MEDICINES FORMULARY Medicines formulary between MCHFT and primary care as agreed by the Joint Medicines Management Group Welcome to the MCHFT Medicines Formulary. The formulary includes medicines that have been approved by the Joint Medicines Management Group (JMMG) for prescribing within the trust. The purpose of the formulary is to ensure prescribing is evidence based and cost effective. All prescribing within the trust (i.e. inpatient, outpatient and FP10HNC prescribing) must comply with the formulary. This will be monitored on a regular basis. Some drugs may appear in more than one section. Information on prescribing in primary care is available via the Medicines Management Team website: http://www.centralandeasterncheshiremmt.nhs.uk This is a good point of reference to confirm the continuation of medicines in primary care after initiation at MCHFT. Please note medicines contained in the primary care formulary are not automatically formulary at MCHFT. The formulary is arranged in sections corresponding to those in the British National Formulary (BNF) as below; INTRODUCTION .......................................................................................................................................... 2 UPDATES TO THE FORMULARY (LAST UPDATED AUGUST 2019) ....................................................... 4 1. GASTRO-INTESTINAL SYSTEM ............................................................................................................. 7 2. CARDIOVASCULAR SYSTEM .............................................................................................................. 11 3. RESPIRATORY SYSTEM ...................................................................................................................... 17 4. CENTRAL NERVOUS SYSTEM ............................................................................................................ 21 5. INFECTIONS ......................................................................................................................................... 28 6. ENDOCRINE SYSTEM .......................................................................................................................... 31 7. OBSTETRICS, GYNAECOLOGY AND URINARY-TRACT DISORDERS .............................................. 37 8. MALIGNANT DISEASE AND IMMUNOSUPPRESSION ........................................................................ 40 9. NUTRITION AND BLOOD...................................................................................................................... 51 10. MUSCULOSKELETAL AND JOINT DISORDERS ............................................................................... 56 11. EYE ...................................................................................................................................................... 59 12. EAR, NOSE AND OROPHARYNX ....................................................................................................... 63 13. SKIN ..................................................................................................................................................... 65 14. IMMUNOLOGICAL PRODUCTS AND VACCINES .............................................................................. 71 15. ANAESTHESIA .................................................................................................................................... 72 (Last updated August 2019) Page 1 of 73 i Introduction Operation of the Formulary Items available for general prescribing and restricted items are identified according to the following colour coding; MCHFT Formulary Item Colour Code Items available for general prescribing Second line/use on specialist advice Consultant prescribing only Removed from the Formulary/Do not prescribe Where a drug is the subject of a NICE Technology Appraisal (TA) the reference number of the guidance is given below the drug entry. Where a drug has been approved by the Joint Medicines Management Group (JMMG, formerly a committee named JMMC) the month and year of the relevant meeting is also listed below the drug entry. NICE guidance can be found at; Technology Appraisals (TA) http://www.nice.org.uk/guidance/published?type=ta Clinical Guidelines (CG) http://www.nice.org.uk/guidance/published?type=cg MHRA Alerts and recalls on drugs and medical devices https://www.gov.uk/drug-device-alerts This information is summarised in the form of PowerPoint slides on the new SharePoint intranet site. Please search or click ‘Introduction to the MCHFT Formulary' Patients taking a non-formulary drug on admission Treatment with a non-formulary drug may be continued in this instance; however it must be borne in mind that there may be a delay in obtaining a non-formulary drug. Additions