Recommendations of the Pharmaceutical benefit Advisory Committee
10 July 2007
1. SUMMARY
The Pharmaceutical Benefit Advisory Committee met on 10 July 2007 to consider the inclusion and/or deletion of certain products from the Prescribed List. The PBAC recommended
i. The inclusion of the following items:
438 items – classification status green
20 items – classification status amber
ii. The deletion of 3 items detailed in this report
- BACKGROUND
i. Classification of medicines
Recent and extensive work has been undertaken to move long term prescribing of medicines from hospital specialists to GPs and develop a single Island formulary. This change allows the seamless transfer of patient treatment from the secondary care sector to general practice. It is also a means of communicating relevant clinical details between consultant and GP. Shared care prescribing agreements are used to combine the best of both primary and secondary care for the benefit of the patient.
The Pharmaceutical Benefits Advisory Committee will now consider the impact of adding each new drug to the List on an individual basis at the time of application and its appropriate classification. Thus, three categories of medicine are defined:
- Green items – These medicines are available for all General Practitioners to prescribe
- Amber items – These medicines must be initiated in the hospital but long term prescribing may be transferred to primary care within a shared- care framework
- Red items – these medicines will only be available in the hospital environment
With regard to the H&SS accountability for shared care governance, the proposed joint formulary has been approved and ratified by H&SS Drug and Therapeutic Committee in addition to PACT and PBAC approval. To strengthen governance arrangements, the formulary will be separated into the three categories. The inclusion of the drugs will result in an additional £1.3 million (approximate) cost to the Health Insurance fund. The fund has sufficient resources to fund this development
ii. Omega-3-acid ethyl esters capsules 1g (Omacor - Solvay), (classification - green)
The inclusion of Omacor in the Prescribed List is supported by Dr Andrew Mitchell, Consultant Physician at Jersey General Hospital.
Previously, a decision on the addition of Omacor to the Prescribed List was deferred pending publication of NICE guidance. This guidance suggests that Omacor should be considered as part of lifestyle measures to increase dietary intake of omega-3-fatty acids. Adding Omacor to the prescribed list would allow GPs a further option for lifestyle measures for post MI patients.
iii. Rosuvastatin 5mg, 10mg, 20mg (classification - green)
Cholesterol lowering treatment - Rosuvastatin was deferred from the November 2006 meeting pending analysis of prescribing data and estimates of cost savings through preferential use of the drug instead of atorvastatin.
Local specialists have strongly requested the addition of rosuvastatin to provide a further option in cholesterol-lowering treatments for those who do not tolerate existing options, and to provide a less expensive alternative to atorvastatin.
iv. Solifenacin tablets 5mg, 10mg (classification - green)
Licensed use: treatment for urinary frequency, urgency and urge incontinence – 5-10mg once daily. (£340-£440). The inclusion of this item in the Prescribed List would provide a further option for the treatment of urinary incontinence. In view of the relatively poor tolerance of drugs in this class, and the subjective response of patients, such an additional option may be worthwhile providing less expensive options are used first-line.
- 435 items – classification –green (appendix one)
Recent and extensive work has been undertaken to move long term prescribing of medicines from hospital specialists to GPs and develop a single Island formulary. The list provided in appendix one represents items that should be included on the formulary. Although available for General Practitioners to prescribe, the majority of items are unlikely to be used in primary care.
vi. 20 items – classification amber (appendix two for protocols)
- 20 items – appendix two (classification amber)
- 6-mercaptopurine Inflammatory bowel disease
- Atypical neuroleptics Schizophrenia -(amisulpride, olanzapine, quetiapine)
- Azathioprine Rheumatoid arthritis and connective tissue disorders
- Cabergoline Parkinson’s Disease
- Ciclosporin Rheumatoid arthritis, autoimmune disease, renal transplant
- Ciclophosphamide Rheumatoid arthritis, autoimmune disease
- Valproate semisodium Acute mania
- Donepezil Alzheimer’s disease
- Entacapone Parkinson’s disease
- Galantamine Alzheimer’s disease
- Lithium Bipolar illness
- Memantine Alzheimer’s disease
- Methotrexate Rheumatoid arthritis, psoriasis
- Pergolide Parkinson’s disease
- Pramipexole Parkinson’s disease
- Ropinirole Parkinson’s disease
- Sirolimus Renal transplant
- Tacrolimus Organ transplant
Items to be deleted from the Prescribed List
Phenytoin tablets (non-proprietary) - Three month notice to be given
Atrovastatin 10mg; 20; mg; 40mg - Three month notice to be given
Ramipril tablet formulation (non-proprietary) all strengths - Three month notice to be given.
- RECOMMENDATION
The Minister is asked to approve changes to take effect from 1 October 2007.
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