoxolone methyl NHSE but not commissioned NO – DO NOT PRESCRIBE

Baricitinib NHSE and CCG (depending on NO – DO NOT PRESCRIBE . Not routinely commissioned by NHSE (paediatric indications) indication) Basiliximab NHSE NO – DO NOT PRESCRIBE

Beclabuvir NHSE but not commissioned NO – DO NOT PRESCRIBE

Bedaquiline NHSE NO – DO NOT PRESCRIBE

Begelomab NHSE but not commissioned NO – DO NOT PRESCRIBE

Belatacept NHSE but not commissioned NO – DO NOT PRESCRIBE

Belimumab NHSE NO – DO NOT PRESCRIBE

Bendamustine* NHSE / CDF NO – DO NOT PRESCRIBE

Benralizumab NHSE NO – DO NOT PRESCRIBE Beperminogene perplasmid NHSE but not commissioned NO – DO NOT PRESCRIBE

Betaine NHSE NO – DO NOT PRESCRIBE

Bevacizumab NHSE / CDF 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? Bezlotoxumab CCG but not commissioned NO – DO NOT PRESCRIBE

Bictegravir NHSE but not commissioned NO – DO NOT PRESCRIBE

Biktarvy® (bictegravir + NHSE but not commissioned NO – DO NOT PRESCRIBE emtricitabine + tenofovir alafenamide fumarate) Bimagrumab NHSE but not commissioned NO – DO NOT PRESCRIBE

Biotin NHSE but not commissioned NO – DO NOT PRESCRIBE

Blinatumomab* NHSE NO – DO NOT PRESCRIBE

Blisibimod NHSE but not commissioned NO – DO NOT PRESCRIBE

Bortezomib NHSE / CDF NO – DO NOT PRESCRIBE

Bosentan NHSE NO – DO NOT PRESCRIBE

Bosutinib NHSE NO – DO NOT PRESCRIBE

Botulinum toxin A NHSE and CCG (depending on NO – DO NOT PRESCRIBE indication) Botulinum toxin B CCG NO – DO NOT PRESCRIBE

Brentuximab* NHSE NO – DO NOT PRESCRIBE

Brigatinib* NHSE NO – DO NOT PRESCRIBE Brimapitide 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?

Brincidofovir NHSE but not commissioned NO – DO NOT PRESCRIBE

Brodalumab NHSE and CCG (depending on NO – DO NOT PRESCRIBE . Not routinely commissioned by NHSE (paediatric indications) indication) Brolucizumab CCG but not commissioned NO – DO NOT PRESCRIBE

Burosumab NHSE NO – DO NOT PRESCRIBE

C C1 esterase inhibitor NHSE NO – DO NOT PRESCRIBE

Cabazitaxel* NHSE NO – DO NOT PRESCRIBE

Cabotegravir NHSE but not commissioned NO – DO NOT PRESCRIBE

Cabozantinib* NHSE NO – DO NOT PRESCRIBE

Calcifediol NHSE but not commissioned NO – DO NOT PRESCRIBE

Canakinumab NHSE NO – DO NOT PRESCRIBE

Cannabidiol NHSE NO – DO NOT PRESCRIBE . Excluded for epilepsy indications only

Capecitabine* NHSE NO – DO NOT PRESCRIBE

Caplacizumab NHSE but not commissioned NO – DO NOT PRESCRIBE

Carfilzomib* 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?

Carglumic acid NHSE NO – DO NOT PRESCRIBE

Carnitine (Levocarnitine) NHSE MKCCG –DO NOT PRESCRIBE for . When used for carnitine deficiency NEW and EXISTING new patients patients, may be prescribed (after initiation by the specialist) . Should not be prescribed under any other circumstances. BCCG and LCCG - YES – may be prescribed (claw-back mechanism in place from NHSE) Caspofungin NHSE NO – DO NOT PRESCRIBE

Cenegermin NHSE but not commissioned NO – DO NOT PRESCRIBE

Ceralifimod NHSE but not commissioned NO – DO NOT PRESCRIBE

Ceritinib* NHSE NO – DO NOT PRESCRIBE

Cerliponase alfa NHSE but not commissioned NO – DO NOT PRESCRIBE

Certolizumab pegol NHSE and CCG (depending on NO – DO NOT PRESCRIBE . Not routinely commissioned by NHSE (paediatric indications) indication) Cetuximab NHSE NO – DO NOT PRESCRIBE

Chenodeoxycholic acid NHSE but not commissioned NO – DO NOT PRESCRIBE

Cholic acid NHSE but not commissioned NO – DO NOT PRESCRIBE

Ciclosporin* 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

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? transplant . Claw back mechanism in place for BCCG and LCCG with NHSE . When given for any other indication, not excluded from National Tariff so can be prescribed Cidofovir NHSE NO – DO NOT PRESCRIBE

Cinacalcet NHSE MKCCG – DO NOT PRESCRIBE . When used for hyperparathyroidism in renal dialysis, may be for new renal dialysis patients prescribed in both new (after initiation by secondary care) or other indications and existing patients . When given for any other indication, not excluded from BCCG and LCCG - YES – may be National Tariff so can be prescribed (after initiation by prescribed (claw-back secondary care) mechanism in place from NHSE) inhalation NHSE when given by nebulisation NO – DO NOT PRESCRIBE . Any other form, not excluded from National Tariff so can be / inhalation, but not prescribed commissioned Ciprofloxacin liposomal NHSE when given by nebulisation NO – DO NOT PRESCRIBE . Any other form, not excluded from National Tariff so can be / inhalation, but not prescribed commissioned Cladribine NHSE NO – DO NOT PRESCRIBE

