Prescribed List Amendments: 1 April 2013

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A decision made 22 February 2013:

Decision Reference: MD-S-2013-0016
Decision Summary Title :	Changes to be made to the Prescribed List (Jersey) as at 1 April 2013		Date of Decision Summary:	21 February 2013
Decision Summary Author:	Prescribing Adviser		Decision Summary: Public or Exempt?	Public
Type of Report: Oral or Written?	Written		Person Giving Oral Report:	N/A
Written Report Title :	Changes to be made to the Prescribed List (Jersey) as at 1 April 2013		Date of Written Report:	21 February 2013
Written Report Author:	Prescribing Adviser		Written Report : Public or Exempt?	Public
Subject: Changes to be made to the Prescribed List (Jersey) as at 1 April 2013
Decision(s): Further to Article 15, paragraphs (11) and (12), of the Health Insurance (Jersey) Law 1967, and having consulted with the Pharmaceutical Benefit Advisory Committee, the Minister decided to make amendments to the Prescribed List with effect from 1 April 2013 as set out in the accompanying report.
Reason(s) for Decision: The Pharmaceutical Benefit Advisory Committee met on 29 January to consider the Minister’s proposals and has provided the accompanying written report confirming its recommendations in respect of amendments to the Prescribed List. The changes reflect current evidence and expert advice, and ensure that patients in Jersey have access to an appropriate range of modern, safe and effective treatments from their GPs at a proportionate cost to the Fund.
Resource Implications: The overall impact of the changes represent an anticipated saving to the Fund of at least £95,000 per annum.
Action required: Business Manager to issue a public notice listing amendments and notify all approved medical practitioners and approved contractors.
Signature:		Position: Minister
Date Signed:		Date of Decision (If different from Date Signed):

Prescribed List Amendments: 1 April 2013

CHANGES TO BE MADE TO THE PRESCRIBED LIST (JERSEY) AS AT 1 APRIL 2003

Summary

The Pharmaceutical Benefit Advisory Committee (PBAC) met on 29 January 2013 to consider applications for changes to the Prescribed List.

The PBAC recommended the addition of two new medicinal products. In addition, five new formulations of medicines currently included in the Prescribed List were recommended for addition. Two products were recommended to be listed as ‘generic only’, and minor changes were recommended to entries in the Prescribed List for two medicines. One item was recommended for removal.

Recommendations
1. Items to be added to the Prescribed List

2.1.1. Rasagiline tablets 1mg (shared care; open order)

The Committee was unanimous in its recommendation for rasagiline tablets to be added to the Prescribed List for initiation by a specialist and long-term prescribing in primary care under a shared care protocol.

Rasagiline is a monoamine oxidase-B inhibitor licensed for the treatment of Parkinson’s disease. It is an effective treatment that has been approved for use within the hospital by the Drug & Therapeutics Committee. There is no NICE recommendation for this medicine.

Rasagiline is currently prescribed by the Consultant Neurologist at Jersey General Hospital for around 30 patients but can only be supplied through the hospital pharmacy. Other medicines for Parkinson’s disease may be prescribed and dispensed in the community. Adding rasagiline to the Prescribed List, under a shared care protocol, removes any unnecessary restriction on its availability. Rasagiline is an expensive medicine but similar in cost to a number of other medicines for Parkinson’s disease. Its addition to the Prescribed List is expected to increase total annual expenditure by around £30,000. In the past 12 months, around £160,000 was spent on medicines for Parkinson’s disease dispensed in the community.

2.1.2. Letrozole tablets 2.5mg (generic only)

The Committee was unanimous in its recommendation for letrozole tablets to be added to the Prescribed List for initiation in primary or secondary care, although it is unlikely that anyone other than a specialist in breast cancer would initiate treatment. Letrozole will only be reimbursed as a generic product.

