RECOMMENDATIONS OF THE
PHARMACEUTICAL BENEFIT ADVISORY COMMITTEE
7 June 2016 and 20 September 2016
Summary
The Pharmaceutical Benefit Advisory Committee (PBAC) met on 7 June 2016 and on 20 September 2016 to consider applications for changes to the Prescribed List.
The PBAC recommended the following changes to the Prescribed List:
1 Additions to the Prescribed List
1.1 A range of emollient products for the treatment of skin conditions as follows:
1.1.1 Aveeno cream, Aveeno bath additive
1.1.2 Cetraban cream
1.1.3 Epaderm cream
1.1.4 Emollin aerosol
1.1.5 White soft paraffin
1.2 Isoniazid tablets 100mg for the treatment of tuberculosis (NB a request to add this product was withdrawn at the meeting on 20 September 2016
1.3 Clobazam tablets 10mg for epilepsy
1.4 Measles, Mumps and Rubella (MMR) vaccine for ‘catch up’ vaccination in primary care
1.5 Testosterone gel 50mg/5g sachet for hormone replacement
1.6 Coal tar solution 5% for psoriasis and atopic eczema
1.7 Levetiracetam injection 500mg/5mL for symptom control in palliative care
1.8 Tafluprost/timolol 15mcg/5mg eye drops per mL for the treatment of glaucoma
1.9 Brinzolamide/brimonidine 10mcg/2mg per mL eye drops for glaucoma
1.10 Brinzolamide/timolol 10mg/5mg per mL eye drops for glaucoma
1.11 Dexamethasone/tobramycin 1mg/3mg per mL for post-surgical treatment of eye inflammation and infection
1.12 Sacubitril with valsartan tablets (24mg/26mg, 49mg/51mg, 97mg, 103mg) for the treatment of selected patients with chronic heart failure in accordance with guidance published by NICE
1.13 Azelaic acid cream 20% (Skinoren brand) for the treatment of acne
1.14 Bimatoprost preservative free eye drops 300mcg/mL
1.15 Timolol 1mg/g eye gel 0.4g (Tiopex brand) for the treatment of glaucoma
2 Items for removal from the Prescribed List
2.1 The Committee supported a request from the Consultant for Infectious Disease at Jersey General Hospital for the removal of all products for the treatment of tuberculosis
2.2 The Committee reiterated its support for the removal of products containing omega-3 acid ethyl esters (brand name Omacor, plus generic equivalents)
3 Other amendments to the Prescribed List
3.1 The Committee recommended removal of the ‘generic only’ entry for salmeterol/fluticasone metered-dose inhaler
4 Rejected applications
4.1 Applications for two products to be added to the Prescribed List were not supported:
4.1.1 Vitamin B12 (cyanocobalamin) tablets
4.1.2 Apraclonidine eye drops 0.5%, 1% for glaucoma
5 Financial impact
The overall financial impact of the additions to the Prescribed List was considered to be around £30,000 pa, largely due to the recommendation for sacubitril with valsartan. Anticipated growth in the use of this product will increase the cost impact of this product to around £125,000 pa by 2020/21.
The removal of medicines for the treatment of tuberculosis, and removal of products containing omega-3 acid ethyl esters will reduce total expenditure by an estimated £47,000 pa.
Mrs Alison Creed
Chair, PBAC
21 September 2016
Recommendations
- Items to be added to the Prescribed List
1.1 | A range of emollient products for the treatment of skin conditions as follows: Aveeno cream, Aveeno bath additive Cetraban cream Epaderm cream Emollin aerosol White soft paraffin The Committee considered the outcome of a review of emollient products carried out in conjunction with the dermatology team at Jersey General Hospital and supported recommendations to increase choice for patients. Emollients are an important part of the treatment of a number of skin conditions and their optimal use can reduce exacerbations and the need for treatment escalation. Providing patients with a range of convenient and cosmetically acceptable was felt to be a priority in this therapeutic area. |
1.2 | Isoniazid tablets 100mg for the treatment of tuberculosis The Committee supported this application on 7th June but agreed to the subsequent request, discussed at the meeting on 20th September, to remove all products for the treatment of tuberculosis from the Prescribed List. The Consultant for Infectious Diseases at Jersey General Hospital considered this range of treatments to require restriction to specialist use only. |
1.3 | Clobazam tablets 10mg for epilepsy The Committee noted that clobazam is an option for the treatment of epilepsy that is currently supplied only through the hospital despite other treatments for epilepsy being available from the GP. Addition to the Prescribed List will allow patients with epilepsy to receive all of their medicines in primary care. |
1.4 | Measles, Mumps and Rubella (MMR) vaccine for ‘catch up’ vaccination in primary care In response to national advice to make MMR vaccine available for pregnant women requiring ‘catch-up’ vaccination, the Committee agreed to make the MMR vaccine available through the Prescribed List. |
1.5 | Testosterone gel 50mg/5g sachet for hormone replacement The Committee supported the addition of this product to the Prescribed List as a replacement for testosterone injections, which are in short supply. |
1.6 | Coal tar solution 5% for psoriasis and atopic eczema The Committee supported the addition of this product to the Prescribed List as a treatment for selected patients with eczema or psoriasis. |
1.7 | Levetiracetam injection 500mg/5mL for symptom control in palliative care The Committee supported an application by the palliative care team for the addition of this product to the Prescribed List for use in accordance with local guidelines. In making this product available, it is hoped that patients requiring palliative care in the community will be able to access symptomatic treatment more quickly. |