Clazakizumab NHSE but not commissioned NO – DO NOT PRESCRIBE

Clofarabine* CDF NO – DO NOT PRESCRIBE

Cobicistat NHSE NO – DO NOT PRESCRIBE

Cobitolimod NHSE and CCG (depending on NO – DO NOT PRESCRIBE indication), but not commissioned Co-careldopa internal tube NHSE when given as an intestinal NO – DO NOT PRESCRIBE . As an intestinal gel (Duodopa®) – 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? intestinal gel gel . As any other form, not excluded from National Tariff so can be prescribed Colestilan* NHSE NO – DO NOT PRESCRIBE

Colistimethate sodium (when NHSE and CCG (depending on MKCCG –DO NOT PRESCRIBE . As a powder / injection for nebulisation (Colomycin®/ delivered via nebulisation/ indication) Promixin®) for cystic fibrosis, can be prescribed for both inhalation) BCCG and LCCG - YES – may be new and existing patients (NHSE policy A01/P/b) under prescribed in certain forms shared care . As a dry powder for inhalation (Colobreathe®) for cystic fibrosis – DO NOT PRESCRIBE . As any other form, not excluded from National Tariff but secondary care prescribing only – DO NOT PRESCRIBE . BCCG and LCCG have claw-back mechanism in place from NHSE Collagenase CCG when used in outpatients NO – DO NOT PRESCRIBE only

Combivir® (zidovudine + NHSE NO – DO NOT PRESCRIBE lamivudine) Conestat alfa NHSE NO – DO NOT PRESCRIBE

Crizanlizumab NHSE but not commissioned NO – DO NOT PRESCRIBE Crizotinib NHSE / CDF NO – DO NOT PRESCRIBE

CX601 (Darvadstrocel) CCG but not commissioned NO – DO NOT PRESCRIBE

Cyclic pyranopterin NHSE but not commissioned NO – DO NOT PRESCRIBE monophosphate Cysteamine (mercaptamine) 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?

D Dabrafenib NHSE NO – DO NOT PRESCRIBE

Daclizumab NHSE but not commissioned NO – DO NOT PRESCRIBE

Damoctocog alfa pegol NHSE but not commissioned NO – DO NOT PRESCRIBE

Daratumumab* NHSE NO – DO NOT PRESCRIBE

Darbepoetin* NHSE and CCG (depending on MKCCG – DO NOT PRESCRIBE . When used in renal dialysis, may be prescribed in both new indication) for new patients (after initiation by secondary care) and existing patients . For use in pre-dialysis, not commissioned – DO NOT BCCG and LCCG - YES – may be PRESCRIBE prescribed in certain indications . When given for any other indication, not excluded from (claw-back mechanism in place National Tariff so can be prescribed from NHSE) Darunavir NHSE NO – DO NOT PRESCRIBE

Darvadstrocel (CX601) CCG but not commissioned NO – DO NOT PRESCRIBE

Dasabuvir NHSE NO – DO NOT PRESCRIBE

Dasatinib NHSE / CDF NO – DO NOT PRESCRIBE

Decitabine NHSE but not commissioned NO – DO NOT PRESCRIBE

Deferasirox 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) Deferiprone NHSE and CCG (depending on NO – DO NOT PRESCRIBE indication) Defibrotide NHSE NO – DO NOT PRESCRIBE

Delamanid NHSE NO – DO NOT PRESCRIBE

Descovy® (emtricitabine + NHSE NO – DO NOT PRESCRIBE tenofovir alafenamide) Desferrioxamine NHSE and CCG (depending on NO – DO NOT PRESCRIBE indication) Dexamethasone intravitreal CCG NO – DO NOT PRESCRIBE . As an intravitreal implant (Ozurdex®) / intraocular implant / implant / dexamethasone intra-erythrocyte – DO NOT PRESCRIBE intraocular implant / . As any other form, not excluded from National Tariff so can dexamethasone intra-erythrocyte be prescribed Dexrazoxane NHSE NO – DO NOT PRESCRIBE

Diaminopyridine (3,4)* NHSE NO – DO NOT PRESCRIBE

Dibotermin alfa NHSE and CCG (depending on NO – DO NOT PRESCRIBE indication) Dichlorphenamide NHSE but not commissioned NO – DO NOT PRESCRIBE

Didanosine NHSE NO – DO NOT PRESCRIBE

Digoxin immune fab CCG NO – DO NOT PRESCRIBE

Dimethyl fumarate (licensed NHSE and CCG (depending on NO – DO NOT PRESCRIBE preparation) indication)

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? Dinutuximab* NHSE NO – DO NOT PRESCRIBE

Diroximel fumarate NHSE but not commissioned NO – DO NOT PRESCRIBE

Docetaxel* NHSE NO – DO NOT PRESCRIBE

Dolutegravir NHSE NO – DO NOT PRESCRIBE

Domagrozumab NHSE but not commissioned NO – DO NOT PRESCRIBE

Doravirine NHSE but not commissioned NO – DO NOT PRESCRIBE

Dornase alfa NHSE MKCCG - NO – DO NOT . As a nebuliser solution (Pulmozyme®) for cystic fibrosis, can PRESCRIBE be prescribed for both new and existing patients (NHSE policy A01/P/b) under shared care BCCG and LCCG – YES – may be . For any other indication, not commissioned – DO NOT prescribed in certain indications PRESCRIBE . BCCG and LCCG have claw-back mechanism in place from NHSE Drisapersen NHSE but not commissioned NO – DO NOT PRESCRIBE

Dupilumab NHSE and CCG (depending on NO – DO NOT PRESCRIBE indication) E Ecallantide NHSE but not commissioned NO – DO NOT PRESCRIBE

Eculizumab 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? Edasalonexent NHSE but not commissioned NO – DO NOT PRESCRIBE

Edratide NHSE but not commissioned NO – DO NOT PRESCRIBE

Efavirenz NHSE NO – DO NOT PRESCRIBE

Efraloctocog alfa / efmoroctocog NHSE NO – DO NOT PRESCRIBE alfa / factor VIII Fc fusion protein (Elocta®)

Eftrenonacog alfa NHSE NO – DO NOT PRESCRIBE

Elbasvir NHSE NO – DO NOT PRESCRIBE

Eliglustat NHSE NO – DO NOT PRESCRIBE

Elosulfase alfa NHSE NO – DO NOT PRESCRIBE

Eltrombopag NHSE and CCG (depending on NO – DO NOT PRESCRIBE indication) Elvitegravir NHSE NO – DO NOT PRESCRIBE

Elvucitabine NHSE but not commissioned NO – DO NOT PRESCRIBE

Emapalumab NHSE but not commissioned NO – DO NOT PRESCRIBE

Emricasan NHSE but not commissioned NO – DO NOT PRESCRIBE

Emtricitabine 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?

