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Information and public services for the Island of Jersey

L'înformâtion et les sèrvices publyis pouor I'Île dé Jèrri

Prescribed List as at 1 February 2022

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A decision made 12 January 2022:

Decision Reference:  MD-S-2022-0001

Decision Summary Title :

DS Prescribed list as of 1 February 2022

Date of Decision Summary:

7 January 2022

Decision Summary Author:

Policy Principal

Decision Summary:

Public or Exempt?

Public

Type of Report:

Oral or Written?

Written

Person Giving

Oral Report:

NA

Written Report

Title :

WR report PBAC 11 November 2021

Date of Written Report:

5 January 2022

Written Report Author:

Prescribing Advisor

Written Report:

Public or Exempt?

 

Public

Subject: Changes to be made to the Prescribed List (Jersey) as of 1 February 2022

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 2022 (unless stated otherwise) as set out in the accompanying report and supporting document.

Reason(s) for Decision: The Pharmaceutical Benefit Advisory Committee met to consider applications for changes to the Prescribed List and made the following recommendations:

 

1. Items to be added to the Prescribed List from 1 February 2022

 

1.1 Ferric maltol (iron 30mg) capsules for the treatment of iron deficiency anaemia in patients who have failed to tolerate two other oral iron supplements and would otherwise require intravenous iron therapy.

 

1.2 Lacosamide 50mg, 100mg, 150mg, 200mg tablets; 10mg/ml oral solution sugar free for the treatment of focal seizures in adults and children following initiation by a neurologist

 

1.3 Ciclesonide 80mcg, 160mcg inhaler for the prevention of asthma in adults and children (aged 12 years and older)

 

1.4 Trazodone 50mg tablets as an additional strength for a medicine already included in the List

 

1.5 Hydroxychloroquine 300mg tablets as an additional strength for a medicine already included in the List

 

2. Items to be removed from the Prescribed List from 1 May 2022 following discontinuation

 

2.1 Ethinylestradiol 20microgram / Norethisterone acetate 1mg tablets; Ethinylestradiol 30microgram / Norethisterone acetate 1.5mg tablets; Ethinylestradiol 35microgram / Norethisterone 500microgram tablets

 

2.2 Fluocinolone acetonide 0.0025% cream (Synalar 1 in 10 dilution)

 

3. Items to be removed from the Prescribed List from 1 August 2022 following consultation with healthcare professionals

 

3.1 Ascorbic acid 100mg tablets

 

3.2 Ascorbic acid 500mg tablets (NB Ascorbic acid 500mg chewable tablets will remain in the List where required for co-prescribing with methenamine)

 

3.3 Ascorbic acid 50mg tablets

 

3.4 Vitamin B compound strong tablets

 

3.5 Vitamins capsules

 

4. Items not recommended for inclusion in the Prescribed List

 

4.1 Aripiprazole 1mg/ml oral solution requested as an additional pharmaceutical form for a medicine already included in the List

 

4.2 Paravit-CF capsules

 

5. Other recommendations

 

5.1 Liraglutide 6mg/ml solution for injection 3ml pre-filled disposable devices (Saxenda brand) as an adjunct to weight management – following consultation, the Committee recommended that this product should remain on the Prescribed List subject to starting and stopping criteria.

 

 

The above recommendations 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 and community prescribers at a proportionate cost to the Fund.

Resource Implications: The overall financial impact of the above changes is expected to be a cost increase of around £10,000 pa.

Action required: Health Zone Manager at Customer and Local Services to issue a 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):

 

Hide report
Prescribed List as at 1 February 2022

RECOMMENDATIONS OF THE

PHARMACEUTICAL BENEFIT ADVISORY COMMITTEE

 

Summary

 

The Pharmaceutical Benefit Advisory Committee (PBAC) met on 11 November 2021 to consider applications for changes to the Prescribed List.

The PBAC has recommended the following changes to the Prescribed List to be implemented from 1 February 2022, unless stated otherwise.

 

1.       Items to be added to the Prescribed List from 1 February 2022

1.1   Ferric maltol (iron 30mg) capsules for the treatment of iron deficiency anaemia in patients who have failed to tolerate two other oral iron supplements and would otherwise require intravenous iron therapy.