to the formulary The addition of a new drug or preparation will only be made after approval by the Joint Medicines Management Group. To request an addition to the formulary a New Product Request (NPR) form must be submitted to the JMMG. This form can be found under Frequently Used Forms- Medicines Management on the old trust intranet. Otherwise please search New Product Request on the new SharePoint intranet. New non-formulary drugs required for an individual patient in exceptional circumstances Such an application for a “one-off” use may be made to the chairperson of the JMMG, if the drug is required before the next JMMG meeting. Please contact Senior Clinical Pharmacist – Medicines Optimisation for more information. Local Health Economy (LHE) Formulary Policy (Vale Royal, South Cheshire and Eastern Cheshire areas). The LHE Formulary is intended to cover prescriptions written in primary care or recommendations by hospital doctors in respect of outpatients or patients leaving hospital after an admission. The Area Prescribing Group (APG) agrees on a formulary status of medicines. These are designated by the following colours: (Last updated August 2019) Page 2 of 73 Primary Care Formulary Item Colour Code • Green = Recommended • Green/Yellow = On formulary • Yellow = A second or third line option within a drug group • Pink (Specialist Recommendation) = Medicines that can safely be initiated in primary care on the recommendation of a specialist • Pink (Specialist Initiation) = Medicines that require specialist initiation and/or stabilisation before prescribing is transferred to primary care • Pink (Shared Care) = Medicines that require a more formal shared-care approach including regular secondary care review and monitoring • Purple = Consultant/ Specialist only prescribing • Red = Discouraged • Grey = Discouraged; not considered suitable for prescribing • Blue = No formulary decision made / formulary position not yet considered (not to be prescribed until a formulary status has been agreed) Free of Charge Medicines A free of charge medicines scheme is defined as an arrangement where a UK licensed or unlicensed medicine is provided free of charge by the pharmaceutical company to an individual patient or an identified cohort of patients. Commissioners and providers will only undertake a free of charge scheme if the principles outlined in the RMOC policy are followed. Please refer to the RMOC July 2018 policy available on the Trust Intranet and on the SPS website (click here) BACK TO TOP (Last updated August 2019) Page 3 of 73 ii Updates to the formulary UPDATES TO THE FORMULARY 2019 Date BNF Update Details Section See formulary entry for full details August 4.1.1 Melatonin prolonged release microtablets 1mg and 5mg (Slenyto®) 2019 8.1.5 Atezolizumab 8.2.3 Blinatumomab 10.2 Nusinersen 13.2.1 Aproderm – Colloidal oat cream July 6.1.2.3 Ertugliflozin 2019 6.3.2 Dexamethasone Liquid 6.4.2 Testogel (1% testosterone gel) 8.2.3 Ocrelizumab 8.2.4 Lenalidomide June 4.6 Droperidol 2019 8.1.5 Abemaciclib Cabozantinib 8.2.3 Durvalumab Nivolumab 8.3.4.2 Enzalutamide 10.1.3 Certolizumab pegol 13.5.3 Tildrakizumab Area Prescribing Group May 2019 update: 6.1.1 Prescribing Commissioning Policy - Freestyle Libre Flash Glucose Monitoring System - May 2019 Reclassification of formulary status as GREY (Removed from the Formulary/Do not prescribe): 1.9.4 Creon 40,000 units Product withdrawn June 2019 11.3.3 Aciclovir eye ointment Product withdrawn June 2019 11.8.1 Lubristil Eye Gel Product withdrawn June 2019 May 8.1.5 Bosutinib 2019 Brentuximab vedotin April Section i. Free of Charge (FOC) Medicines Schemes (RMOC July 2018) 2019 Link to the policy and blank FOC Medicines Form added to the intranet 6.1.2.3 Ertugliflozin 8.1.5 Abemaciclib Brigatinib Daratumumab Pertuzumab Pembrolizumab Sunitinib 8.2.4 Tisagenlecleucel Benralizumab Venetoclax 10.1.3 Abatacept Reclassification of formulary status as GREY (Removed from the Formulary/Do not prescribe): 1.6.2 Co-danthramer capsules & co-danthrusate capsules Product withdrawn August 6.1.1.1 2015 6.6.2 Hypurin Bovine Insulin (all presentations) Product withdrawn August 2017 (Last updated August 2019) Page 4 of 73 Strontium ranelate Product withdrawn July 2017 9.5.1.1 Calcium-Sandoz® syrup Product withdrawn April 2015 March 4.9.1 Opicapone 2019 5.1.7 TauroLock® Catheter Lock Solution 6.1.2.3 Semaglutide (Ozempic®) 8.1.5 Bevacizumab Dabrafenib Encorafenib 9.6.4 Prescribing Guidance for the Management of Vitamin D Deficiency – guidance link added February 1.7.4 Darvadstrocel 2019 3.2 Combisal® metered dose inhaler Salmeterol/fluticasone 25/50, 25/125 & 25/250 5.1.7 Cefoxitin Clofazamine 6.4.1.2 Ulipristal acetate (Esmya®) – Formulary reclassification Updated licensed indication and restrictions Aug