Enfuvirtide NHSE NO – DO NOT PRESCRIBE

Entecavir NHSE NO – DO NOT PRESCRIBE

Entolimod NHSE but not commissioned NO – DO NOT PRESCRIBE

Enzalutamide* NHSE NO – DO NOT PRESCRIBE

Epclusa® (sofosbuvir + NHSE NO – DO NOT PRESCRIBE velpatasvir) Epoetins (all variants)* NHSE and CCG (depending on MKCCG- DO NOT PRESCRIBE . When used in renal dialysis in NEW and EXISTING patients, indication) for new patients may be prescribed (after initiation by the specialist) . For use in pre-dialysis, not commissioned – DO NOT BCCG and LCCG – YES, may be PRESCRIBE prescribed in certain indications . When given for any other indication, not excluded from (claw-back mechanism in place National Tariff so can be prescribed from NHSE) Epoprostenol NHSE and CCG (depending on NO – DO NOT PRESCRIBE indication) Epratuzumab NHSE but not commissioned NO – DO NOT PRESCRIBE

Eprodisate NHSE but not commissioned NO – DO NOT PRESCRIBE

Eptinezumab CCG but not commissioned NO – DO NOT PRESCRIBE

Eptotermin alfa 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? Erenumab CCG but not commissioned NO – DO NOT PRESCRIBE

Eribulin* NHSE / CDF NO – DO NOT PRESCRIBE

Erlotinib NHSE NO – DO NOT PRESCRIBE

Erythropoietins* NHSE and CCG (depending on MKCCG – DO NOT PRESCRIBE . When used in renal dialysis, may be prescribed in both new indication) for new patients (after initiation by secondary care) and existing patients . For use in pre-dialysis, not commissioned – DO NOT BCCG and LCCG - YES – may be PRESCRIBE prescribed in certain indications . When given for any other indication, not excluded from (claw-back mechanism in place National Tariff so can be prescribed from NHSE) Etanercept NHSE and CCG (depending on NO – DO NOT PRESCRIBE indication) Etelcalcetide NHSE NO – DO NOT PRESCRIBE

Eteplirsen NHSE but not commissioned NO – DO NOT PRESCRIBE

Etravirine NHSE NO – DO NOT PRESCRIBE

Etrolizumab CCG but not commissioned NO – DO NOT PRESCRIBE

Everolimus NHSE / CDF NO – DO NOT PRESCRIBE

Eviplera® (tenofovir + NHSE NO – DO NOT PRESCRIBE emtricitabine + rilpivirine) Evolocumab 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) Evotaz® (Atazanavir + Cobicistat) NHSE NO – DO NOT PRESCRIBE

Ex-vivo expanded autologous NHSE but not commissioned NO – DO NOT PRESCRIBE human corneal epithelial cells containing stem cells F Factors VII, VIIa, VIII, VIII Fc fusion NHSE NO – DO NOT PRESCRIBE protein, VIII inhibitor bypassing factor, IX and XIII (Coagadex®)* NHSE but not commissioned NO – DO NOT PRESCRIBE

Fampridine NHSE but not commissioned NO – DO NOT PRESCRIBE

Fasinumab CCG but not commissioned NO – DO NOT PRESCRIBE

Fibrinogen NHSE NO – DO NOT PRESCRIBE

Fibroblast growth factor 1 gene NHSE but not commissioned NO – DO NOT PRESCRIBE therapy Fidaxomicin (Dificlir®) CCG but not commissioned NO – DO NOT PRESCRIBE

Filgotinib CCG but not commissioned NO – DO NOT PRESCRIBE

Filgrastim** NHSE NO – DO NOT PRESCRIBE

Fingolimod 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? Fitusiran NHSE but not commissioned NO – DO NOT PRESCRIBE

Fluocinolone acetonide CCG NO – DO NOT PRESCRIBE . As an intravitreal implant (Iluvien®) – DO NOT PRESCRIBE intravitreal implant . Fluocinolone as any other form, not excluded from National Tariff so can be prescribed Fomepizole CCG NO – DO NOT PRESCRIBE

Forigerimod acetate NHSE but not commissioned NO – DO NOT PRESCRIBE

Fosamprenavir NHSE NO – DO NOT PRESCRIBE

Foscarnet NHSE NO – DO NOT PRESCRIBE

Fostamatinib disodium NHSE but not commissioned NO – DO NOT PRESCRIBE

Fostemsavir NHSE but not commissioned NO – DO NOT PRESCRIBE

Fremanezumab CCG but not commissioned NO – DO NOT PRESCRIBE

G Galcanezumab CCG but not commissioned NO – DO NOT PRESCRIBE

Galsufase NHSE NO – DO NOT PRESCRIBE

Galunisertib NHSE but not commissioned NO – DO NOT PRESCRIBE

Ganciclovir NHSE NO – DO NOT PRESCRIBE

Ganetespib 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?