1.2   Lacosamide 50mg, 100mg, 150mg, 200mg tablets; 10mg/ml oral solution sugar free for the treatment of focal seizures in adults and children following initiation by a neurologist

1.3   Ciclesonide 80mcg, 160mcg inhaler for the prevention of asthma in adults and children (aged 12 years and older)

1.4   Trazodone 50mg tablets as an additional strength for a medicine already included in the List

1.5   Hydroxychloroquine 300mg tablets as an additional strength for a medicine already included in the List

 

2.       Items to be removed from the Prescribed List from 1 May 2022 following discontinuation

2.1   Ethinylestradiol 20microgram / Norethisterone acetate 1mg tablets; Ethinylestradiol 30microgram / Norethisterone acetate 1.5mg tablets; Ethinylestradiol 35microgram / Norethisterone 500microgram tablets

2.2   Fluocinolone acetonide 0.0025% cream (Synalar 1 in 10 dilution)

 

  1. Items to be removed from the Prescribed List from 1 August 2022 following consultation with healthcare professionals

3.1   Ascorbic acid 100mg tablets

3.2   Ascorbic acid 500mg tablets (NB Ascorbic acid 500mg chewable tablets will remain in the List where required for co-prescribing with methenamine)

3.3   Ascorbic acid 50mg tablets

3.4   Vitamin B compound strong tablets

3.5   Vitamins capsules


 

  1. Items not recommended for inclusion in the Prescribed List

 

4.1   Aripiprazole 1mg/ml oral solution requested as an additional pharmaceutical form for a medicine already included in the List

4.2   Paravit-CF capsules

 

  1. Other recommendations
    1.    Liraglutide 6mg/ml solution for injection 3ml pre-filled disposable devices (Saxenda brand) as an adjunct to weight management – following consultation, the Committee recommended that this product should remain on the Prescribed List subject to starting and stopping criteria.

1

 


 


 

 

Mrs Alison Creed

PBAC Chair

 


Recommendations

1.       Items to be added to the Prescribed List from 1 February 2022

 

1.1   Ferric maltol (iron 30mg) capsules is licensed for the treatment of certain patients with iron deficiency anaemia. It is more expensive than other oral iron supplements used in this indication, but some patients don’t tolerate these very well and so require intravenous iron therapy in hospital. Published experience suggests that ferric maltol may reduce the need for patients, who have failed to tolerate at least two other iron supplements, to have intravenous iron, so avoiding the cost and inconvenience of hospital treatment.  PBAC recommended that it be made available for use in the community in such patients. The estimated cost impact to the HIF is £10,000 pa (but this is expected to be offset by similar costs avoided from reducing the use of intravenous iron in hospital).

1.2   Lacosamide 50mg, 100mg, 150mg, 200mg tablets; 10mg/ml oral solution sugar free is licensed for the long-term treatment of certain types of seizures in adults and children and included in NICE guidelines for these indications. It should only be initiated by a neurologist, but PBAC felt that it should be included in the List to support on-going prescribing in primary care. The estimated cost impact to the HIF is £55,000 pa

1.3   Ciclesonide 80mcg, 160mcg inhaler is licensed for the prevention of asthma in adults and children (aged 12 years and older). Other inhaled steroids are included in the List for this indication, and some are less expensive but the Consultant Respiratory specialist at the hospital has found that a small number of patients can be effectively treated with ciclesonide who do not respond adequately or tolerate these other inhaled steroids. PBAC recommended that it be added to the List for use in such patients. The estimated cost impact to the HIF is £15,000 pa

1.4   Trazodone 50mg tablets as an additional strength for a medicine already included in the List. It’s inclusion in the List is expected to have minimal cost impact (£<1,000 pa).

1.5   Hydroxychloroquine 300mg tablets as an additional strength for a medicine already included in the List. It’s inclusion in the List is expected to have minimal cost impact (£<1,000 pa).

 

2.       Items to be removed from the Prescribed List from 1 May 2022

PBAC noted that the following products are now discontinued and should be removed from the Prescribed List.

2.1   Ethinylestradiol 20microgram / Norethisterone acetate 1mg tablets; Ethinylestradiol 30microgram / Norethisterone acetate 1.5mg tablets; Ethinylestradiol 35microgram / Norethisterone 500microgram tablets

2.2   Fluocinolone acetonide 0.0025% cream (Synalar 1 in 10 dilution)

 

 

  1. Items to be removed from the Prescribed List from 1 August 2022

 

PBAC has previously recommended that a few vitamin products should be removed from the Prescribed List as they have no therapeutic value (other than as a placebo), or a better alternative is also included in the List, and, if required by patients, they can be purchased over the counter. 

