Prescribed List: Changes from 1 February 2018

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A decision made 12 January 2018:

Decision Reference: MD-S-2018-0002
Decision Summary Title :	Changes to Prescribed List as of 1 February 2018	Date of Decision Summary:	5 January 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 :	Changes to be made to the Prescribed List as of 1 February 2018	Date of Written Report:	5 January 2018
Written Report Author:	Prescribing Advisor	Written Report : Public or Exempt?	Public
Subject: Changes to be made to the Prescribed List (Jersey) as at 1 February 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 February 2018.
Reason(s) for Decision: The Pharmaceutical Benefit Advisory Committee met on 30 November 2017 and has provided the Minister with the accompanying written report setting out its recommendations in respect of amendments to the Prescribed List. Items to be added to the Prescribed List Pimecrolimus cream 1% Progesterone oral capsule 100mg Mometasone Furoate Cream/Ointment 0.1% Doxycycline Soluble Tablet 100mg Adrenaline Solution for injection 150mcg, 300mcg, 500mcg (Emerade auto-injector brand) Oilatum Junior Bath Additive Emollient Desmopressin Oral Lyophilisate 25mcg, 50mcg Items to be removed from the Prescribed List Ampicillin Other amendments orphenadrine elixir 25mg/5ml amended to orphenadrine oral solution 50mg/5ml’ 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 increase total annual expenditure for Pharmaceutical Benefit by up to £95,000.

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 February 2018

RECOMMENDATIONS OF THE

PHARMACEUTICAL BENEFIT ADVISORY COMMITTEE

30 November 2017

Summary

The Pharmaceutical Benefit Advisory Committee (PBAC) met on 30 November 2017 to consider applications for changes to the Prescribed List.

The PBAC recommended the following changes to the Prescribed List:

1 New products to be added to the Prescribed List

1.1 Pimecrolimus cream 1% (open order) for the treatment of patients (aged 2 years and over) with mild or moderate atopic dermatitis where treatment with topical corticosteroids is either inadvisable or not possible including due to intolerance, lack of effect, use in areas where prolonged steroids are inappropriate (eg face and neck)

1.2 Progesterone micronized oral capsule 100mg (open order) as an adjunct with oestrogen in post-menopausal women with an intact uterus

2 Additional preparations of products already listed

2.1 Mometasone Furoate Cream/Ointment 0.1% (generic only) for the treatment of patients (2 years and over) with inflammatory and pruritic manifestations of psoriasis (excluding widespread plaque psoriasis) and atopic dermatitis

2.2 Doxycycline dispersible sugar free tablet 100mg (generic only) for the treatment of infections caused by susceptible organisms

2.3 Adrenaline Solution for injection autoinjectors 150mcg, 300mcg, 500mcg (Emerade brand) for the emergency treatment of severe acute allergic reactions

2.4 Oilatum Junior Bath Additive Emollient for the treatment of eczema and dry skin

2.5 Desmopressin Oral Lyophilisate sugar free 25mcg, 50mcg (open order) for the symptomatic treatment of nocturia due to idiopathic nocturnal polyuria in adults

3 Items to be removed from the Prescribed List

3.1 Ampicillin – all formulations to be removed due to lack of use. Use not supported by local guidelines for the management of infection.

4 Other amendments to the Prescribed List

4.1 Orphenadrine oral solution sugar-free 50mg/5ml to replace the entry for orphenadrine elixir 25mg/5mL

5 Applications deferred

5.1 Atomoxetine / Methylphenidate for attention deficit disorder in adults

6 Applications not supported

6.1 Capsaicin cream 0.025%/0.075% for the treatment of post-herpetic neuralgia and osteoarthritis

7 Changes to the Dental List

The following changes were recommended to bring the Dental List in line with both the Prescribed List and the Dental Prescribing List for England and Wales

7.1 Add artificial saliva gel, pastilles and protective spray to bring Dental List in line with Prescribed List

7.2 Add azithromycin tablets 250mg, 500mg (generic only) and oral suspension 200mg/5mL (generic only)

7.3 Add doxycycline dispersible tablets (sugar free) 100mg (generic only)

7.4 Add metronidazole tablets 200mg (generic only), and oral suspension 200mg/5mL (generic only)

Financial impact

The proposed changes to the Prescribed List and Dental List are estimated to increase total annual expenditure by up to £95,000, mostly due to a shift in the prescribing of established products from hospital to the community.