Gantenerumab CCG but not commissioned NO – DO NOT PRESCRIBE

Gefitinib NHSE NO – DO NOT PRESCRIBE

Gemcitibine* NHSE NO – DO NOT PRESCRIBE

Gemtuzumab ozogamicin* NHSE NO – DO NOT PRESCRIBE

Genvoya® (tenofovir alafenamide NHSE NO – DO NOT PRESCRIBE + emtricitabine + elvitegravir + cobicistat) Gevokizumab NHSE but not commissioned NO – DO NOT PRESCRIBE

Givosiran NHSE but not commissioned NO – DO NOT PRESCRIBE

Glatiramer acetate NHSE NO – DO NOT PRESCRIBE

Glecaprevir NHSE NO – DO NOT PRESCRIBE

Glucarpidase NHSE NO – DO NOT PRESCRIBE

Glycerol phenylbutyrate NHSE but not commissioned NO – DO NOT PRESCRIBE

Golimumab NHSE and CCG (depending on NO – DO NOT PRESCRIBE indication) Granulocyte-macrophage colony- NHSE but not commissioned NO – DO NOT PRESCRIBE stimulating factor (Leukine®)* Grazoprevir 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?

Guselkumab CCG NO – DO NOT PRESCRIBE

H Haem Arginate NHSE NO – DO NOT PRESCRIBE

Halofuginone NHSE but not commissioned NO – DO NOT PRESCRIBE

Harvoni® (sofosbuvir + ledipasvir) NHSE NO – DO NOT PRESCRIBE

HIV vaccine NHSE but not commissioned NO – DO NOT PRESCRIBE

Human alpha1-proteinase NHSE but not commissioned NO – DO NOT PRESCRIBE inhibitor Human heterologous liver cells NHSE but not commissioned NO – DO NOT PRESCRIBE

Human parathyroid hormone- NHSE but not commissioned NO – DO NOT PRESCRIBE related protein analogue Hydroxypropyl betadex Commissioning responsibility NO – DO NOT PRESCRIBE unclear I Ibalizumab NHSE but not commissioned NO – DO NOT PRESCRIBE

Ibrutinib* NHSE / CDF NO – DO NOT PRESCRIBE

Icatibant NHSE NO – DO NOT PRESCRIBE

Idarucizumab CCG 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?

Idebenone NHSE but not commissioned NO – DO NOT PRESCRIBE

Idelalisib* NHSE / CDF NO – DO NOT PRESCRIBE

Idursulfase NHSE NO – DO NOT PRESCRIBE

IL6 receptor MAb (SA237) Commissioning responsibility NO – DO NOT PRESCRIBE unclear Iloprost NHSE and CCG (depending on NO – DO NOT PRESCRIBE indication) NHSE NO – DO NOT PRESCRIBE

Imetelstat NHSE but not commissioned NO – DO NOT PRESCRIBE

Imiglucerase NHSE NO – DO NOT PRESCRIBE

Immunoglobulin, human normal NHSE NO – DO NOT PRESCRIBE (intravenous) Immunoglobulin, human normal NHSE NO – DO NOT PRESCRIBE (subcutaneous) NHSE NO – DO NOT PRESCRIBE

Inebelizumab NHSE but not commissioned NO – DO NOT PRESCRIBE

Infliximab NHSE and CCG (depending on NO – DO NOT PRESCRIBE indication) 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? Inotuzumab ozogamicin* NHSE NO – DO NOT PRESCRIBE

Interferon alfa NHSE NO – DO NOT PRESCRIBE

Interferon alpha-n3 NHSE but not commissioned NO – DO NOT PRESCRIBE

Interferon beta NHSE NO – DO NOT PRESCRIBE

Invertase Commissioning responsibility NO – DO NOT PRESCRIBE unclear Ipilimumab* NHSE NO – DO NOT PRESCRIBE

Isavuconazole NHSE NO – DO NOT PRESCRIBE

Ivacaftor NHSE NO – DO NOT PRESCRIBE

Ixazomib NHSE but not commissioned NO – DO NOT PRESCRIBE

Ixekizumab CCG NO – DO NOT PRESCRIBE

J K Kaletra® (ritonavir + lopinavir) NHSE NO – DO NOT PRESCRIBE

Ketorolac with phenylephrine CCG but not commissioned NO – DO NOT PRESCRIBE

Kivexa® (abacavir + lamivudine) 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? L Lamivudine NHSE NO – DO NOT PRESCRIBE

Lampalizumab CCG but not commissioned NO – DO NOT PRESCRIBE

Lanadelumab NHSE but not commissioned NO – DO NOT PRESCRIBE

Lanreotide NHSE and CCG (depending on Yes – may be prescribed in . For new patients: Contact MOT for advice indication) certain indications . For current patients: Continue to prescribe as per JPC (BCCG and LCCG) guidance on somatostatin analogues (via GP Ref) . BCCG and LCCG have claw-back mechanism in place from NHSE Lanthanum carbonate NHSE when used in adult renal BCCG/LCCG – may be . BCCG and LCCG claw-back mechanism in place from NHSE dialysis patients prescribed . When used in adult renal dialysis, may be prescribed in both new (after initiation by secondary care) and existing MKCCG – DO NOT PRESCRIBE patients under shared care. . When given for any other indication, not excluded from National Tariff so can be prescribed Lapatinib NHSE but not commissioned NO – DO NOT PRESCRIBE

Laquinimod NHSE but not commissioned NO – DO NOT PRESCRIBE

Laronidase NHSE NO – DO NOT PRESCRIBE

Lebrikizumab NHSE but not commissioned NO – DO NOT PRESCRIBE

Ledipasvir NHSE NO – DO NOT PRESCRIBE

Lenalidomide NHSE / CDF 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? Lenograstim** NHSE NO – DO NOT PRESCRIBE

