DORSET MEDICINES ADVISORY GROUP Recommendation Summary Formerly the Bournemouth, Dorset and Poole Health Technologies Forum, DMAG represents the four provider Trusts and GPs within the Clinical Commissioning Group (CCG). It provides recommendations to the CCG s clinical commissioning committee (CCC) on the prescribing and commissioning of medicines. Summary of recommendations considered at a meeting of the group on 7 th November 2017. Formulary entries and associated documents can be accessed at www.dorsetformulary.nhs.uk. PRODUCT DECISION COMMENTS 1. Products re-categorised Alginates: Melgisorb Sorbsan Urgosorb Hydrofibres: Aquacel Extra Aquacel Extra Ribbon 2 Hydrating dressings: Purilon Gel Aquaform Gel Actiform Cool Hydrocolloids: Duoderm 1
Comfeel Plus without adhesive border Hydrocoll Basic Wound contact layers: Mepitel Antimicrobials: Silver dressings. Aqaucel Ag range Biatain Ag Protease modulating matrix: Promogran Topical negative pressure therapy: Vacutex Ascorbic Acid for patients with scurvy At the last DMAG meeting, it had been recommended that ascorbic acid be reclassified from green to not recommended on the formulary, however it was noted by the formulary working group that there were a small number of patients admitted every year with scurvy. It was therefore agreed to re-categorise ascorbic acid to red for patients with scurvy. simethicone (Infacol and other brands) Formulary entry for Ferrous Fumarate for endoscopy use only Formulation to be removed from the Formulary entry Following work undertaken by the CCG Medicines Optimisation team on BNF drugs classified as Less Suitable to Prescribe the Formulary Working Group recommended that simethicone (Infacol and other brands) be re-categorised as red for endoscopy use only. The group had considered the formulary entry for ferrous fumarate as this specifies syrup but the tablets represent a cost-effective alternative to ferrous sulphate in primary care. It was proposed that mention of the formulation should be removed from the formulary. 2
vancomycin for the treatment of C. difficile liothyronine n amber drug Approved for new patients, amber for patients who cannot be stopped after specialist review and red for mental health indications Members approved the recommendation from the Antimicrobial Working Group to re-classify oral vancomycin for the treatment of C. difficile from red to amber. it was recommended that until the outcome of the NHSE low clinical value consultation was known, liothyronine should be re-categorised as non-formulary for new patients, but for those patients who cannot be stopped after specialist review, to be categorised as amber with shared care guidelines, in order to support the GPs who were asked to continue to prescribe. In addition, it would remain with secondary care for mental health. PRODUCT DECISION COMMENTS 2. New requests Hydrocolloid Fibrous Dressings: KerraCel flat and rope Hydrating dressings: ActiveHeal Hydrogel KerraLite Cool Hydrocolloids: Comfeel Plus Transparent Antimicrobials - Manuka honey Medihoney antibacterial honey tulle Medihoney antibacterial wound gel*not just wound gel Medihoney HCS All recommendations from the Joint Wound Formulary Group for removals and new additions were approved with a review agreed after 6 months to consider financial impact and further product developments. 3
Antimicrobials Silver dressings Askina Calgitrol Paste KerraContact Ag Polyhexylmethylene biguanide (PHMB): Suprasorb X Dialkylcarbamoyl chloride (DACC): Cutimed Sorbact Swabs Cutimed Sorbact gel Both K-Two and K-Two reduced to remain as green K-Lite (standard) Island dressings / ancillary items: Melolin Softpore Clinipore Adhesive Tape: Hypafix Ancillary Items K-Soft long Protease modulating matrix: UrgoClean Protease modulating matrix: Urgostart contact green product Amber 4
pyrimethamine sulfadiazine for toxoplasmosis Freestyle Libre sensors 3. Products considered by NICE Dimethyl fumarate (Skilarence ) Tofacitinib for moderate to severe rheumatoid arthritis (NICE TA 480) Approved The Diabetes Working Group decided to defer a recommendation until further information was made available from the DVLA about the use of these sensors and driving. DMAG members noted that the Northern Regional Medicines Optimisation Committee (RMOC) had made a decision to make them available despite the evidence-base being very weak. DMAG members to feedback to RMOC South regarding their recommendations for Freestyle Libre. Members approved the addition of dimethyl fumarate (Skilarence ) to the formulary as a red drug within the criteria for use of the NICE TA 475. 4. Miscellaneous recommendations by DMAG Position statement for the use of preservative free eye drops Oscillating positive expiratory pressure devices commissioning statement. Approved re-issue of the statement. Approved as not recommended for use A commissioning statement had been produced to support recommendations that these items were not to be placed on the formulary pending any proposal for inclusion. Roflumilast Shared Care Guidance Approved Shared Care Guideline Pending final amendments 5
Alogliptin 5. Further Assessment / Evidence Required Breast Site Specific Group s business case for bisphosphonates 6. Expired Documents Reviewed Cautionary warning to be added to the Formulary entry for alogliptin Interim recommendations for amber with shared care approved pending further discussions / developments It was considered that as alogliptin is currently the first line choice on the formulary and based on the significant use locally a prudent approach would be to add a caution on the formulary to avoid use in patients with ischemic heart disease (IHD) and recommend to GPs that they search for patients on alogliptin with IHD. This approach was thought to be proportionate to the risk. The use of adjuvant bisphosphonate treatment in breast cancer was supported in principle pending a commissioning discussion and development of a shared care agreement which should be brought back to the March DMAG. Also need to continue to link with the Cancer Partnership to consider the implementation of this proposal and ensure this is raised with the Operational and Finance Reference Group. Medication which may contribute to falls For further development by the Polypharmacy Working Group It had been identified at the polypharmacy working group that it would be desirable to work to one list consistently across the county. This will be progressed by the working group. Classification of products: RED drugs for hospital use only AMBER with shared care drugs suitable for use with shared care arrangements AMBER drugs suitable for use without shared care arrangements GREEN drugs suitable for prescribing in primary and secondary care Not Recommended' drugs not recommended for use in Dorset The new traffic light system can be found on the Dorset CCG internet at: Dorset CCG - Traffic light scheme 6