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) Ciprofloxacin 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 Factor X (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) Imatinib 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) Indinavir 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) Inotersen 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) Osilodrostat 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? Romiplostim 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 Sildenafil** 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 Tadalafil** 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 Tafamidis 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 Valbenazine 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 Vonicog alfa 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