Mrs Alison Creed

Chair, PBAC

1 December 2017

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

1.1	Pimecrolimus cream 1% for the treatment of patients (aged 2 years and over) with mild or moderate atopic dermatitis where treatment with topical corticosteroids is either inadvisable or not possible including due to intolerance, lack of effect, use in areas where prolonged steroids are inappropriate (eg face and neck) There is already an established use of this product within the hospital and outpatients are prescribed and supplied through the hospital service. The Committee agreed that it was appropriate for GPs to be able to continue to prescribe such specialist-initiated treatment as well as, where appropriate, initiate treatment themselves. The hospital service estimated that up to 200 patients use the product, which would create a cost pressure for the HIF of around £90,000 pa, assuming each patient receives a prescription for 1x60g tube of cream each month.
1.2	Progesterone oral capsule 100mg as an adjunct with oestrogen in post-menopausal women with an intact uterus Two applications from GPs were considered for this product with claims that it offers a better tolerated option for some women requiring hormone-replacement therapy. While the Committee noted that better evidence was needed to support these claims, they agreed that the product offers an alternative for some women with little or no overall cost impact.
1.3	Mometasone Furoate Cream/Ointment 0.1% for the treatment of patients (2 years and over) with inflammatory and pruritic manifestations of psoriasis (excluding widespread plaque psoriasis) and atopic dermatitis There is already an established use of this topical steroid within the hospital and outpatients are prescribed and supplied through the hospital service. The Committee agreed that it was appropriate for GPs to be able to continue to prescribe such specialist-initiated treatment as well as, where appropriate, initiate treatment themselves. The hospital service estimated that up to 60 patients use the product, which would create a cost pressure for the HIF of around £5,000 pa, assuming each patient receives a prescription for 1x100g tube of cream each month.
1.4	Doxycycline Soluble Tablet 100mg for the treatment of infections caused by susceptible organisms This soluble tablet provides an alternative for patients who cannot swallow the capsules already included in the List. Although more expensive than the capsules, only small numbers of patients are expected to be prescribed the soluble tablets so the cost impact is estimated as being minimal (<£500 pa).
1.5	Adrenaline Solution for injection 150mcg, 300mcg, 500mcg (Emerade auto-injector brand) for the emergency treatment of severe acute allergic reactions This product provides a safer and more easily used device for the emergency administration of adrenaline compared to the product currently available on the List. It also offers the higher strength of adrenaline that is recommended in treatment guidelines. The addition of this product to the Prescribed List will be cost neutral.
1.6	Oilatum Junior Bath Additive Emollient for the treatment of eczema and dry skin. This product provides a perfume-free alternative to the Oilatum Bath Emollient currently included in the Prescribed List at no additional cost.
1.7	Desmopressin Oral Lyophilisate 25mcg, 50mcg for the symptomatic treatment of nocturia due to idiopathic nocturnal polyuria in adults Desmopressin tablets are already included in the Prescribed List but the lowest strength currently available is 60mcg. Lower doses are used for treating older men with nocturia. These two strengths of tablet allow the use of lower doses where indicated at no additional cost.

2 Other changes to the Prescribed List

2.1 The antibiotic ampicillin was recommended for removal from the Prescribed List as it is not recommended in current treatment guidelines for infections and is seldom prescribed.

2.2 The Committee noted that orphenadrine elixir 25mg/5ml is no longer available and supported the amendment of the List entry to ‘orphenadrine oral solution 50mg/5ml’.