Prescribed List: Changes from 1 April 2018

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A decision made 2 March 2018:

Decision Reference: MD-S-2018-0016
Decision Summary Title :	Changes to Prescribed List as of 1 April 2018		Date of Decision Summary:	26 February 2018
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 :	Changes to be made to the Prescribed List as of 1 April 2018		Date of Written Report:	26 February 2018
Written Report Author:	Policy Principal		Written Report : Public or Exempt?	Public
Subject: Changes to be made to the Prescribed List (Jersey) as at 1 April 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 April 2018.
Reason(s) for Decision: The Pharmaceutical Benefit Advisory Committee met on 22 February 2018 and has provided the Minister with the accompanying written report setting out its recommendations in respect of amendments to the Prescribed List. Additional preparations of product already listed Estradiol hemihydrate (Estring) 7.5micrograms/24hours vaginal delivery system for the local treatment of urogenital symptoms of the menopause. Other amendments Aripiprazole tablet is recommended for reimbursement as generic product only Midazolam oromuscosal (buccal) solution entry to be amended to include the treatment of prolonged, acute, convulsive seizures in infants, toddlers, children and adolescents. Oseltamivir oral suspension entry to be amended to oseltamivir oral solution SF 15mg/mL and oral suspension 6mg/mL
Resource Implications: The impact of these 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 April 2018

RECOMMENDATIONS OF THE

PHARMACEUTICAL BENEFIT ADVISORY COMMITTEE

22 February 2018

Summary

The Pharmaceutical Benefit Advisory Committee (PBAC) met on 22 February 2018 to consider applications for changes to the Prescribed List.

The PBAC recommended the following changes to the Prescribed List:

1 Additional preparations of products already listed

1.1 Estradiol hemihydrate (Estring) 7.5micrograms/24hours vaginal delivery system for the local treatment of urogenital symptoms of the menopause.

2 Items to be listed as generic only

2.1 Aripiprazole tablet is recommended for reimbursement as generic product only.

3 Other amendments to the Prescribed List

3.2 Oseltamivir oral suspension – List entry to be amended to oseltamivir oral solution SF 15mg/mL and oral suspension 6mg/mL.

Financial impact

The overall net financial impact of the proposed changes to the Prescribed List is expected to be cost-neutral.

Mrs Alison Creed

Chair, PBAC

23 February 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

1.1. Estradiol hemihydrate (Estring) 7.5micrograms/24hours vaginal delivery system for the local treatment of urogenital symptoms of the menopause.

This product is increasingly recommended by hospital specialists as a long-acting alternative to other oestrogen-containing products. It is an effective, long-established treatment that is cost-neutral compared to other topical products.

2 Other changes to the Prescribed List

2.1. Aripiprazole tablet to be Listed as ‘generic only’. The Committee noted that the category M reimbursement price for aripiprazole tablets is around £1.20 per pack and recommends that this product is listed for generic reimbursement only to ensure the lowest reimbursement price. There are few prescriptions for aripiprazole dispensed each month so the financial impact of this change is expected to be negligible.

3 Other amendments to the Prescribed List

3.1 Midazolam oromuscosal (buccal) solution – List entry to be amended to include the treatment of prolonged, acute, convulsive seizures in infants, toddlers, children and adolescents (from 3 months to < 18 years). Midazolam is currently recommended in the List for use in palliative care (an unlicensed use). The Committee recommended that the entry should now also reflect use for the licensed indication of seizures in children. There financial impact of this change is expected to be negligible.

3.2 Oseltamivir oral suspension – List entry to be amended to oseltamivir oral solution SF 15mg/mL and oral suspension 6mg/mL. The Committee recommended this change to ensure the List reflects currently available products. There will be no financial impact associated with the change.

Other considerations

4.1 Medicines considered less suitable for prescribing in primary care.

The Committee reviewed recommendations made by NHS England about a list of medicines considered by an expert panel to be less suitable for prescribing in primary care. The Committee noted that, of this list, only 5 products are included in the Jersey Prescribed List (dosulepin, trimipramine, liothyronine, hepatitis B vaccine, oxycodone/naloxone). Local consultation about the recommendations for these 5 products resulted in 3 responses. The Committee considered these responses, the relatively low use of these products, and the recommendations made by NHS England and agreed that local prescribers should continue to be reminded of the limited role and, in some cases, relatively high cost of these products. However, the Committee was satisfied that these 5 products were already used with discretion and did not agree to their removal from the Prescribed List.

4.2 Therapeutic groups excluded from the Prescribed List

The Committee noted that a number of groups of medicinal products and devices were not included in the Prescribed List despite their routine prescribing in other health economies. These groups include:

Wound management products
Ancillaries for patients with diabetes
Smoking cessation products
Maintenance therapy for substance misuse (methadone, buprenorphine)
Appliances including for stoma and incontinence
Enteral (‘sip’) feeds
Home oxygen

The Committee considered the broad clinical benefit and demand for these groups but noted that, despite occasional requests for them to be added to the Prescribed List, other models of funding are available as for influenza vaccine. The Committee also noted that, for some of these products, health professionals other than GPs were the more knowledgeable about their selection and use; restricting prescribing to GPs would, therefore, not necessarily improve access.

Two groups, in particular were discussed: wound management products and ancillaries for patients with diabetes. The Committee noted the development of proposals for community pharmacists to work with community specialist nurses to provide wound management products to patients. The Committee also supported requests for ancillaries to be added to the Prescribed List so that they could be prescribed by GPs at the same time as treatments for diabetes. However, the Committee heard that SSD and HSSD are to meet to consider funding proposals for ancillaries for patients with diabetes, and awaits the outcome of these discussions.