Changes to the Prescribed List (Pharmaceuticals)

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A decision made (04.12.06) to approve changes to be made to the Prescribed List (Jersey) as at 1st January 2007.

Subject:	Changes to be made to the Prescribed List (Jersey) as at 1 January 2007
Decision Reference:	MD-S-2006-0067	Exempt clause(s):		N/a
Type of Report: (oral or written)	Written	Person Giving Report (if oral):		N/a
Telephone or e-mail Meeting?	N/a	Report File ref:		2/2/4
Written report – Title	Prescribed List (Jersey) 1 January 2007
Written report – Author (name and job title)	Rosie Goulding, Policy Principal
Decision(s): To approve the changes to the Prescribed List (Jersey) as recommended by the Pharmaceutical Benefits Advisory Committee from the meeting held on the 21 November 2006 To be included: Lercanidipine tablets 10mg, 20 mg Bisoprolol tablets 1.25mg, 2.5 mg, 3.75 mg, 5 mg, 7.5mg 10 mg Metroprolol tablets 50 mg 100mg Nicorandil tablets 10mg, 20 mg Clopidogrel tablets 75 mg Beclometasone CFC-free metered-dose inhaler 50 mcg, 100 mcg, 200 mcg, 250 mcg (Clenil Modultite Reinstatement of branded products for antibiotic suspensions Enzira and agrippal Influenza Vaccines To be deleted: QVAR Fluvirion - influenza vaccine
Reason(s) for decision: The Pharmaceutical Benefits Advisory Committee met on the 21 November 2006, they have provided the Department with a list of recommended changes to the Prescribed List (Jersey) to become effective from 1 January 2007. The Pharmaceutical Benefits Advisory Committee aim to ensure that General Practitioners have the choice available to them of modern, safe and effective medicines. The Department is constantly seeking out ways to reduce the cost of public money spent on medication in the community. They have achieved this in the past by introducing generic items in place of branded items once the patent has been removed. This has significantly reduced the cost and has enabled the Department to add a wider variety of medications onto the Prescribed List (Jersey). The Pharmaceutical Benefits Advisory Committee has provided a list of recommendations for new medications and formulations to be included on the Prescribed List (Jersey) from 1 January 2007.
Action required: The Minister is asked to approve the recommendations made by the Pharmaceutical Benefits Advisory Committee and for these changes to come into effect as at 1 January 2007
Signature: Senator P.F. Routier			Date of Decision:

Changes to the Prescribed List (Pharmaceuticals)

Recommendations of the Pharmaceutical benefit Advisory Committee

21 November 2006

1. SUMMARY

The Pharmaceutical Benefit Advisory Committee met on 21 November 2006 to consider the inclusion and/or deletion of certain products from the Prescribed List. The PBAC recommended the inclusion of eight products and the deletion of two products detailed in this report.

2. BACKGROUND

i. Lercanidipine Tablets 10mg, 20mg

Lercanidipine appears to offer an effective alternative to amlodipine for patients who experience troublesome unwanted effects, typically oedema. It should, therefore, be added to the Prescribed List. However, lercanidipine is more expensive than existing calcium channel blockers in the Prescribed List.

Approximate annual cost:

Amlodipine 5 10 mg daily £28 - £34

Lercanidipine 10 – 20 mg daily £76 - £143

Felodipine 5 – 10 mg £58 - £78

ii. Bisoprolol tablets 1.25mg, 2.5mg, 3.75mg, 5mg, 7.5mg, 10mg [1]

Bisoprolol is now an inexpensive and well established beta-blocker with a wide range of licensed indications. It should be added to the Prescribed List.

iii. Metoprolol tablets 50mg, 100mg1

Metoprolol is an inexpensive and well established beta-blocker with a wide range of licensed indications. It should be added to the Prescribed List.

iv. Nicorandil tablets 10mg, 20mg 1

Nicorandil should be added to the Prescribed List for the treatment of patients with angina who remain symptomatic despite optimal therapy with other antianginal drugs.

Approximate annual cost:

Nicorandil 10 – 20 mg daily £100 - £190 (due off patent)

Atenolol 100 mg daily £17

Isosorbide mononitrate £22

v. Clopidogrel tablets 75mg 1

Clopidogrel should be added to the Prescribed List only following initiation in secondary (or tertiary) care for use under a shared-care agreement. It should only be used, in combination with aspirin, for patients with acute coronary syndrome or after stenting (unlicensed indication), or as a monotherpay for patients who require antiplatelet therapy but have true aspirin hypersensitivity. Recommended subject to shared care protocols that address corporate governance issues

Approximate annual cost:

Clopidogrel 7mg once daily £460

Asprin 75mg once daily £11

vi. Beclometasone CFC-free metered-dose inhaler 50mcg, 100mcg, 200mcg, 250mcg (Clenil Modultite)

Clenil Modulite should be added to the Prescribed List and Qvar withdrawn. Patients should be actively switched to CFC-free beclometasone at the earliest opportunity.

vii. Reversal of decision to change all antibiotic suspensions to ‘generic only’ – reinstatement of branded products for antibiotic suspensions

viii. Enzira and Agrippal Influenza Vaccines – Enzira and Agrippal approved for 2006/2007 season only.

Items to be deleted from the Prescribed List

Qvar – Three month notice to be given

Fluvirion – Influenza Vaccine

3. RECOMMENDATION

The Minister is asked to approve changes to take effect from 1 January 2007.

[1] Approval sought from the Consultant - Cardiology