GREAT WESTERN HOSPITALS NHS FOUNDATION TRUST. Formulary Working Group 2.30pm 19 th June 2014 Seminar Room 7, The Academy, GWH

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1 Formulary Working Group 2.30pm 19 th June 2014 Seminar Room 7, The Academy, GWH The 3T s Formulary Swindon CCG & Wiltshire CCG Great Western Hospitals NHS Foundation Trust (In collaboration with Avon and Wiltshire Mental Health Partnership and Oxford Health NHS Foundation Trust Attendees: Dr Ravi Chinthapalli (RC) (chair) Lisa King () (mins) Dr Rachel Hobson () Paul Clarke (PC) Dr Peter Mack (PM) Dr Stephan Hinze (SH) Apologies: Dr Tony Wright (TW) Consultant Paediatrician & Chair, GWHNHSFT Formulary Pharmacist, GWHNHSFT Formulary Pharmacist, Wiltshire CCG Pharmaceutical Advisor, Swindon CCG GP representative, Swindon CCG Consultant Neurologist, GWHNHSFT (for item 6.2 only) GP representative, Wiltshire CCG Agenda Item Description Action by whom Action by when 1 APOLOGIES 2 MINUTES OF LAST MEETING The minutes of the May meeting were agreed as accurate. to upload a pdf version to the patient website and forward to TPC for information MATTERS ARISING Generic Oxycodone and Fentanyl gave a brief update on progress with Longtec and Shortec, confirming that Dr Maxwell has updated his Enhanced Recovery Program drug chart labels and that will attend Prospect Hospice s Drug & Therapeutics meeting on 23 rd June to discuss the switch. to feedback asap and, if Prospect Hospice are happy to switch, to implement switch at GWH asap to also gather more information on Mezolar and ask palliative care team for their thoughts on switching fentanyl patches. Apomorphine TLS briefed the meeting that, whilst it had been felt at the last meeting that Individual Funding Requests (IFR) should be completed for each patient if GWH wished to receive funding for these patients in 2014/15, Wilts CCG do not feel this is appropriate and hence will only consider a business case for additional funding from 2015/16. PC confirmed that prescribers could complete IFRs for 2014/15 although there was no guarantee that funds would be available. to feedback accordingly. Denosumab SCA tabled a revision of the current Denosumab for discussion. FWG approved the document subject to a few minor amendments. to amend, update eformulary, master files and patient website and communicate decision to prescribers. T:\Pharmacy\3 T's Formulary\FWG Meetings\FWG Minutes\Mins_2014\FWG_Minutes_19_Jun_2014.Doc Page 1 of 8

2 Joint DMARDs SCA / confirmed that no comments had yet been received from Gastro team on this document. to follow up as time allows. 4 CHAPTER/SECTION UPDATES 4i Endocrine Chapter Review Insulin degludec funding form RC briefed the meeting that he has received further correspondence from the Diabetes team, who with hindsight feel Wilts CCG s Prior Approvals form will take too long to complete. to feedback their suggestions on how the form might be shortened to Wilts CCG. PC clarified that Swindon CCG do not have a Prior Approvals process but would be keen to set up a procedure tracker forf insulin degludec which could reduce the amount of paperwork needed. RC/ PC/ PM/ to investigate this further and report back at next FWG meeting. RC/PC /PM/ APC Steering Group Merging Gastro chapters apologised that she had been unable to progress this work since the last meeting. to ask GWH Gastro team for their comments on the proposed changes, especially the proposal to remove pantoprazole from formulary. Merging Respiratory chapters apologised that she had been unable to progress this work since the last meeting. to ask GWH Respiratory team for their comments on proposed changes, especially the proposal to remove theophylline liquid and change tiotropium respimat and and fluticasone inhalers / accuhalers to TLS green. Merging cardiovascular chapters This item was held over until next month s meeting. 5 NEW DRUG UPDATE The UKMI New Drugs Online Newsletter May 2014 was tabled for discussion and actions were suggested. to action and update the New Drug database accordingly i 6 ii NEW DRUG REQUESTS Linaclotide Dr Peter Hanson (PH) RC briefed the meeting that he had had some discussions with PH about his linaclotide application and, whilst PH confirmed that he would be happy for linaclotide to be an amber drug, there was no confirmation as yet that his directorate would be willing to fund the first 12 weeks of treatment. RC to follow up with PH and EP. Perampanel Stephan Hinze (SH) SH joined the meeting to discuss his formulary application for perampanel. He confirmed that it would be used last line, as an additional option for refractory patients and that all patients would be under the care of the Epilepsy clinic and hence regularly reviewed. It was noted that GPs would not be required to undertake RC T:\Pharmacy\3 T's Formulary\FWG Meetings\FWG Minutes\Mins_2014\FWG_Minutes_19_Jun_2014.Doc Page 2 of 8

