SOMERSET PRESCRIBING FORUM

Transcription

1 SOMERSET PRESCRIBING FORUM Minutes of the meeting held at Wynford House, Yeovil, on Wednesday 14 November 2012 Present Position Initials Chair, Drug & Therapeutics Committee, Taunton & Somerset NHS Foundation Trust (chair) GP, Chair of Prescribing & Medicines Management group, Somerset CCG Information Pharmacist, Yeovil District Hospital Locality Medicines Manager, NHS Somerset GP, Somerset Local Medical Committee representative Associate Director, Head of Medicines Management, NHS Somerset Patient Representative Chair, Drug & Therapeutics Committee, Yeovil District Hospital Secondary Care Commissioning Manager, NHS Somerset Development Pharmacist, Somerset Local Pharmaceutical Committee Pharmacy Technician, Medicines Management, NHS Somerset Introduction chaired the meeting 1 APOLOGIES Apologies were received from: 2 DECLARATION OF INTERESTS No new declarations of interest were made. 3 MINUTES OF THE LAST MEETING HELD ON 14 SEPT 2012 The minutes were accepted as an accurate record of the meeting. Schedule of Actions outcomes are listed on November schedule Item 9. Bisphosphonate drug holidays. No feedback from secondary care has been received. Starting a drug holiday should remain a clinical decision depending on individual risks & benefits eg. not appropriate for patients having frequent fractures but may be suitable where pt has been on bisphosphonate & bmd has increased. NB safety of bisphosphonates beyond 10 years treatment has not been studied. A formal guideline is not recommended. Item closed. Somerset Prescribing Forum Page 1 of 6

2 4 Terms of Reference Previous discussion has focused on timing & joint meetings of PAMM/SPF. There are practical difficulties in achieving this, the aspiration of PAMM is to fund some of the PAMM GPs to attend forum meetings in the afternoon. Looking forward it is proposed that the future role of forum should include review and advice on management of non-pbr drugs that are not covered by specialist commissioning eg anti TNFs, lucentis. Consideration needs to be wider than drug cost & effectiveness. Forum should continue to offer an opportunity for debate by inviting representation from clinicians making a bid for funding. SPF would also have ability to make financial budget decisions within allocated budget so that decisions made can be implemented more rapidly than has sometimes happened in the past. Commissioning managers for the trusts should be invited to attend, data for RUH & RNHRD should also be considered. Discussions outside of meeting with PAMM, finance & non-pbr management group are all positive and it was agreed that the ToR should be updated. Other considerations for SPF: Review & benchmarking of NICE implementation Horizon scanning Review uptake & delivery of Healthcare at home It was agreed that meetings should carry on in Yeovil as accommodation is available but to keep under revue if attendance from other areas is difficult. 5 Formulary Applications 5.1 Rituximab for SLE presented the case for approving the use of rituximab for treating acute flares of SLE and ANCA vascultis (currently only available by IFR request). Estimated 10 SLE cases annually in Somerset. It was decided not to approve for SLE as available trials have failed to show benefit for preventing flares. A licensed product is available though not approved by NICE an appeal is in progress. IFR route will still be available, and if the evidence base changes or patient group that will benefit can be more precisely defined the request will be reviewed. NB For clarity, note that if an IFR has been approved for a patient & a similar need subsequently arises, a further IFR is not needed. Forum formally agreed to commission rituximab for ANCA vasculitis, once conventional options are exhausted. to write to finance. Traffic light to be updated. 5.2 Mannitol & Tobramycin for cystic fibrosis There is one Somerset patient who took part in the Bristol trial of mannitol for cystic fibrosis. Published FAD is positive. Forum agreed to continue funding (with proviso there is no change in FAD) commissioned from secondary care as RED drug & funded by PBR budget. Traffic lights to be updated when NICE decision is published. Tobramycin has been approved by NICE for inhalation and will be included in the formulary as a RED drug as for mannitol. Traffic light to be updated. 5.3 Ivabradine for heart failure Indication now NICE approved. Formulary & traffic light to be updated as AMBER for this indication. NICE specifies that monitoring & titration is carried out by GPwSI or heart failure specialist nurse service not available currently in primary care in Somerset. Somerset Prescribing Forum Page 2 of 6

3 Somerset patients fitting the criteria for treatment will have to remain within secondary care, including prescribing. Current gap in service responsibility of CCG. 5.4 Naltrexone for alcohol dependence Turning Point is commissioned to run addiction services within Somerset and have requested the addition of oral naltrexone for treating alcohol addiction. Licensed product is Adepend an orphan drug costing 47.42/28 days. Other products are licensed for the treatment of opioid dependence cost less (approx. half). Forum agreed to approve use of generic naltrexone for indication of treatment of alcohol addiction. Product to be AMBER drug with shared care traffic light/formulary to be updated. 6 D&TC Decisions Taunton/Yeovil no contentious decisions 7 NICE 7.1 NICE technology appraisal checklist Presented for awareness. Commissioners & providers may have to complete depending on view from new Local Commissioning Board 7.2 New guidance Sep - Oct 2012 Presented for information. The following comments on specific guidance were made: CG150 Diagnosis & Management of Headache A number of the medicine recommendations are off-license. A reference table for the formulary has been produced. Forum approved use of the off license indications. NB Commissioning acupuncture is not a forum responsibility. CG151 Neutrogenic Sepsis Protocols at T&S are not quite concordant eg single use tazocin. Discussions within trust on-going, to be brought back to forum. CG152 Crohn s Disease: Management in adults, children & young people Presented for information. 7.3 NICE Bites September 2012 Neonatal Infections Presented for information. NICE Bites October 2012 Diagnosis & Management of Headache Presented for information. 8 HORIZON SCANNING 8.1 UKMi New Product Evaluations October 2012 Presented for information. The volume of work is potentially huge. suggested the focus should be on any drugs where Somerset may wish to commission before NICE reach a recommendation. Forum members are asked to review & seek opinion from colleagues for potential applications. Somerset Prescribing Forum Page 3 of 6