Lenvatinib* NHSE NO – DO NOT PRESCRIBE

Leronlimab NHSE but not commissioned NO – DO NOT PRESCRIBE

Letermovir NHSE but not commissioned NO – DO NOT PRESCRIBE

Levodopa + Carbidopa (co- NHSE when given as an intestinal NO – DO NOT PRESCRIBE . As an intestinal gel (Duodopa®) – DO NOT PRESCRIBE careldopa) gel . As any other form, not excluded from National Tariff so can be prescribed Levocarnitine NHSE MKCCG –DO NOT PRESCRIBE . When used for carnitine deficiency (after initiation by the specialist), may be prescribed. BCCG and LCCG - YES – may be . Should not be prescribed under any other circumstances. prescribed (claw-back mechanism in place from NHSE) Levofloxacin (when delivered via NHSE when given as a solution for NO – DO NOT PRESCRIBE . As a solution for inhalation in cystic fibrosis – DO NOT nebulisation/inhalation) inhalation PRESCRIBE . As any other form, not excluded from National Tariff so can be prescribed Levoketoconazole NHSE but not commissioned NO – DO NOT PRESCRIBE

Lipegfilgrastim** NHSE but not commissioned NO – DO NOT PRESCRIBE

Liothyronine CCG NO – DO NOT PRESCRIBE . Excluded from national tariff when administered intravenously only – DO NOT PRESCRIBE . As any other form, not excluded from National Tariff but prescribing to be retained by secondary care – 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? Liposomal cytarabine– NHSE NO – DO NOT PRESCRIBE daunorubicin Lixivaptan NHSE and CCG (depending on NO – DO NOT PRESCRIBE indication), but not commissioned Lomitapide NHSE NO – DO NOT PRESCRIBE

Lonafarnib NHSE but not commissioned NO – DO NOT PRESCRIBE

Lopinavir NHSE NO – DO NOT PRESCRIBE

Lumacaftor with Ivacaftor NHSE NO – DO NOT PRESCRIBE

Luspatercept NHSE but not commissioned NO – DO NOT PRESCRIBE

Lusutrombopag CCG NO – DO NOT PRESCRIBE

Lutetium (177Lu) oxodotreotide NHSE NO – DO NOT PRESCRIBE

M Macimorelin NHSE but not commissioned NO – DO NOT PRESCRIBE

Macitentan NHSE NO – DO NOT PRESCRIBE

Mannitol (when delivered via NHSE NO – DO NOT PRESCRIBE . When given by nebulisation / inhalation for cystic fibrosis – nebulisation/inhalation) DO NOT PRESCRIBE . When given by nebulisation / inhalation for any indication other than cystic fibrosis, not commissioned – DO NOT PRESCRIBE . As any other form, not excluded from National Tariff but 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? secondary care prescribing only – DO NOT PRESCRIBE Maralixibat NHSE but not commissioned NO – DO NOT PRESCRIBE

Maraviroc NHSE NO – DO NOT PRESCRIBE

Maribavir NHSE but not commissioned NO – DO NOT PRESCRIBE

Masitinib NHSE and CCG (depending on NO – DO NOT PRESCRIBE indication), but not commissioned Mavrilimumab Commissioning responsibility NO – DO NOT PRESCRIBE unclear Mecasermin NHSE NO – DO NOT PRESCRIBE

Mepolizumab NHSE and CCG (depending on NO – DO NOT PRESCRIBE . Commissioned by NHSE for asthma indication) . Not commissioned by CCGs for COPD Mercaptamine (cysteamine) NHSE NO – DO NOT PRESCRIBE

Mesenchymal stem cells (e.g. NHSE but not commissioned NO – DO NOT PRESCRIBE Prochymal®)* Metreleptin NHSE NO – DO NOT PRESCRIBE

Mexiletine NHSE but not commissioned NO – DO NOT PRESCRIBE

Micafungin NHSE NO – DO NOT PRESCRIBE

Midostaurin* NHSE NO – DO NOT PRESCRIBE

Migalastat 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? Miglustat NHSE NO – DO NOT PRESCRIBE

Momelotinib NHSE but not commissioned NO – DO NOT PRESCRIBE

Mycophenolate mofetil* NHSE when used for DO NOT PRESCRIBE for new . When used for immunosuppression post-transplant in immunosuppression post- patients . EXISTING patients, may be prescribed transplant . BCCG and LCCG have claw-back mechanism in place from NHSE . When given for any other indication, not excluded from National Tariff so can be prescribed Mycophenolic acid* NHSE when used for DO NOT PRESCRIBE for new . When used for immunosuppression post-transplant in immunosuppression post- patients . EXISTING patients, may be prescribed (after initiation by transplant the specialist) . BCCG and LCCG have claw-back mechanism in place from NHSE . When given for any other indication, not excluded from National Tariff so can be prescribed N Natalizumab NHSE NO – DO NOT PRESCRIBE

Nelarabine* CDF NO – DO NOT PRESCRIBE

Nelfinavir NHSE NO – DO NOT PRESCRIBE

Nevirapine NHSE NO – DO NOT PRESCRIBE

Nexobrid Commissioning responsibility NO – DO NOT PRESCRIBE unclear Nilotinib 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?

Nintedanib NHSE NO – DO NOT PRESCRIBE

Niraparib* NHSE / CDF NO – DO NOT PRESCRIBE

Nitazoxanide NHSE but not commissioned NO – DO NOT PRESCRIBE

Nitisinone NHSE NO – DO NOT PRESCRIBE

Nitric oxide NHSE NO – DO NOT PRESCRIBE

Nivolumab* NHSE / CDF NO – DO NOT PRESCRIBE

Nusinersen NHSE but not commissioned NO – DO NOT PRESCRIBE

O Obeticholic acid NHSE NO – DO NOT PRESCRIBE

Obinutuzumab* NHSE / CDF NO – DO NOT PRESCRIBE Ocrelizumab NHSE NO – DO NOT PRESCRIBE