3 additional monitoring although would need to be mindful of sideeffects (incl. suicidal ideation) and drug interactions (incl. with oral contraceptives). It was agreed that perampanel should be added to formulary but there was considerable discussion as to the most appropriate traffic light status and whether a SCA was necessary. It was agreed that perampanel would be added to formulary as an amber drug in patients over 12 years old with additional prescribing advice to be sent out with clinic letters. It was confirmed that perampanel would remain nonformulary for patients under 12 years old in view of low patient numbers. / to draft prescribing guidance and circulate for comment. to amend eformulary, master files, patient website, core database, eprescribing, GWH JAC and Boots JAC. Oxcarbazepine Stephan Hinze (SH) SH also tabled his formulary application for oxcarbazepine for discussion. It was noted that this was an older drug, similar to carbamazepine but with fewer sideeffect, and useful in patients intolerant to carbamazepine. Since oxcarbazepine is recommended in NICE guidance, FWG agreed that it should be added to formulary as an amber drug. to amend eformulary, master files, patient website, core database, eprescribing, GWH & Boots JAC. Generic levetiracetam Stephan Hinze (SH) SH confirmed that he would be happy for all new patients to receive generic levetiracetam and for all existing patients whose epilepsy had not been difficult to control to switch to generic levetiracetam, but felt the patients whose epilepsy had been difficult to control prior to Keppra should only be switched to generic levetiracetam after discussion with a Consultant Neurologist. to discuss further with Wilts GP representative before any change of wording on the formulary. SH also confirmed that GWH could supply generic levetiracetam for all new patients and all patients admitted on generic levetiracetam but should supply Keppra to patients admitted on Keppra. to implement this change locally. Miscellaneous formulary issues Stephan Hinze (SH) Phenobarbitone SH requested that the formulary entry for phenobarbitone be amended to allow initiation in new patients by a Consultant Neurologist. FWG agreed to this change. to amend eformulary, master files and patient website accordingly. Acetozolamide, rifinamide and ethosuximide SH asked if these drugs, which appear on formulary for use only in children, could be made available for use in adults. FWG confirmed that formulary applications would be needed before these drugs could be considered for use in adults. 7 NEW EVIDENCE SUMMARY There was no report available to discuss this month. 8 NICE / T:\Pharmacy\3 T's Formulary\FWG Meetings\FWG Minutes\Mins_2014\FWG_Minutes_19_Jun_2014.Doc Page 3 of 8

