Categorisation and Formulary Choices of Inhaled Corticosteroids for Adults Inhaled Corticosteroid (ICS) only – Metered Dose Inhalers (MDI) MDI Beclometasone dipropionate Use with a compatible Fluticasone Propionate spacer device Prescribe by BRAND Clenil Modulite® Qvar®(extrafine) Qvar®(extrafine) Flixotide® Evohaler MDI Easi-Breathe Low Dose 100mcg, two puffs twice a 50 mcg, two puffs twice a day 50 mcg, two puffs twice a day 50 mcg, two puffs twice a day (BDP equivalent day (200 dose) (200 dose) (200 dose) (120 dose) ≤400mcg BDP) £4.45/month £4.72/month £4.64/month £5.44/month Medium Dose 200mcg, two puffs twice a 100 mcg, two puffs twice a day 100 mcg, two puffs twice a day 125mcg, two puffs twice a day (BDP equivalent day (200 dose) (200 dose) (200 dose) (120 dose) 400-1000mcg BDP) £9.70/month £10.33/month £10.17/month £12.50/month High Dose 250mcg, two puffs twice a 100 mcg, four puffs twice a day 100 mcg, four puffs twice a day 250mcg, two puffs twice a day (BDP equivalent day (200 dose) (200 dose) (200 dose) (120 dose) >1000mcg BDP) £9.77/month £20.66/month £20.34/month £20.00/month Simultaneous specialist OR referral recommended 250mcg four puffs, twice a day (200 dose) £19.55/month Prices correct as per Drug Tariff and DM&D December2018 1st line choices (dark green, solid border) 2nd line choices (light green, dashed border) Approved by Hertfordshire Medicines Management Committee – October 2018 Inhaled Corticosteroid (ICS) only – Dry Powder Inhalers (DPI) Beclometasone DPI dipropionate Budesonide Fluticasone Propionate Prescribe by BRAND Non-proprietary Non-proprietary Pulmicort Turbohaler® Flixotide® Accuhaler Easyhaler® Easyhaler® Low Dose 200mcg, one puff twice a day 100mcg, two puffs twice a day 100mcg, two puffs twice a day 100mcg, one puff twice a day (BDP equivalent (200 dose) (200 dose) (200 dose) OR (60 dose) ≤400mcg BDP) £4.48/ month £5.31/month 200mcg, one puff twice a day £8.00/month (100 dose) £8.55/month Medium Dose 200mcg, two puff twice a day 200mcg, two puffs twice a day 200mcg, two puffs twice a day 250mcg, one puff twice a day (BDP equivalent (200 dose) (200 dose) (100 dose) OR (60 dose) 400-1000mcg BDP) £8.96/month £10.62/month 400mcg, one puffs twice a day £25.51/month (50 dose) £17.10/month High Dose 400mcg, two puffs twice a day 400mcg, two puffs twice a day 500mcg, one puff twice a day (BDP equivalent (100 dose) (50 dose) (60 dose) >1000mcg BDP) £21.25/month £34.20/month £43.37/month Simultaneous specialist referral recommended Prices correct as per Drug Tariff and DM&D December2018 1st line choices (dark green, solid border) 2nd line choices (light green, dashed border) Approved by Hertfordshire Medicines Management Committee – October 2018 Combination Inhalers (ICS and LABA) – Metered Dose Inhalers (MDI) Always use a combination ICS/LABA to improve adherence and guarantee that the LABA is not taken without the ICS MDI Beclometasone Fluticasone Use with a dipropionate propionate with Fluticasone propionate with salmeterol compatible spacer (extrafine) with formoterol device formoterol Prescribe by Fostair®MDI Flutiform®MDI Sereflo®MDI AirFluSal® MDI Sirdupla®MDI Seretide® Evohaler BRAND Low Dose 100/6, one puff twice a 50/5, two puffs twice a 50/25, two puffs twice a (BDP equivalent day (120 dose) day (120 dose) day (120 dose) ≤400mcg BDP) £14.66/month £14.40/ month £18.00/month Not available Not available Not available Medium Dose 100/6 two puff twice a 125/5, two puffs twice a 125/25, two puffs twice 125/25, two puffs twice 125/25, two puffs 125/25, two puffs twice (BDP equivalent day (120 dose) day (120 dose) a day (120 dose) a day (120 dose) twice a day (120 dose) a day (120 dose) 400-1000mcg £29.32/month £28.00/month £16.49/ month £18.50/ month £22.45/ month £23.45/month BDP) High Dose 200/6, two puff twice a 250/10, two puffs twice 250/25. two puffs twice 250/25. two puffs twice 250/25. two puffs 250/25. two puffs twice (BDP equivalent day (120 dose) a day (120 dose) a day (120 dose) a day (120 dose) twice a day (120 dose) a day (120 dose) >1000mcg BDP) £29.32/month £45.56/month £27.99/month £29.95/month £38.85/month £39.85/month Simultaneous specialist referral recommended Prices correct as per Drug Tariff and DM&D December2018 1st line choices (dark green, solid border) 2nd line choices (light green, dashed border) Approved by Hertfordshire Medicines Management Committee – October 2018 Combination Inhalers (ICS and LABA) – Dry Powder Inhalers (DPI) Always use a combination ICS/LABA to improve adherence and guarantee that the LABA is not taken without the ICS MDI Beclometasone Use with a dipropionate Budesonide with formoterol Fluticasone furoate Fluticasone propionate with salmeterol compatible spacer (extrafine) with with vilanterol device) formoterol Prescribe by Fostair® DuoResp Spiromax® Symbicort® Turbohaler Relvar Ellipta® Aerivio Spiromax® Seretide® Accuhaler BRAND NEXThaler AirFluSal Forspiro® Low Dose 100/6, one puff twice a 160/4.5, one puff twice 200/6, one puff twice a 100/50, one puff twice a (BDP equivalent day (120 dose) a day (120 dose) day (120 dose) day ≤400mcg BDP) £14.66/month £13.98/month £14.00/month (60 dose) Not available £18.00/month 100/6 two puff twice a 160/4.5, two puff twice 200/6, two puff twice a 250/50, one puff twice a Medium Dose 92/22, one puff once a day (120 dose) a day (120 dose) OR day (120 dose) OR day (BDP equivalent day £29.32/month 400-1000mcg 320/9, one puff twice a 400/12, one puff twice a (30 dose) (60 dose) BDP) day (60 dose) day (60 dose) £22.00/month £35.00/month £28.00/month £27.97/ month Not available High Dose 200/6, two puff twice a 320/9, two puff twice a 400/12, two puff twice a 184/22, one puff once a 500/50. one puff twice 500/50, one puff twice a (BDP equivalent day (120 dose) day (60 dose) day (60 dose) day (30 dose) a day (60 dose) day (60 dose) >1000mcg BDP) £29.32/month £55.94/month £56.00/month £29.50/month £29.97/month £32.74/month Simultaneous specialist referral recommended Prices correct as per Drug Tariff and DM&D December2018 1st line choices (dark green, solid border) 2nd line choices (light green, dashed border) Approved by Hertfordshire Medicines Management Committee – October 2018 .