Ocriplasmin CCG NO – DO NOT PRESCRIBE

Octocog alfa NHSE NO – DO NOT PRESCRIBE

Octreolin NHSE but not commissioned NO – DO NOT PRESCRIBE

Octreotide NHSE and CCG (depending on Yes – may be prescribed in . For new patients: Contact MOT for advice indication) certain indications- please seek . For current patients: Continue to prescribe as per JPC 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? advice for MKCCG patients guidance on somatostatin analogues (via GP Ref) . BCCG and LCCG have a claw back mechanism in place with NHSE Odefsey® (emtricitabine + NHSE NO – DO NOT PRESCRIBE rilpivirine + tenofovir alafenamide) Ofatumumab NHSE NO – DO NOT PRESCRIBE

Olaparib* NHSE NO – DO NOT PRESCRIBE

Olaratumab* CDF NO – DO NOT PRESCRIBE

Olesoxime NHSE but not commissioned NO – DO NOT PRESCRIBE

Omalizumab NHSE and CCG (depending on NO – DO NOT PRESCRIBE indication) Ombitasvir NHSE NO – DO NOT PRESCRIBE

Omidria® (Ketorolac + CCG but not commissioned NO – DO NOT PRESCRIBE Phenylephrine)

Orkambi® (Lumacaftor + NHSE NO – DO NOT PRESCRIBE Ivacaftor) NHSE but not commissioned NO – DO NOT PRESCRIBE

Osimertinib* CDF NO – DO NOT PRESCRIBE

Ozanimod 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? P Pacritinib NHSE but not commissioned NO – DO NOT PRESCRIBE

Palivizumab NHSE NO – DO NOT PRESCRIBE

Palbociclib* NHSE NO – DO NOT PRESCRIBE

Panitumumab* NHSE NO – DO NOT PRESCRIBE

Panobinostat* NHSE NO – DO NOT PRESCRIBE

Para-aminosalicylic acid NHSE NO – DO NOT PRESCRIBE

Parathyroid hormone NHSE NO – DO NOT PRESCRIBE

Parenteral nutrition (PN) NHSE when duration is more than NO – DO NOT PRESCRIBE 14 days / initiated prior to admission / home PN Paricalcitol NHSE NO – DO NOT PRESCRIBE

Paritaprevir NHSE NO – DO NOT PRESCRIBE

Pasireotide NHSE and CCG (depending on NO – DO NOT PRESCRIBE . Commissioned for Cushing’s Disease only (NHSE) indication) Patisiran NHSE but not commissioned NO – DO NOT PRESCRIBE

Pazopanib NHSE NO – DO NOT PRESCRIBE

Pegaspargase* 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?

Peg interferon alfa NHSE NO – DO NOT PRESCRIBE

Peg interferon beta-1a NHSE NO – DO NOT PRESCRIBE

Pegbelfermin NHSE but not commissioned NO – DO NOT PRESCRIBE

Pegfilgrastim** NHSE but not commissioned NO – DO NOT PRESCRIBE

Pegunigalsidase alfa NHSE but not commissioned NO – DO NOT PRESCRIBE

Pegvaliase NHSE but not commissioned NO – DO NOT PRESCRIBE

Pegvisomant NHSE NO – DO NOT PRESCRIBE

Pegylated liposomal doxorubicin* NHSE / CDF NO – DO NOT PRESCRIBE

Pembrolizumab* NHSE NO – DO NOT PRESCRIBE

Pemetrexed* NHSE NO – DO NOT PRESCRIBE

Peptide receptor radionucleotide CDF but not commissioned NO – DO NOT PRESCRIBE therapy* Pertuzumab* NHSE NO – DO NOT PRESCRIBE

Phenylephrine with ketorolac CCG but not commissioned NO – DO NOT PRESCRIBE

Pibrentasvir 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? Pirfenidone NHSE NO – DO NOT PRESCRIBE

Pitolisant CCG but not commissioned NO – DO NOT PRESCRIBE

Pixantrone* NHSE NO – DO NOT PRESCRIBE

Plerixafor NHSE NO – DO NOT PRESCRIBE

Poloxamer 188 Commissioning responsibility NO – DO NOT PRESCRIBE unclear Pomalidomide NHSE NO – DO NOT PRESCRIBE

Ponatinib NHSE NO – DO NOT PRESCRIBE

Ponesimod NHSE but not commissioned NO – DO NOT PRESCRIBE

Poractant alfa* NHSE NO – DO NOT PRESCRIBE

Posaconazole NHSE NO – DO NOT PRESCRIBE

Pretomanid NHSE but not commissioned NO – DO NOT PRESCRIBE

Protein C NHSE NO – DO NOT PRESCRIBE

Prothrombin complex NHSE NO – DO NOT PRESCRIBE

Q R

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? Radium-223 dichloride* NHSE / CDF NO – DO NOT PRESCRIBE

Raltegravir NHSE NO – DO NOT PRESCRIBE

Ramucirumab* NHSE but not commissioned NO – DO NOT PRESCRIBE

Ranibizumab CCG NO – DO NOT PRESCRIBE Rasburicase NHSE NO – DO NOT PRESCRIBE

Raxibacumab NHSE but not commissioned NO – DO NOT PRESCRIBE

Recombinant human CCG but not commissioned NO – DO NOT PRESCRIBE thrombomodulin Recombinant von Willebrand NHSE but not commissioned NO – DO NOT PRESCRIBE factor* Refanalin NHSE but not commissioned NO – DO NOT PRESCRIBE

Regorafenib NHSE NO – DO NOT PRESCRIBE

Reloxaliase Commissioning responsibility NO – DO NOT PRESCRIBE unclear Reltecimod CCG but not commissioned NO – DO NOT PRESCRIBE

Reparixin NHSE but not commissioned NO – DO NOT PRESCRIBE

Reslizumab NHSE NO – DO NOT PRESCRIBE

Reveglucosidase Alfa 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? Rezolsta® (darunavir + cobicistat) NHSE NO – DO NOT PRESCRIBE

Ribavirin** NHSE NO – DO NOT PRESCRIBE

Ribociclib* NHSE NO – DO NOT PRESCRIBE

Rigosertib NHSE but not commissioned NO – DO NOT PRESCRIBE

Rilpivirine NHSE NO – DO NOT PRESCRIBE

Riluzole** CCG Yes – may be prescribed . For use in the amyotrophic lateral sclerosis (ALS) form of Motor Neurone Disease, may be prescribed in new patients (following initial three month supply by secondary care) and existing patients under shared care.