Consultation with healthcare professional across Jersey resulted in 6 responses with the principal view that no product should be removed if it had a therapeutic use. With this in mind, there was further consultation with the Consultant for Infectious Disease at the hospital about the role of ascorbic acid as an adjuvant to methenamine when used to treat and prevent urinary tract infections. For this indication only, it was agreed to retain the least expensive form of ascorbic acid in the List – ascorbic acid 500mg chewable tablets.

 

The following products are recommended for removal from the Prescribed List with an estimated reduction in costs to the HIF of around £70,000 pa.

3.1   Ascorbic acid 100mg tablets

3.2   Ascorbic acid 500mg tablets (NB chewable tablets 500mg to be retained)

3.3   Ascorbic acid 50mg tablets

3.4   Vitamin B compound strong tablets

3.5   Vitamins capsules

 

  1. Items not recommended for inclusion in the Prescribed List

 

4.1   Aripiprazole 1mg/ml oral solution was considered for addition to the List as an additional pharmaceutical form for a medicine already included in the List. However, PBAC recommended against its inclusion as it would be seldom used and an alternative product, dispersible tablets, could be used.

 

4.2   Paravit-CF capsule was considered for addition to the List for the specific use of patients with cystic fibrosis under the care of hospital specialists. While PBAC acknowledged this as an appropriate use, the numbers of eligible patients are small and could continue to be supplied from the hospital along with their other specialist medicines.

 

  1. Other recommendations
    1.    Liraglutide 6mg/ml solution for injection 3ml pre-filled disposable devices (Saxenda brand) was reviewed as an adjunct to weight management. Following consultation with healthcare professionals across Jersey, PBAC agreed that removal from the List would be problematic. In addition, the Committee felt that support should be given to allow primary care practitioners to effectively manage their patients. However, certain restrictions on the use of liraglutide (and similar medicines) would be needed to ensure that it is used cost-effectively and in accordance with both the manufacturer’s recommendations and those of NICE. Consequently, PBAC recommended that this product should remain on the Prescribed List subject to the following starting and stopping criteria:

1

 


 

  • Liraglutide (Saxenda) will continue to be included in the Prescribed List, as an adjunct for managing overweight and obesity in adults alongside a reduced-calorie diet and increased physical activity, only if:
    • they have a body mass index (BMI) of at least 35 kg/m2 (or at least 32.5 kg/m2 for members of minority ethnic groups known to be at equivalent risk of the consequences of obesity at a lower BMI than the white population) and
    • they have non-diabetic hyperglycaemia (defined as a haemoglobin A1c level of 42 mmol/mol to 47 mmol/mol [6.0% to 6.4%] or a fasting plasma glucose level of 5.5 mmol/litre to 6.9 mmol/litre) and
    • they have a high risk of cardiovascular disease based on risk factors such as hypertension and dyslipidaemia and
    • use is supported by a multidisciplinary team in primary or secondary care
  • In addition:
    • Liraglutide must be prescribed by brand name (Victoza or Saxenda) to ensure that patients receive the appropriate product for their indication
    • In line with the manufacturer’s recommendations, adult patients should be started at a dose of 0.6 mg once daily and the dose increased to 3.0 mg once daily in increments of 0.6 mg with at least one-week intervals. Treatment should be stopped if escalation to the next dose step is not tolerated for two consecutive weeks.
    • New adults starting on treatment with Saxenda must be discontinued after 12 weeks on the 3.0 mg/day dose if they have not lost at least 5% of their initial body weight
    • Adults already receiving Saxenda (for more than 12 weeks) must be discontinued if they have not lost at least 5% of their initial body weight or if they have failed to reach the recommended dose of 3mg/day


 

 

 

 

SUPPORTING DOCUMENT: CHANGES TO THE PRESCRIBED LIST

 

 

Estimated cost impact of changes to the Prescribed List

 

Financial impact

 

The overall financial impact of the above changes is expected to be an increase in net annual expenditure of around £10,000.    

 

 

Product

Change to Prescribed List

Estimated annual cost impact

  1. Ferric maltol (iron 30mg) capsules

Addition

£10,000 (but note expectation that this cost will be offset by reduction in costs for hospital treatment)

  1. Lacosamide 50mg, 100mg, 150mg, 200mg tablets; 10mg/ml oral solution sugar free

Addition

£55,000

  1. Ciclesonide 80mcg, 160mcg inhaler

Addition

£15,000

  1. Trazodone 50mg tablets

Addition

Minimal

  1. Hydroxychloroquine 300mg tablets

Addition

Minimal

  1. Vitamin products (assorted)

Removal

£70,000

 

 

1

 

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