Letrozole is a non-steroidal aromatase inhibitor for the treatment of breast cancer. It is one of three such products recommended by NICE and is the drug of choice in its class for the local breast oncologist. It is an effective treatment that has been approved for use within the hospital by the Drug & Therapeutics Committee. Letrozole is currently prescribed by local breast cancer specialists for around 40 patients but can only be supplied through the hospital pharmacy. Other aromatase inhibitors for breast cancer (anastrozole, exemestane) may be prescribed and dispensed in the community. Adding letrozole to the Prescribed List removes any unnecessary restriction on its availability.

The addition of letrozole to the Prescribed List is expected to increase total annual expenditure by around £2,000. In the past 12 months, around £15,000 was spent on medicines for breast cancer dispensed in the community.

2.1.3 Fluticasone/formoterol aerosol inhalation (Flutiform) 50/5mcg, 125/5mcg, 250/10mcg (120 dose unit inhaler) [brand specific]

The Committee was unanimous in its recommendation that Flutiform should be added to the Prescribed List and also recommended that it should be promoted for use in preference to its comparator, Seritide metered-dose inhaler (Evohaler), with a switch programme to ensure predicted savings are achieved. Flutiform will be added as a recommendation on Scriptswitch and the Prescribing Adviser will work with local practices to implement a switch programme.

Flutiform is an inhaler containing a combination of a corticosteroid (fluticasone) and a long-acting bronchodilator (formoterol). It is licensed for the treatment of asthma and marketed as a competitor to Seretide (which contains fluticasone and salmeterol). At its two highest strengths, Flutiform is less expensive than Seretide. In the past 12 months, around £580,000 was spent on Seretide metered-dose inhalers; if these had been prescribed as Flutiform, this cost would have been reduced by 22% (£127,000).

2.1.4 Mesalazine preparations (various; open order)

Mesalazine m/r granules - 1g, 2g sachet
Mesalazine foam enema
Mesalazine tablets 800mg

Mesalazine m/r tablets 1g

Mesalazine is licensed for the treatment of ulcerative colitis. A very limited range of mesalazine containing products have been included in the Prescribed List for many years. Over this time, more formulations have become available that make it easier and more convenient for patients to take this long-term treatment. The proposed formulations were recommended unanimously for inclusion in the Prescribed List to increase choices available. In the past 12 months, around £95,000 was spent on mesalazine products dispensed in the community. The addition of the proposed products is likely to be cost neutral.

Items to be listed as ‘generic only’

There was unanimous support for the following patent-expired medicines to be listed as ‘generic only’ so that prescribing costs can be reduced through the compulsory use of lower-cost generic versions:

Omacor – to be listed as ‘eicosapentaenoic acid 460mg / docosahexaenoic acid 380mg capsules’
Montelukast – all formulations

Both medicines have not yet had a generic reimbursement price set in the Drug Tariff so savings cannot be accurately calculated. However, expenditure on these medicines could be expected to reduce by at least 50% over the next 12 months.

Other changes to the Prescribed List

4.1 Haloperidol liquid 500mcg/5ml has been discontinued and should be removed from the List

4.2 Benzoyl peroxide gel 5% and 10% is listed as Panoxyl brand only but this brand is out of stock. Benzoyl peroxide gel 5% and 10% should be listed as ‘open order’ so that other suitable brands may be dispensed.

4.3 Haloperidol solution 10mg/5mL should be relisted as ‘haloperidol oral liquid 2mg/mL’ to be consistent with the Drug Tariff description.

Summary table with estimated annual costs

Table 1: Additions to the Prescribed List

Item	Reason for change	Net effect on annual expenditure
Rasagiline tablets 1mg	Improve access to hospital-initiated treatment with this medicine	Additional cost £30,000
Letrozole tablets 2.5mg	Improve access to hospital-initiated treatment with this medicine	Additional cost £2,000
Flutiform metered dose inhaler	Provide lower cost alternative to Seretide metered-dose inhaler	Saving £127,000
Mesalazine m/r granules 1g, 2g Mesalazine foam enema; Mesalazine tablets 800mg; Mesalazine m/r tablets 1g	Extend the range of mesalazine formulations available to support patient choice and convenience	Expected to be cost-neutral