Rimeporide NHSE but not commissioned NO – DO NOT PRESCRIBE

Rintatolimod CCG but not commissioned NO – DO NOT PRESCRIBE

Riociguat NHSE NO – DO NOT PRESCRIBE

Risankizumab CCG NO – DO NOT PRESCRIBE

Ritonavir NHSE NO – DO NOT PRESCRIBE

Rituximab NHSE and CCG (depending on NO – DO NOT PRESCRIBE indication) Rivipansel sodium 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? NHSE and CCG (depending on NO – DO NOT PRESCRIBE indication) Romosozumab CCG but not commissioned NO – DO NOT PRESCRIBE

Ropeginterferon alfa-2b NHSE but not commissioned NO – DO NOT PRESCRIBE

Roxadustat NHSE but not commissioned NO – DO NOT PRESCRIBE

Rurioctocog alfa pegol NHSE but not commissioned NO – DO NOT PRESCRIBE

Ruxolitinib NHSE NO – DO NOT PRESCRIBE

Ruzasvir NHSE but not commissioned NO – DO NOT PRESCRIBE

S Sacrosidase NHSE but not commissioned NO – DO NOT PRESCRIBE

Sapropterin NHSE NO – DO NOT PRESCRIBE

Saquinavir NHSE NO – DO NOT PRESCRIBE

Sarilumab NHSE and CCG (depending on NO – DO NOT PRESCRIBE indication) Satralizumab NHSE but not commissioned NO – DO NOT PRESCRIBE

Sebelipase alfa NHSE but not commissioned NO – DO NOT PRESCRIBE

Secukinumab NHSE and CCG (depending on NO – DO NOT PRESCRIBE indication) 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? Selexipag NHSE NO – DO NOT PRESCRIBE

Sevelamer NHSE when used in adult renal MKCCG – YES - existing patients . When used in adult renal dialysis, may be prescribed in both dialysis patients only new (after initiation by secondary care) and existing patients BCCG and LCCG - Yes – may be under shared care. prescribed (claw-back . When given for any other indication, not excluded from mechanism in place from NHSE) National Tariff so can be prescribed ** NHSE when used in pulmonary Yes – may be prescribed in . For use in pulmonary arterial hypertension – DO NOT arterial hypertension certain indications PRESCRIBE . For any other indication, not excluded from National Tariff so can be prescribed Siltuximab Commissioning responsibility NO – DO NOT PRESCRIBE unclear Simeprevir NHSE NO – DO NOT PRESCRIBE

Sirolimus NHSE when used for DO NOT PRESCRIBE for new . When used for immunosuppression post-transplant immunosuppression post- patients EXISTING patients, may be prescribed transplant . BCCG and LCCG have claw-back mechanism in place from NHSE . When given for any other indication, not excluded from National Tariff so can be prescribed Sirolimus, intravitreal CCG but not commissioned NO – DO NOT PRESCRIBE

Sirukumab CCG but not commissioned NO – DO NOT PRESCRIBE

Sodium oxybate NHSE and CCG (depending on NO – DO NOT PRESCRIBE indication) Sodium phenylbutyrate 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? Sofosbuvir NHSE NO – DO NOT PRESCRIBE

Solanezumab Commissioning responsibility NO – DO NOT PRESCRIBE unclear Solriamfetol CCG but not commissioned NO – DO NOT PRESCRIBE

Somapacitan CCG but not commissioned NO – DO NOT PRESCRIBE

Somatrogon CCG but not commissioned NO – DO NOT PRESCRIBE

Somatropin CCG Yes – may be prescribed . For use in line with NICE TAs 64 and 188, may be prescribed in new patients (after initiation by secondary care) and existing patients. Please see the prescribing advice on GP Ref for additional information. . GP prescriber must contact MOT for confirmation of funding before proceeding to prescribe Sorafenib NHSE NO – DO NOT PRESCRIBE

Stavudine NHSE NO – DO NOT PRESCRIBE

Stribild® (tenofovir + cobicistat + NHSE NO – DO NOT PRESCRIBE elvitegravir + emtricitabine) Strimvelis* NHSE NO – DO NOT PRESCRIBE

Sucroferric oxyhydroxide NHSE NO – DO NOT PRESCRIBE

Sunitinib 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? Symtuza® (darunavir + cobicistat NHSE NO – DO NOT PRESCRIBE + emtricitabine + tenofovir alafenamide) T Tabalumab NHSE but not commissioned NO – DO NOT PRESCRIBE

Tacrolimus* NHSE when used for DO NOT PRESCRIBE for new . When used for immunosuppression post-transplant in immunosuppression post- patients EXISTING patients, may be prescribed transplant . BCCG and LCCG have claw-back mechanism in place from NHSE . When given for any other indication, not excluded from National Tariff so can be prescribed ** NHSE when used in pulmonary Yes – may be prescribed in . For use in pulmonary arterial hypertension – DO NOT arterial hypertension certain indications PRESCRIBE . For any other indication, not excluded from National Tariff so can be prescribed NHSE but not commissioned NO – DO NOT PRESCRIBE

Taliglucerase alfa NHSE NO – DO NOT PRESCRIBE

Talimogene laherparepvec* NHSE NO – DO NOT PRESCRIBE

Tanezumab CCG but not commissioned NO – DO NOT PRESCRIBE

Taribavirin NHSE but not commissioned NO – DO NOT PRESCRIBE

Teduglutide NHSE but not commissioned NO – DO NOT PRESCRIBE

Telaprevir 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? Telbivudine NHSE but not commissioned NO – DO NOT PRESCRIBE

