Changes to Prescribed List (Jersey) as of 1 September 2019

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A decision made on 12 July 2019

Decision Reference: MD-S-2019-0051
Decision Summary Title :	DS_Changes to Prescribed List as of 1 Sept 2019		Date of Decision Summary:	9 July 2019
Decision Summary Author:	Policy Principal		Decision Summary: Public or Exempt?	Public
Type of Report: Oral or Written?	Written		Person Giving Oral Report:	N/A
Written Report Title :	WR_Report PBAC 20 June 2019		Date of Written Report:	9 July 2019
Written Report Author:	Policy Principal		Written Report : Public or Exempt?	Public
Subject: Changes to be made to the Prescribed List (Jersey) as of 1 September 2019
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 September 2019 as set out in the accompanying report.
Reason(s) for Decision: The Pharmaceutical Benefit Advisory Committee met on 20 June 2019 and has provided the Minister with recommendations and the accompanying written report regarding amendments to the Prescribed List. Items to be added to the Prescribed List Ganciclovir eye ointment 0.1% to replace discontinued aciclovir eye ointment Nifedipine modified release capsules 20mg, 30mg, 60mg to allow all brands/manufacturers Latanoprost and timolol unit dose eye drops 50micrograms/5mg Vaginal lubricants (brands Sylk, YES; excludes pre-filled applicators) Bismuth subsalicylate 17.5mg/mL oral suspension (generic only) to replace discontinued tripotassium dicitratobismuthate (De-Nol) Other changes to the Prescribed List Remove aciclovir eye ointment 3% Remove tripotassium dicitratobismuthate (De-Nol) that is now discontinued Remove lidocaine gel 2% as rarely prescribed and only available as special manufactured product. Allow all brands and manufacturers for nifedipine modified-release tablets and capsules 20mg, 30mg, 60mg 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 and community prescribers at a proportionate cost to the Fund.
Resource Implications: The overall financial impact of the above changes is expected to be cost neutral with the possibility of a very small reduction in total expenditure.
Action required: Health Zone Manager at Customer and Local Services 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):

Changes to Prescribed List (Jersey) as of 1 September 2019

RECOMMENDATIONS OF THE

PHARMACEUTICAL BENEFIT ADVISORY COMMITTEE

20 June 2019

Summary

The Pharmaceutical Benefit Advisory Committee (PBAC) met on 20 June 2019 to consider applications for changes to the Prescribed List.

The PBAC was unanimous in its recommendations for the following changes to the Prescribed List.

Items to be added to the Prescribed List
1. Ganciclovir eye ointment 0.1% to replace discontinued aciclovir eye ointment
2. Nifedipine modified release capsules 20mg, 30mg, 60mg to allow all brands/manufacturers
3. Latanoprost and timolol unit dose eye drops 50micrograms/5mg
4. Vaginal lubricants (brands Sylk, YES; excludes pre-filled applicators)
5. Bismuth subsalicylate 17.5mg/mL oral suspension (generic only) to replace discontinued tripotassium dicitratobismuthate (De-Nol)

Other changes to the Prescribed List
1. Remove aciclovir eye ointment 3%
2. Remove tripotassium dicitratobismuthate (De-Nol) that is now discontinued
3. Remove lidocaine gel 2% as rarely prescribed and only available as special manufactured product.
4. Allow all brands and manufacturers for nifedipine modified-release tablets and capsules 20mg, 30mg, 60mg

Financial impact

The overall financial impact of the above changes is expected to be cost neutral with the possibility of a very small reduction in total expenditure.

Mrs Alison Creed

Chair, PBAC

5 July 2019

Recommendations

Items to be added to the Prescribed List
1. Ganciclovir eye ointment 0.1% to replace discontinued aciclovir eye ointment
  - Aciclovir eye ointment, an antiviral product to treat viral infections of the eye, has been discontinued. Ganciclovir is the only alternative product.
2. Nifedipine modified release capsules 20mg, 30mg, 60mg to allow all brands/manufacturers
  - The Prescribed List restricts the choice of nifedipine modified release products to Adalat brand and tablets. These products are currently in short supply. The Committee, therefore, agreed to relax the supply of nifedipine modified release products so that any brand/manufacturer could be dispensed and so that both capsule and tablet formulations can be prescribed and supplied.
3. Latanoprost and timolol unit dose eye drops 50micrograms/5mg
  - The Prescribed List currently includes a multi-application product containing latanoprost and timolol for the treatment of glaucoma. However, this product contains a preservative, which some patients cannot tolerate. The Committee, therefore, agreed that it is appropriate to also add a preservative-free product to the Prescribed List.
4. Vaginal lubricants (brands Sylk, YES; multi-application products only)
  - Vaginal lubricants are recommended by clinical guidelines for the treatment of menopausal symptoms and can be a helpful alternative to hormonal therapy. The Committee, therefore, felt it was appropriate to include these products as an option. There are a number of vaginal lubricants on the market that are reimbursable on an NHS prescription. The brands Sylk and YES were requested in the application and supported. However, the Committee considered the pre-filled single application device for these brands to offer poor value for money and excluded them from the recommendation.
5. Bismuth subsalicylate 17.5mg/mL oral suspension (generic only) to replace discontinued tripotassium dicitratobismuthate (De-Nol)
  - Treatment guidelines recommend a bismuth-containing product as part of eradication therapy for H.pylori. The only bismuth-containing product on the Prescribed List is now discontinued. Bismuth subsalicylate oral suspension is an appropriate alternative that is now also supplied through the hospital.

Estimated cost impact of PBAC recommendations 20 June 2019
Recommended product	Estimated cost impact
1.1 Ganciclovir eye ointment to replace discontinued aciclovir eye ointment	Cost increase of less than £500 pa. Ganciclovir eye ointment 0.1% 5g costs £19.99, around double the cost of aciclovir eye ointment that it replaces. However, based on usage data for aciclovir, few prescriptions for ganciclovir are expected to be dispensed so the estimated cost impact is low.
1.2 Nifedipine modified release capsules 20mg, 30mg, 60mg to allow all brands/manufacturers	Cost reduction of up to £11,000 pa. Amending the entry to allow any brand/manufacturer of nifedipine modified release (M/R) tablet or capsule will provide more flexibility and, because of the lower cost of nifedipine M/R capsule products, could reduce total expenditure by up to 40% (from £28k pa to £17k pa)
1.3 Latanoprost and timolol unit dose eye drops 50micrograms/5mg	Cost increase of less than £1,000 pa Latanoprost and timolol unit dose eye drops 50micrograms/5mg (30 doses) costs £13.49 compared with £6.57 for the multi-dose product currently on the List. However, overall use is expected to be low so limiting the estimated cost impact to less than £1,000 pa.
1.4 Vaginal lubricants (brands Sylk, YES; multi-application products only)	Cost increase of around £5,000 pa Multi-application products of Sylk (40g tube) and YES VM and YES WB (100g tube) cost £5.16 and £7, respectively. Each product is expected provide at least 75 applications. Assuming 200 women receive an average of 4 prescriptions per year, the total cost impact is estimated at £5,600 pa.
1.5 Bismuth subsalicylate 17.5mg/mL oral suspension (generic only) to replace discontinued tripotassium dicitratobismuthate (De-Nol)	Cost increase of less than £500 Each treatment course of bismuth subsalicylate costs around £13. Overall use is expected to be low so limiting overall cost impact.