RECOMMENDATIONS OF THE
PHARMACEUTICAL BENEFIT ADVISORY COMMITTEE
Summary
The Pharmaceutical Benefit Advisory Committee (PBAC) met on 13 February 2020 to consider applications for changes to the Prescribed List.
The PBAC was unanimous in its recommendations for the following changes to the Prescribed List to be implemented from 1 April 2020, unless stated otherwise.
1. Items to be added to the Prescribed List
1.1 Ticagrelor 60mg tablets (interim recommendation November 2019)
1.2 Sodium hyaluronate 0.2% eye drops preservative free
1.3 VitA-POS™֥ eye ointment preservative free
1.4 Colesevelam 625mg tablets
1.5 Colestipol 5g granules sachets sugar free
1.6 Mesalazine 1g suppositories
1.7 Trimbow™ 87micrograms/dose / 5micrograms/dose / 9micrograms/dose inhaler
1.8 Rivaroxaban 2.5mg tablets, 10mg tablets
1.9 Captopril 25mg/5ml oral solution sugar free
1.10 Aciclovir eye ointment (temporary reinstatement for 6 months only to allow for pharmacy stock to be used up)
2. Items to be removed from the Prescribed List
Removal from March 2021:
2.1 Pethidine tablets
2.2 Flurazepam capsules
Removal from June 2020:
2.3 Pethidine injection
2.4 Aminophylline injection
2.5 Danazol capsules
2.6 Demeclocycline capsules
2.7 Diethylstilbestrol 5mg tablet
2.8 Dihydrocodeine injection
2.9 Disopyramide injection
2.10 Ephedrine injection
2.11 Fentanyl injection
2.12 Pergolide tablets
2.13 Sodium cromoglicate caps 100mg
2.14 Uvistat sun screen Factor 30
2.15 Phenelzine tablets
2.16 Phenindione tablets
2.17 Phenoxybenzamine capsules
2.18 Pimozide tablets
- Other changes to the Prescribed List
The following two products were recommended for reimbursement as ‘Generic only’.
3.1 Budesonide 64micrograms/dose nasal spray
3.2 Bimatoprost 300micrograms/ml eye drops
- Other considerations
- An application for the addition of imiquimod 5% cream, for the treatment of a number of skin conditions, was supported at the meeting in September 2019 on the condition that it was supported by the hospital dermatologist, with appropriate training for primary care prescribers and development of shared care guidance. However, the hospital dermatology team were not supportive of the product being available in primary care, stating that it required specialist initiation and follow-up. The consultant dermatologist was also concerned that it might be used without specialist input. The Committee considered this new information and agreed not to pursue the addition of imiquimod to the List.
4.2 Nepafenac 3mg/ml eye drops was not recommended for addition to the Prescribed List. This anti-inflammatory eye drop is used following cataract surgery and not thought to be appropriate for ongoing prescribing in primary care. In addition, ophthalmic surgeons at JGH use another anti-inflammatory product as their drug of choice.
4.3 An application for the FebriDx point of care test to be added to the Prescribed List was considered but not recommended. The Committee agreed that the product was potentially helpful in the management of patients with suspected upper respiratory tract infections and could help to avoid the unnecessary prescribing of antibacterials. They, therefore, supported efforts to identify possible sources of funding but did not feel that restricting access through prescription was the right approach.
4.4 Acetic acid 2% ear spray was not recommended for addition to the Prescribed List. This product is recommended in local guidelines as an option in the treatment of otitis externa, which causes pain in the ear canal. Since acetic acid ear drops avoid the need to use antibiotics, its use was supported by the Committee. However, the Committee also noted that the ear drops can be bought over the counter from pharmacies and prescribers should be encouraged to recommend the product to patients.
Financial impact
The overall financial impact of the above changes is expected to be cost neutral.
Mrs Alison Creed
Chair, PBAC
17 February 2020
Recommendations
- Items to be added to the Prescribed List
1.1 Sodium hyaluronate 0.2% eye drops preservative free
1.2 VitA-POS™֥ eye ointment preservative free
These two eye products are used for the treatment of dry eye. They provide alternatives to products included in the Prescribed List, many of which have been in short supply. Although the unit cost of these two products is more than existing products, they have a 6-month in use expiry (compared with a 1-2 month expiry for other products) and so offer the potential for less waste and fewer units to be needed throughout the year, reducing treatment costs overall.