4 8i NICE TAs There were no NICE TAs for discussion this month. 8ii NICE CGs There were no NICE CGs for discussion this month. 9 MHRA Drug Safety Updates/Letters to professionals The contents of MHRA Drug Safety Update May 2014 were noted. It was agreed that links should be included to this MHRA Drug Safety Update from the eformulary entries for domperidone, voriconazole and adrenaline and that all relevant prescribers should be advised accordingly. 10 Amantadine in MS briefed the meeting that amantadine is recommended as an offlabel treatment for fatigue in MS patients in current NICE guidance, but it is only on formulary for treatment of Parkinson s Disease. In light of NICE recommendations, FWG confirmed that it would consider adding amantadine to formulary as an amber drug if GWH Neurologists complete a formulary application for it. to feedback to GWH Neurologists accordingly. 11 AWP Dementia leaflets tabled AWP s Sleep and Dementia leaflet for discussion and confirmed that s recent comments on this version had been picked up by Dr Manchip. It was agreed that this item was held over until final versions of all leaflets were available for discussion. BS to provide final versions when available. BS 12 AOB 12.1 Drug Tariff and contract changes There were no significant drug tariff changes to discuss this month MMT (Formulary) Recruitment update advised that, as GWH had failed to recruit to this post so far, she was meeting with Jane Coleborn and Mike Lewis on 26 th June to discuss the future direction of the post. to feedback at the next FWG meeting Epistatus Product Licensing confirmed that Epistatus multidose vials were now licensed for use in adults, but there would a further delay in obtaining a licence for the multidose vials in children and a licence of prefilled syringes. FWG agreed to continue to use unlicensed / offlabel Epistatus locally until such licences had been obtained Nutilis Clear briefed the meeting that GWH Speech and Language Therapists, with the support of GWH Dietitians, had requested a switch from Nutilis to Nutilis Clear powder. This is because the latter is more palatable, produces a clear solution/gel, and does not get thicker and thicker over time hence patients are likely to be more compliant with it and less at risk of aspiration. In view of the costs involved, will ask for a formulary application to be T:\Pharmacy\3 T's Formulary\FWG Meetings\FWG Minutes\Mins_2014\FWG_Minutes_19_Jun_2014.Doc Page 4 of 8

5 completed and investigate costs further Cancellation of August meeting requested that FWG s August meeting be cancelled, since this was traditionally the meeting fewest people could attend and it would allow additional time for outstanding actions to be completed and annual report / work plan to be written. FWG agreed to cancel its August meeting. to advise all accordingly. Next FWG Meeting: 2.00pm 17 th July 2014, Seminar Room 5, The Academy, GWH. Future Meetings: 21 st August 2014 ** This meeting has been CANCELLED ** 2 5pm 18 th September 2014 Seminar Room 5, The Academy, GWH 2 5pm 16 th October 2014 Seminar Room 5, The Academy, GWH 2 5pm 20 th November 2014 Seminar Room 7, The Academy, GWH 2 5pm 18 th December 2014 Seminar Room 5, The Academy, GWH 2 5pm Agreed as an Accurate Record: Chair: Dated: T:\Pharmacy\3 T's Formulary\FWG Meetings\FWG Minutes\Mins_2014\FWG_Minutes_19_Jun_2014.Doc Page 5 of 8

6 via GWH internet site and in response to requests under the Freedom of Information Act. NEW/OUTSTANDING ACTIONS Meeting Date Subject Action Required Action By Comments Date for Zoledronic Acid Produce costing paper and assess impact on local care pathways and confirm GWH capacity issues /NF All Review of osteoporosis pathway underway in Wilts. Await outcome. Status completion? Pending Pending Temazepam Produce switching document SM/TT In progress Pending Acne Guidance Finalise document and circulate for In progress? Pending approval outside of the meeting ALL Infection Chapter Produce 1 st draft of review In progress Pending Review ITP Pathway Send comments to Awaiting development? Pending of wider Wilts pathway Prevention of MI Produce draft Omacor statement In progress Pending Sodium Fluoride Request New Drug Request Await NDR form? Pending 1.1% Toothpaste Generic fentanyl and oxycodone Meet Prospect hospice team FWG Pending to chase Prospect on oxycodone and implement GWH switch Pending Produce oxycodone guidance /KB Await comments. Pending Polytar Circulate documents for discussion NF Pending Cyclogest pessaries Request NDR form to change TLS Awaiting form? Pending Linaclotide Ask for clarification on patient no.s & Awaiting further Pending no. of OPD appointments for IB. information from GWH GI SCAs Produce 1st draft of joint SCA and Await final comments Pending circulate for comment. and FWG review Insulin degludec Implement short CCG Prior /PC/PM/ Await information on Pending funding form Approvals forms RC procedure tracker Pending APC Chapter 1 Confirm Gastro team happy with proposed changes. Confirm BCAP/ ICID happy to keep mesalazine and urso amber APC Chapter 3 Confirm Resp team happy with proposed changes. Pending Pending T:\Pharmacy\3 T's Formulary\FWG Meetings\FWG Minutes\Mins_2014\FWG_Minutes_19_Jun_2014.Doc Page 6 of 8