Temozolomide* NHSE but not commissioned NO – DO NOT PRESCRIBE

Temsirolimus NHSE but not commissioned NO – DO NOT PRESCRIBE

Tenofovir NHSE NO – DO NOT PRESCRIBE

Tenofovir alafenamide NHSE NO – DO NOT PRESCRIBE

Teriflunomide NHSE NO – DO NOT PRESCRIBE

Teriparatide NHSE and CCG (depending on NO – DO NOT PRESCRIBE indication) Tetrahydrobiopterin NHSE NO – DO NOT PRESCRIBE

Tezacaftor NHSE but not commissioned NO – DO NOT PRESCRIBE

Thalidomide NHSE NO – DO NOT PRESCRIBE

Thrombin NHSE NO – DO NOT PRESCRIBE

Thrombomodulin, recombinant CCG but not commissioned NO – DO NOT PRESCRIBE human Tildrakizumab CCG NO – DO NOT PRESCRIBE

Tipranavir NHSE NO – DO NOT PRESCRIBE

Tisagenlecleucel* CDF 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?

Tivozanib* NHSE NO – DO NOT PRESCRIBE

Tobramycin, via nebulisation / NHSE and CCG (depending on Yes – may be prescribed in . As a powder / injection for nebulisation (Tobi®/Bramitob®) inhalation indication) certain forms for cystic fibrosis, can be prescribed for both new and existing patients (NHSE policy A01/P/b) under shared care . As a dry powder for inhalation (Tobi® Podhaler) for cystic fibrosis – DO NOT PRESCRIBE . As any other form, not excluded from National Tariff but secondary care prescribing only – DO NOT PRESCRIBE . BCCG and LCCG have a claw back mechanism in place with NHSE Tocilizumab NHSE and CCG (depending on NO – DO NOT PRESCRIBE indication) Tofacitinib NHSE and CCG (depending on NO – DO NOT PRESCRIBE indication), but not commissioned Tolvaptan NHSE and CCG (depending on NO – DO NOT PRESCRIBE indication) Trabectedin* NHSE NO – DO NOT PRESCRIBE

Tralokinumab NHSE but not commissioned NO – DO NOT PRESCRIBE

Trametinib* NHSE NO – DO NOT PRESCRIBE

Trastuzumab* NHSE NO – DO NOT PRESCRIBE

Trastuzumab emtansine* NHSE NO – DO NOT PRESCRIBE

Treprostinil diethanolamine** 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?

Treprostinil sodium** NHSE but not commissioned NO – DO NOT PRESCRIBE

Trientine NHSE NO – DO NOT PRESCRIBE

Trifluridine–tipiracil* NHSE NO – DO NOT PRESCRIBE

Triheptanoin NHSE but not commissioned NO – DO NOT PRESCRIBE

Triumeq® (abacavir + lamivudine NHSE NO – DO NOT PRESCRIBE + dolutegravir)

Trizivir® (zidovudine + lamivudine NHSE NO – DO NOT PRESCRIBE + abacavir) Truvada® (emtricitabine + NHSE NO – DO NOT PRESCRIBE tenofovir) U Upadacitinib CCG but not commissioned NO – DO NOT PRESCRIBE

Uridine triacetate NHSE but not commissioned NO – DO NOT PRESCRIBE

Ustekinumab NHSE and CCG (depending on NO – DO NOT PRESCRIBE indication) V Vadadustat NHSE and CCG (depending on NO – DO NOT PRESCRIBE indication), but not commissioned CCG 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? Valganciclovir NHSE NO – DO NOT PRESCRIBE

Vancomycin (unique delivery Commissioning responsibility NO – DO NOT PRESCRIBE system) unclear Vandetanib NHSE but not commissioned NO – DO NOT PRESCRIBE

Vapreotide Commissioning responsibility NO – DO NOT PRESCRIBE unclear Vatiquinone NHSE but not commissioned NO – DO NOT PRESCRIBE

Vedolizumab NHSE and CCG (depending on NO – DO NOT PRESCRIBE indication) Velaglucerase alfa NHSE NO – DO NOT PRESCRIBE

Velcalcetide NHSE but not commissioned NO – DO NOT PRESCRIBE

Velmanase alfa NHSE but not commissioned NO – DO NOT PRESCRIBE

Vemurafenib NHSE NO – DO NOT PRESCRIBE

Venetoclax* NHSE / CDF NO – DO NOT PRESCRIBE

Verteporfin CCG NO – DO NOT PRESCRIBE

Vestronidase alfa NHSE but not commissioned NO – DO NOT PRESCRIBE

Viekirax® (ritonavir + ombitasvir + NHSE NO – DO NOT PRESCRIBE paritaprevir) Voclosporin CCG 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?

Volanesorsen NHSE but not commissioned NO – DO NOT PRESCRIBE

Von Willebrand factor, NHSE but not commissioned NO – DO NOT PRESCRIBE recombinant NHSE but not commissioned NO – DO NOT PRESCRIBE

Voretigene neparvovec NHSE but not commissioned NO – DO NOT PRESCRIBE

Voriconazole NHSE NO – DO NOT PRESCRIBE

Voxelotor NHSE but not commissioned NO – DO NOT PRESCRIBE

VX-210 (Cethrin) NHSE but not commissioned NO – DO NOT PRESCRIBE

W X Y Z Zepatier® (elbasvir + grazoprevir) NHSE NO – DO NOT PRESCRIBE

Ziconotide NHSE but not commissioned NO – DO NOT PRESCRIBE

Zidovudine NHSE NO – DO NOT PRESCRIBE

*Not on NHS England/NHS Improvement high cost drugs exclusions list ** Removed from exclusions list for 2019-20.

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 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