EAST LANCASHIRE HEALTH ECONOMY MEDICINES MANAGEMENT BOARD MINUTES OF THE MEETING HELD ON WEDNESDAY 15 th JUNE 2016 AT 12.30pm IN SEMINAR ROOM 6, LEARNING & DEVELOPMENT CENTRE, ROYAL BLACKBURN HOSPITAL PRESENT: Mr N Fletcher (NF) Mrs C Woffindin (CW) Mr V Goodey (VG) Mrs C Dugdale (CD) Ms A Atkinson (AA) Dr K Burch (KB) Dr J Randall (JR) Dr T McKenzie (TM) Mrs D Hogg (DH) Mr A Gray (AG) Ms K Disley (KD) Ms J Kenyon (JK) Mr J Vaughan (JV) In Attendance Ms L Prince Director of Pharmacy ELHT (Acting Chairperson) Medicines Information Manager, ELHT Assistant Director of Pharmacy, Clin Service ELHT Meds Management Pharmacist NHS BwD CCG Pharmacist LCFT (representing Mrs C Harding) Consultant Microbiologist ELHT GP, NHS BwD CCG GP, EL CCG Non-Medical Prescribing Lead, ELHT Clinical Pharmacist, ELHT Finance Department ELHT Head Medicines Commissioning NHS BwD Commissioning Support Pharmacist NHS EL/BwD (Representing L Rogan) Medicines Management Technician EL CCG 2016/077: APOLOGIES: Dr D Gavan (DG) Dr L Rogan (LR) Dr S Jackson (SJ) Consultant Radiologist ELHT Head of Medicines Commissioning NHS EL CCG Clinical Commissioning Group MM Lead, GP EL (comments received for agenda items) 2016/078: DECLARATION OF INTEREST None declared relevant to agenda items. 2016/079: MINUTES OF MAY MEETING: Item 2016/071 2016/072 also Epimax cream added to formulary. Otherwise accepted as a correct record. Lancs Hospitals Trust (ELHT) 1 of 6
2016/080: MATTERS ARISING: 2015/101: NOAC s and Elective Surgery draft guidance has been produced by group led by haematologist and is at consultation stage. VG to follow up progress. 2015/132: Formulary Updates: Oxycodone leaflet is in preparation. 2016/027: LMWH Documents on ELMMB - LR to check with Morcambe Bay re charging to NHS England. 2016/049: Antibiotic Supplies for Paediatrics Paediatric pharmacist suggests that information can be included on discharge letter without requirement for additional leaflet. Possibility of a sticker with information for pink copy of out patient prescriptions to be considered. VG to explore options to provide information in most suitable format. 2016/071, 2016/072: ELHE Integrated Skin Care Guideline & Eczema Guideline these guidelines are for GP s and NMP s and other staff in the integrated skin care service. 2016/073: BAD Specials Recommendations to be cross checked with dermatology specials on formulary and discussed with Derm ongoing. 2016/081: NEW PRODUCT REQUEST INSULIN DEGLUDEC - ADULTS Insulin degludec is requested by Dr Ramtoola, Consultant Diabetes & Endocrinology. Insulin degludec was considered in 2013 and allocated a black traffic light as it was not considered to be cost effective at that time. The diabetes specialists consider it will be beneficial for some of the patients with frequent admissions and clinic visits, with difficult to control diabetes who have tried other long acting insulins. The cost of insulin degludec is to be reduced on 1 st July to a comparable cost to the other long acting insulins. ELMMB now consider that insulin degludec could be a cost effective option for patients with difficult to control diabetes and approve it for addition to formulary. Suggest that its use is monitored and reviewed after a year. Resolved: Insulin Degludec for adults added to formulary for initiation by diabetes specialists. Traffic Light: AMBER 2016/082: NEW PRODUCT REQUEST INSULIN DEGLUDEC - PAEDIATRICS Insulin degludec is requested by Dr Gardner, Consultant Paediatrician, for use in difficult to manage diabetes in adolescents. The timing of the dose is more flexible than the other long acting insulin s, which is likely to be an advantage for adolescents who currently have high admission rates. It is expected that admissions and complications for poorly controlled diabetes will be reduced in this age group. It will offer a cost effective option from the 1 st July when the cost will be comparable to other long acting insulin s. Resolved: Insulin Degludec for paediatrics added to formulary for initiation by paediatric specialists. Traffic Light: AMBER Lancs Hospitals Trust (ELHT) 2 of 6