4 9 South West Cancer Drug Fund This aspect of forum agenda is likely to be subsumed by specialist commissioning. Cohort list now includes most of drugs required. Local spend & outcome data exists but not on a regional level. 10 MHRA Drug Safety Presented for information. The following comments on specific guidance were made: 10.1 MHRA Drug Safety Update September 2012 Gliptins & acute pancreatitis. To be included in MM newsletter to raise awareness MHRA Drug Safety Update October 2012 Risk of hypercalcaemia with denosumab (mainly when used in chemotherapy). Monitoring implications to be discussed at D&T groups at both Taunton & Yeovil. 9 Any other business 9.1 Dates of future meetings Change date for January meeting from 9 th to 16 th. to liaise with re PAMM date 11 DATE OF NEXT MEETING Wednesday 16 th January 2013 MR4 Wynford House, Yeovil at 2.30pm 13 Mar 2013 MR3 8 May 2013 MR2 10 July 2013 MR2 18 Sep 2013 MR2 NB proposed change of week 13 Nov 2013 MR2 Somerset Prescribing Forum Page 4 of 6

5 Somerset Prescribing Forum: SCHEDULE OF ACTIONS NO. SUBJECT OUTSTANDING RESPONSIBILITY ACTION LEAD ACTIONS ARISING FROM THE MEETING HELD ON WEDNESDAY 13 th June Introduction Letter of thanks to - complete 2 New Drug Request Confirmation of agreed proforma form confirmed at YDH & at T&S 3 SCP Octreotide Feedback responses final clarification needed for sc administration. Info then to be put on website & shared with Somerset Partnership 4 Latanoprost To be discussed at T&S D&TC approved as first line agent. Instance where a different agent is used first line should be fed back to secondary care. 6 Boceprevir & Progress report implementation Telaprivir (Hepatitis C) slower than expected. Spend on the 2 drugs to be monitored at PBR meetings 7 Eye Drop Send completed information to & Appliances. complete 8 Anti TNF Pathway Amend to include tocilizumab monotherapy & Rituximab with leflunomide complete 9 Bisphosphonate Drug Holiday 10 Cellulitis Recommendations Write to Ashok Bhalla, Bath Mineral Hospital, & Somerset Acute Trusts requesting statement Clarify with microbiology completed? Primary care recommendations are updated. Item closed. 11 Abiraterone Determine if there are any Somerset patients being treated at outside PCT. Data not available. Carry forward. 12 Botox Pathway Share draft RUH pathway There is minimal usage. NHS Somerset expect prior notification if there is a need. Available at RUH, MPH still considering training. 13 Botox Pathway Identify lead not yet actioned. Delete from agenda pro tem. to check if headache features on Navigator App???? Somerset Prescribing Forum Page 5 of 6

6 14 Cancer Drug Reviews 15 Amisulpiride in dementia 16 Desrazoxane for anthracycline extravasation Discuss with & Cancer drug group no longer required as chemo will come under specialist commissioning & therefore no benefit to primary care to review. Review evidence to check with if item needs to stay on agenda. Awaiting clarification from DoH. Available in secondary care to be managed within existing resources. Stock is held at Musgrove because of possible need to use OOH & expertise resides in Taunton. 17 Exenatide & insulin Confirm whether criteria for continued use in primary care are agreed with secondary care. No feedback from OK. Insulin combined with liraglutide will probably be approved soon. 18 Link to PCT MM web pages 19 VTE treatment & prophylaxis pathway Send link to all SPF members - done Feedback from SPF members Rivaroxaban is now approved as alternative for LMWH & heparin. Feedback to January meeting 20 Methotrexate Monitoring differences clarified. Monitoring for oral & sub cut routes are the same. 21 Update TOR 22 Rituximab for ANCA vasculitis Write to finance 23 Mannitol & Tobramycin for CF Update traffic light 24 Ivabradine for heart Update formulary & traffic light failure 25 Naltrexone for alcohol Update formulary & traffic light dependence 26 CG150 Headache Include table of drugs in formulary 27 CG151 Neutrogenic Sepsis 16/01/ /01/2013 Outcome of discussion re recommendations for antibiotic use 16/01/ Horizon Scanning Identify priorities of products for review by the SPF 29 Gliptins & acute pancreatitis. 30 Denosumab monitoring On-going Include in MM newsletter Outcome of discussion at Taunton & Yeovil D&TCs Somerset Prescribing Forum Page 6 of 6