1.3 Colesevelam 625mg tablets
1.4 Colestipol 5g granules sachets sugar free
These two products, indicated for the reduction of high cholesterol levels, have been recommended as they offer an alternative to a product, colestyramine, that is already included in the Prescribed List but currently unavailable. Switching to these two products in expected to be cost neutral.
1.5 Mesalazine 1g suppositories
Mesalazine 500mg suppositories are already included in the List. Adding this higher strength product increases treatment options for patients at no additional cost.
1.6 Trimbow™ 87micrograms/dose / 5micrograms/dose / 9micrograms/dose inhaler
Trimbow metered dose inhaler contains a combination of 3 medicines for the treatment of chronic obstructive pulmonary disease. It is therapeutically equivalent to the Trelegy inhaler, already included in the Prescribed List, which also contains a combination of 3 medicines. However, Trelegy is a dry powder inhaler device, which may not be suitable for all patients so Trimbow metered dose inhaler offers an alternative type of inhaler device at no additional cost.
1.7 Rivaroxaban 2.5mg tablets, 10mg tablets
Higher strengths of rivaroxaban are already included in the Prescribed List. Since their inclusion, lower strength products have been made available, at the same flat price, but with specific indications of their own.
1.8 Captopril 25mg/5ml oral solution sugar free
This higher strength of captopril oral solution provides a less expensive alternative to the 5mg/5ml strength solution already included in the Prescribed List. For the very small number of older children who require higher doses of captopril in the form of an oral solution, switching to the 25mg/5mL solution could substantially reduce treatment costs.
- Items to be removed from the Prescribed List
PBAC recommends the removal of the following products from the Prescribed List. These products are either no longer prescribed or are less suitable for prescribing in primary care. Since a few patients are currently receiving prescriptions for pethidine tablets and flurazepam capsules, and are likely to be dependent on these products, prescribers will be given 12 months’ notice of their removal. All other products, that are not currently prescribed, will be subject to the usual 3 months’ notice before removal.
Items proposed for removal from the List | Rationale for removal | Number of items dispensed in last 6 months |
Pethidine tablets | Low use. Faculty of Pain Medicine guidance describes pethidine as particularly unsuitable for patients with persistent pain. Its short duration of action may predispose patients to problem drug use and its metabolite, norpethidine, can cause serious central nervous system effects. Pethidine has no clinical advantage over other opioid analgesics | 38 |
Pethidine injection | Low use. Faculty of Pain Medicine guidance describes pethidine as particularly unsuitable for patients with persistent pain. Its short duration of action may predispose patients to problem drug use and its metabolite, norpethidine, can cause serious central nervous system effects. Pethidine has no clinical advantage over other opioid analgesics | 0 |
Flurazepam capsules | Black-listed in the NHS. Flurazepam has a long duration of action so its sedating effects can persist the next day. | 162 |
Aminophylline injection | Low use. No need for use in primary care | 0 |
Danazol capsules | No use | 0 |
Demeclocycline capsules | No use | 0 |
Diethylstilbestrol 5mg tablet | No use | 0 |
Dihydrocodeine injection | No need for use in primary care | 0 |
Disopyramide injection | No need for use in primary care | 0 |
Ephedrine injection | No need for use in primary care | 0 |
Fentanyl injection | No need for use in primary care | 0 |
Pergolide tablets | Specialist use | 0 |
Sodium cromoglicate capsules 100mg | Licensed for the management of food allergy but weak evidence of benefit. | 3 |
Uvistat sunscreen Factor 30 (SPF 50 to remain) | Only indicated for skin protection against UV radiation in abnormal cutaneous photosensitivity when the highest SPF should be prescribed. The BNF advises that products with SPF less than 30 should not normally be prescribed. | 41 |
Phenelzine tablets | No use. BNF notes that this product is less suitable for prescribing. | 0 |
Phenindione tablets | No use. High cost (£21 per tablet) | 0 |
Phenoxybenzamine capsules | Specialist use. | 0 |
Pimozide tablets | No use | 0 |