2016/083: NEW PRODUCT REQUEST FOSFOMYCIN IV Fosfomycin requested by consultant microbiologists for use on their advice only for patients with multi drug resistant infections where other agents are not suitable. It has a different mode of action to all other antibiotics, and is suitable to use in patients with renal impairment. ELMMB approved the addition of fosfomycin to the formulary, restricted to microbiologist approved use only. Resolved: Fosfomycin added to formulary for use only when approved by consultant microbiologist. Traffic Light: RED 2016/084: NEW PRODUCT REQUEST METHOXYFLURANE (PENTHROX ) Methoxyflurane (Penthrox ) requested by Dr Prater, Emergency Medicine Consultant, for the emergency relief of moderate to severe pain. It is self-administered, offers fast relief of acute pain, does not require as much monitoring as opioids and could reduce overall time in the emergency department. It is in a single use inhalation device It is not clear if the support of the anaesthetists has been obtained. Resolved: Methoxflurane requires further discussion with anaesthetists. 2016/085: LMMG CONSULTATIONS (for July LMMG) Clopidogrel Patient Information Leaflet SJ questions why haemorrhagic stroke is included when clopidogrel would not be used. Suggest removing. Riluzole Patient Information Leaflet SJ suggest MND nurse would be useful to include in the do you want more information section. Vitamin D Patient Information Leaflet no comments Lurasadone Recommendation no comments, as it is Lancashire Care specialist medication. Albiglutide Dulaglutide Recommendation Albiglutide agree black traffic light. Dulaglutide supported by diabetic consultants as an alternative to exenatide. SJ has concerns about HbA1c lowering and weight loss information. Comments to be forwarded to LMMG. Resolved: CW to send responses to LMMG. 2016/086: LMMG RECOMMENDATIONS (from May) Ulipristal for treatment of moderate to severe symptoms of Uterine Fibroids in adult women of reproductive age is recommended with an Amber traffic light.. LMMG recommendations accepted as written for ELHE. Consultants to be asked to ensure patients have had counselling on all aspects of the treatment including contraception. Liothyronine for Refractory Hypothyroidism is NOT recommended as add on treatment for refractory hypothyroidism despite adequate monotherapy with levothyroxine. Traffic light: BLACK Lancs Hospitals Trust (ELHT) 3 of 6
Liothyronine prescribing is recommended in secondary and tertiary care for specialist indications as per recommendations. Traffic Light: RED LMMG recommendations accepted as written for ELHE. Prescription Management of Stoma and Incontinence products - LMMG recommendations accepted as written for ELHE. This document will replace the current prescribing guidance document on the website. North West Headache Management Guidelines this guideline has come from the Strategic Clinical Network via LMMG. ELMMB considered this guideline has some useful information but is complex and poorly presented. JV to review and adapt to make it more relevant for local use with clearer presentation. Resolved: JV to review and adapt for local use. 2016/087: FORMULARY UPDATES Buprenorphine patch Butec - Butec 5, 10 and 20 microgram patches are more cost effective and are to replace Butrans 5, 10 & 20 microgram patches on formulary. Sodium chloride 7% nebules Resp-Ease - Resp-Ease 7% nebules are more cost effective and are to replace Nebusal on formulary. Stalevo - Levodopa/Carbidopa/Entacapone ELHT is currently using Stanek brand. Stanek to be added to formulary. Ropinerole XL ELHT currently using Ropilynz XL brand. Ropilynz to be added to formulary. Ideally the formulary on the website needs to reflect what brands, when necessary, are currently used in secondary care. VG will review the Parkinson s disease preparations and the brands in use. Resolved: Changes to formulary approved. VG to review Parkinson s preparations and brands on formulary. 