Prescribed List: Changes from 1 November 2018

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A decision made on 5 October 2018

Decision Reference: MD-S-2018-0059
Decision Summary Title :	DS_Changes to Prescribed List as of 1 Nov 2018		Date of Decision Summary:	25 September 2018
Decision Summary Author:	Prescribing Advisor		Decision Summary: Public or Exempt?	Public
Type of Report: Oral or Written?	Written		Person Giving Oral Report:	N/A
Written Report Title :	WR_Changes to Prescribed List as of 1 Nov 2018		Date of Written Report:	25 September 2018
Written Report Author:	Prescribing Advisor		Written Report : Public or Exempt?	Public
Subject: Changes to be made to the Prescribed List (Jersey) as of 1 November 2018
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 November 2018 as set out in the accompanying report.
Reason(s) for Decision: The Pharmaceutical Benefit Advisory Committee met on 6 September 2018 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 Erythromycin 20mg/isotretinoin 500mcg per gram gel (Isotrexin) for the treatment of acne Mesalazine modified-release 1.2g tablet (Mezavant XL) for the treatment of ulcerative colitis Items to be listed as generic only Pregabalin capsules (all strengths) Other amendments to the Prescribed List Disopyramide modified-release 250mg to be listed as tablets only (removal of capsule formulation) 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 is expected to be cost neutral.
Action required: Business Manager to issue 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: Changes from 1 November 2018

RECOMMENDATIONS OF THE

PHARMACEUTICAL BENEFIT ADVISORY COMMITTEE

6 September 2018

Summary

The Pharmaceutical Benefit Advisory Committee (PBAC) met on 6 September 2018 to consider applications for changes to the Prescribed List.

The PBAC was unanimous in its recommendations for the addition of two new medicinal products to the Prescribed List, together with other changes to entries in the List as follows:

1 Items to be added to the Prescribed List

Erythromycin 20mg/isotretinoin 500mcg per gram gel (Isotrexin) for the treatment of acne
Mesalazine modified-release 1.2g tablet (Mezavant XL) for the treatment of ulcerative colitis

2 Items to be listed as generic only

Pregabalin capsules (all strengths)

3 Other amendments to the Prescribed List

Disopyramide modified-release 250mg to be listed as tablets only (removal of capsule formulation)

Financial impact

The overall financial impact of the above changes is estimated to be cost neutral.

Mrs Alison Creed

Chair, PBAC

7 September 2018

Recommendations

Items to be added to the Prescribed List

There was unanimous support from the Committee for the addition of the following products to the Prescribed List

Erythromycin 20mg/isotretinoin 500mcg per gram gel (Isotrexin) for the treatment of acne

The Committee noted that this combination product for topical use is recommended as part of consensus guidelines for the treatment of acne in primary care. Clinicians felt that its inclusion in the Prescribed List would increase treatment options at no additional cost. However, the Committee noted that since the product contains the antibiotic erythromycin, clinicians should be cautioned to restrict its use to more difficult to treat patients, in accordance with the guidelines, to minimise the development of antibiotic resistance.

Mesalazine modified-release 1.2g tablet (Mezavant XL) for the treatment of ulcerative colitis

The Committee noted that twice-daily preparations of mesalazine are already included in the Prescribed List. The addition of Mezavant XL, a once-daily preparation of the drug, was requested by the hospital specialists in gastroenterology, to improve convenience for patients and increase treatment adherence.

2 Other changes to the Prescribed List

Pregabalin capsules to be listed for ‘generic only’ reimbursement to ensure best value for money. Generic pregabalin now costs less than 10% of the price for the originator brand. Prescribers already prescribe this drug by its generic name, so optimising use of the lower-priced generic product. This change to the Prescribed List ensures that this practice continues and prevents reimbursement for the more expensive originator brand.
Disopyramide modified-release 250mg to be listed as tablets only, with removal of capsule formulation, following discontinuation of the capsules.

Other considerations

Estradiol 1 mg (as estradiol hemihydrate) and drospirenone 2 mg tablets (Angeliq) as hormone-replacement therapy (HRT) for the management of oestrogen deficiency symptoms and prevention of osteoporosis in postmenopausal women.

A request to add this HRT product to the List was declined. The Committee agreed that this product, which is more expensive than other available HRT products on the List, offered no clinically significant advantages over existing options.

Estimated cost impact of PBAC recommendations 6 September 2018
Recommended product	Estimated cost impact
Erythromycin 20mg/isotretinoin 500mcg per gram gel (Isotrexin) for the treatment of acne	None. This is a replacement product, which is of similar price or less expensive than existing treatment options. Use is expected to be low.
Mesalazine modified-release 1.2g tablet (Mezavant XL) for the treatment of ulcerative colitis	Small cost increase (<£1,000 pa). The annual cost of once-daily Mezavant XL formulation of mesalazine is 9% (£44 pa at maintenance dose) more expensive than the twice-daily formulations currently allowed on the List.
Pregabalin capsules – generic only	Significant reductions in expenditure have already been made through generic prescribing of pregabalin following expiry of the patent for the originator brand so additional savings will be minimal. However, listing the product as ‘generic only’ will ensure that reimbursement at the lowest price is maintained.