1.8 | Tafluprost/timolol 15mcg/5mg eye drops per mL for the treatment of glaucoma The Committee supported the addition of this product to the Prescribed List to increase the range of options available for patients managed under the care of the specialist ophthalmologists. |
1.9 | Brinzolamide/brimonidine 10mcg/2mg per mL eye drops for glaucoma The Committee supported the addition of this product to the Prescribed List to increase the range of options available for patients managed under the care of the specialist ophthalmologists. |
1.10 | Brinzolamide/timolol 10mg/5mg per mL eye drops for glaucoma The Committee supported the addition of this product to the Prescribed List to increase the range of options available for patients managed under the care of the specialist ophthalmologists. |
1.11 | Dexamethasone/tobramycin 1mg/3mg per mL for post-surgical treatment of eye inflammation and infection The Committee supported the addition of this product to the Prescribed List to increase the range of options available for patients managed under the care of the specialist ophthalmologists. |
1.12 | Sacubitril with valsartan tablets 24/26mg, 49/51mg, 97/103mg for the treatment of chronic heart failure. In April 2016, NICE published their technology appraisal in support of sacubitril with valsartan for the treatment of chronic heart failure. Treatment with this new product can significantly improve outcomes for selected patients compared with standard therapy and the Committee unanimously supported its addition to the Prescribed List, in accordance with the NICE guidance and subject to initial assessment and prescribing by the hospital specialist. Anticipated uptake is 23 patients in the first year rising to 117 by 2020/21 with potential cost impact of £23,000 pa rising to £125,000 pa. |
1.13 | Azelaic acid cream 20% (Skinoren) for acne The Committee heard that azelaic acid is included in national guidelines for the treatment of acne, as a 2nd/3rd line option for people who find that other topical treatments are too irritant. Azelaic acid cream is a similar cost to other options so is not expected to have a financial impact. The Committee recommended the addition of azelaic acid to the Prescribed List. |
1.14 | Bimatoprost preservative free eye drops 300mcg/mL The Committee supported a recommendation to add this product to the Prescribed List. A preservative-containing product that contains bimatoprost is already included in the List. This product provides an alternative for those who cannot tolerate the preservative. The preservative free product is slightly more expensive but, as use is likely to be low, the overall cost impact is expected to be minimal. |
1.15 | Timolol (Tiopex) 1mg/g eye gel 0.4g unit dose The Committee supported a recommendation to add this product to the Prescribed List as a lower cost alternative to the preservative free timolol preparations that are already included but currently in short supply. The overall cost impact is expected to be minimal due to low use. |
2 Items not recommended for addition to the Prescribed List
2.1 | Vitamin B12 tablets 50mcg for vitamin deficiency The Committee did not support an application for this product. Vitamin B12 is typically given by injection and a suitable product is already included in the Prescribed List. The tablet formulation was not believed to be as effective and is more expensive than the injection. |
2.2 | Apraclonidine eye drops 0.5% (multi-dose), 1% (unit-dose) for glaucoma The Committee did not support an application for this product from the hospital specialist in ophthalmology. Apraclonidine is recommended for only short-term use so would not be suitable for prescribing in primary care. |
Appendix 1: Estimated financial impact of applications
| | Estimated cost impact |
1.1 | A range of emollient products for the treatment of skin conditions as follows: Aveeno cream, Aveeno bath additive Cetraban cream Epaderm cream Emollin aerosol White soft paraffin | None anticipated | |
1.2 | Isoniazid tablets 100mg for the treatment of tuberculosis (NB a request to add this product was withdrawn at the meeting on 20 September 2016 | Application withdrawn | |
1.3 | Clobazam tablets 10mg for epilepsy | £1,500 pa increase | |
1.4 | Measles, Mumps and Rubella (MMR) vaccine for ‘catch up’ vaccination in primary care | <£500 pa increase | |
1.5 | Testosterone gel 50mg/5g sachet for hormone replacement | | |
1.6 | Coal tar solution 5% for psoriasis and atopic eczema | <£1,000 pa increase | |
1.7 | Levetiracetam injection 500mg/5mL for symptom control in palliative care | £5,000 pa increase | |
1.8 | Tafluprost/timolol 15mcg/5mg eye drops per mL for the treatment of glaucoma | None anticipated | |
1.9 | Brinzolamide/brimonidine 10mcg/2mg per mL eye drops for glaucoma | None anticipated | |
1.10 | Brinzolamide/timolol 10mg/5mg per mL eye drops for glaucoma | None anticipated | |
1.11 | Dexamethasone/tobramycin 1mg/3mg per mL for post-surgical treatment of eye inflammation and infection | None anticipated | |
1.12 | Sacubitril with valsartan tablets 24/26mg, 49/51mg, 97/103mg for the treatment of chronic heart failure. | £23,000 pa increase in the first year, rising to £125,000 by 2020/21 | |
1.13 | Azelaic acid cream 20% (Skinoren) for acne | £0 | |
1.14 | Bimatoprost preservative free eye drops 300mcg/mL | Increase in expenditure of < £500 pa | |
1.15 | Timolol (Tiopex) 1mg/g eye gel 0.4g unit dose | Reduction in total expenditure of <£500 pa | |
2.1 | Removal of treatments for tuberculosis | £2,000 pa saving | |
2.2 | Removal of omega-3 ethyl acid esters | £45,000 pa saving | |