2016/088: EAST LANCS DIABETIC RECORD CARD The Integrated Diabetes Service has developed this diabetic record card for use in their service for Type 2 diabetics managed in primary care. It will be used as part of the pathway when this pathway starts to be used. ELMMB approve the record card for EL when pathway starts. BwD could consider if this record card will be helpful in their service. Resolved: EL Diabetic record Card accepted for use. Lancs Hospitals Trust (ELHT) 4 of 6
2016/089: HYDRATION PATHWAY A Task & Finish group in BwD involving EL Community and Lancs Care have been looking at how to prevent dehydration in the community and have developed the hydration pathway. It is an overarching pathway referring to other policies, guidance and leaflets available. ELMMB support the pathway which will be finalised by the group and then launched. Resolved: Hydration pathway supported by ELMMB. 2016/090: NATIONAL CHEMOTHERAPY DOSE BANDING NATIONAL CQUIN The Lancashire multi-professional cancer group agreed to change to national dose banding for intravenous systemic anti-cancer therapy in accordance with the national dose band tables. This is part of a national CQUIN and ELMMB acknowledge this change. Resolved: ELMMB acknowledge the change to National Chemotherapy Dose Bands. 2016/091: NICE RECOMMENDATIONS (from May) Donepezil, galantamine, rivastigmine and memantine for the treatment of Alzheimer s disease - update of TAG 217 recommends donepezil, galantamine & rivastigmine as options for mild as well as moderate disease and memantine as an option for moderate disease for people who cannot take AChE inhibitors and an option for severe disease. Approved in line with NICE. Traffic Light: AMBER Canagliflozin, dapagliflozin and empagliflozin as monotherapies for treating type 2 diabetes (TAG 390) is recommended as an option by NICE. Approved in line with NICE. Traffic Light: GREEN Cabazitaxel for hormone-relapsed metastatic prostate cancer treated with docetaxel (TAG 391) is recommended as an option by NICE. Approved in line with NICE Traffic Light: RED STANDING ITEMS 2016/092: FOR ACTION/INFORMATION: LANCASHIRE MEDICINES MANAGEMENT GROUP MINUTES May 2016 Minutes acknowledged 2016/093: FOR ACTION/INFORMATION: ANTIMICROBIAL STEWARDSHIP COMMITTEE MINUTES April 2016 Minutes acknowledged DATE OF NEXT MEETING Next meeting is Wednesday 20 TH July 2016 12.30pm, Seminar Room 6, Learning and Development Centre, RBH. Lancs Hospitals Trust (ELHT) 5 of 6
ACTION SHEET FROM EAST LANCASHIRE HEALTH ECONOMY MEDICINES MANAGEMENT BOARD WEDNESDAY 15 TH JUNE 2016 MINUTE DECSRIPTION ACTION DATE NUMBER 2015/101 NOAC s And Elective Surgery guideline in progress VG June 16 2015/132 Formulary Updates Oxycodone patient leaflet for brands/generics of opioids in preparation 2016/027 LMWH documents on ELMMB Check tariff position in oncology with NHSE and position in Lancashire 2016/049 Antibiotic Supplies for Paediatrics to explore options for providing information to GP s 2016/073 BAD Specials Recommendations Cross check with dermatology special on formulary. To be discussed with Dermatology 2016/084 New Product request Methoxyflurane (Penthrox) discuss with anaesthetists 2016/086 LMMG Recommendations (from May) North West headache Management guidelines review & adapt for local use VG June 16 LR Jun 16 VG Jun 16 VG Jun 16 NF Jul 16 JV Jul 16 2016/087 Formulary Updates review Parkinson s preparations and brands VG Jul 16 Lancs Hospitals Trust (ELHT) 6 of 6