7 via GWH internet site and in response to requests under the Freedom of Information Act AWP Dementia leaflets Obtain final versions and table for approval to upload to eformulary Amantadine in MS Liaise with GWH Neurologist for formulary application Nutilis Clear Liaise with GWH SLT for formulary application BS Pending Pending Pending COMPLETE ACTIONS Meeting Subject Action Required Action By Comments Date for Status Date completion MHRA AED guidance Work with Neurologists to update formulary in light of MHRA alert. Perampenel New Drug request RC Wording for levetiracetam and perampanel application COMPLETE NOACs in cardioversion Request New Drug Request Review Basingstoke Guidance. RC/PF agreed by FWG No GWH funding available so application will not be progressed. SUSPENDED Eye Chapter Review Make final amendments and publish KW COMPLETE updated chapter ENT Chapter Review Publish updated chapter KW COMPLETE Neuropathic Pain Make amendments and circulate for KW COMPLETE guidance approval Extranet Send out links once live KW/ ASAP COMPLETE Endocrine Chapter Produce final draft and circulate to FWG COMPLETE Review and endocrine team Methylphenidate SCA Review and comment on SCA All COMPLETE Red Drugs in 1 care Review list and identify actions KB// COMPLETE TA298, TA301, TA294 Add to formulary with links Produce pathways KW PC/NF ASAP COMPLETE AWAIT TPC Prevention of MI Review NICE CG and amendment 3Ts guidance where necessary COMPLETE T:\Pharmacy\3 T's Formulary\FWG Meetings\FWG Minutes\Mins_2014\FWG_Minutes_19_Jun_2014.Doc Page 7 of 8

8 via GWH internet site and in response to requests under the Freedom of Information Act Endocrine Chapter Review Feedback to diabetes team Update formulary RC KW COMPLETE COMPLETE Acamprosate SCA Approve final version FWG COMPLETE Generic Sildenafil Feedback to consultants /RC COMPLETE Methylphenidate SCA Bring final version to FWG for approval / BS COMPLETE Valsartan Discuss with cardiologists COMPLETE Generic Yasmin Discuss with Family Planning COMPLETE Formulary adherence Circulate core formulary data by chapter COMPLETE and HCO to FWG quarterly Fumaderm Clarify patient no.s and place in therapy Change of entry COMPLETE ahead of FWG decision to change entry. wording agreed Wilts HRT Guidance Feedback consultant comments and to upload to e COMPLETE Testosterone gel in women approve final version once avasilable. Consider unlicensed use of testosterone gel in women now licensed implants and patches unavailable Apomorphine TLS Investigate if now under specialist commissioning before decision on TLS Esmya licence Clarify clinical need for second course of extension Esmya before decision on entry Nitrofurantoin Compare costs of remaining products and liaise with Antibiotic team on appropriate alternative Ferinject for GI patients Confirm GWH funding in place to support on Coate Dernosumab in 2 prevention Adverts on GWH Extranet use in this patient group then upload. Merge Orthogeri & Rheum SCA ahead of final approval Ask GWH Comm team to remove advert for drug company organised meeting and discuss ways to avoid accusations of partiality in future. FWG / formulary FWG decision on formulary status confirmed FWG decision on TLS confirmed. eformulary amendment agreed GWH & CCG alternatives confirmed to upload to e formulary FWG approved revised SCA with minor change COMPLETE COMPLETE COMPLETE COMPLETE COMPLETE COMPLETE RC COMPLETE T:\Pharmacy\3 T's Formulary\FWG Meetings\FWG Minutes\Mins_2014\FWG_Minutes_19_Jun_2014.Doc Page 8 of 8

GREAT WESTERN HOSPITALS NHS FOUNDATION TRUST

The 3T s Formulary NHS Swindon NHS Wiltshire Great Western Hospitals NHS Foundation Trust (In collaboration with Avon and Wiltshire Mental Health Partnership and Oxford Health NHS Foundation Trust) Attendees: