Prescribed List: Changes from 1 December 2013

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A decision made on 29 November 2013:

Decision Reference: MD-S-2013-0120
Decision Summary Title :	Prescribed List 1 December 2013		Date of Decision Summary:	28 November 2013
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 at 1 December 2013		Date of Written Report:	28 November 2013
Written Report Author:	Policy Principal		Written Report : Public or Exempt?	Public
Subject: Changes to be made to the Prescribed List (Jersey) as at 1 December 2013
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 Minster decided to make amendments to the Prescribed List with effect from 1 December 2013 as set out in the accompanying report.
Reason(s) for Decision: The Pharmaceutical Benefit Advisory Committee met on 8th October 2013 and has provided the Minister with recommendations in respect of amendments to the Prescribed List. The changes 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 at a proportionate cost to the Fund.
Resource Implications: The overall impact of the changes represents an anticipated cost to the Fund of around £46,000 per annum.
Action required: Policy Principal 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 December 2013

Changes to be made to the Prescribed List as of 1 December 2013

Date: 28th November 2013

Author: Policy Principal

The Pharmaceutical Benefit Advisory Committee (PBAC) met on 8 October 2013 to consider applications for changes to the Prescribed List. In line with PBAC recommendations it was agreed the following are to be added to the prescribed list

Nalmefene tablets 18mg for the reduction of alcohol consumption in patients with alcohol dependence.

An application for nalmefene was submitted by the Alcohol and Drugs Service. This is a new medicine that works in a different way to those medicines currently available for GPs to prescribe for their patients with alcohol dependency. Nalmefene is taken ‘ad hoc’ to allow with problem drinking to reduce their alcohol consumption. As such, it addresses the problem faced by many patients presenting in primary care who need support to manage their drinking but who are not yet in need of detoxification.

Nalmefene needs to be used in conjunction with psychosocial support, which will be provided by the Alcohol and Drugs Service. Patients will only be able to receive nalmefene if their GP prescription has been stamped by the Alcohol and Drug Service to indicate ongoing support. This is already established practice for other medicines on the Prescribed List that are used for alcohol dependency. With role out of the island strategy for alcohol dependence, such support will eventually be provided by practice-based staff.

Nalmefene has recently been supported by the NHS in Scotland. There is no NICE appraisal yet published for this intervention.

Estimated cost impact of nalmefene is based on an assumption that only around 20% of eligible patients (around 50 patients) will be able to be managed within current capacity of the Alcohol and Drug Service. This capacity is expected to increase in the coming years and the Committee agreed that an audit of the use of nalmefene was appropriate.

Prucalopride tablets 1mg, 2mg for the treatment of serious constipation in women that has not responded to optimal use of other laxatives. The Committee noted that this treatment has an unusual licensed indication, which restricts its use to women, but that this reflects the clinical trials undertaken with the medicine. The Committee also noted that these trials were conducted several years ago before the routine use of some of the newer laxatives. However, restricted use in the hospital has resulted in prucalopride being the only effective option for a small number of women, demonstrating a limited role. Since the treatment of constipation is a long-term issue, the ongoing treatment of these patients should be within primary care following specialist assessment and initiation. Prucalopride is much more expensive than other laxatives but its cost should be considered against the use of other, more invasive interventions that would otherwise have to be used in the patient group.

On balance, the Committee recommended the addition of prucalopride to the Prescribed List for prescribing by GPs only following initiation by a hospital specialist. It should only be used in women with chronic, severe constipation despite maximal use of at least two other laxatives. Two new formulations of medicines currently included in the Prescribed List will also be added recommended

Following PBAC recommendations, two new formulations will be added to the prescribed list.

Methotrexate pre-filled injection (all strengths brand Metoject) for the treatment of rheumatoid arthritis following initiation by a consultant rheumatologist

Methotrexate tablets are currently available for GP prescribing. The injectable form has a small but defined role in patients with conditions, such as rheumatoid arthritis, who cannot tolerate oral methotrexate or, more commonly, who have not adequately responded to oral methotrexate. Use in such patients results in a greater proportion of the active drug getting in to the patient’s system and having an effect. Methotrexate injection is currently available only through the hospital specialists but is used for the long-term treatment of a number of inflammatory conditions.

Latanoprost (Monopost) single use eye drops 50mcg/mL for the treatment of glaucoma

Latanoprost is one of a group of drugs called prostaglandin analogues that are used for the treatment of glaucoma. This product is presented for single dose use and is around half the price of the alternative, tafluprost that is currently included in the Prescribed List. The Committee recommended the addition of latanoprost (Monopost brand) to the Prescribed List and the switching of patients from tafluprost, which could eventually be considered for removal from the List.

One product, ketoconazole, will be removed from the List following a national safety alert.

The overall impact of the changes listed above represents an anticipated cost to the Fund of around £46,000 per annum.

The Minister acknowledged, but did not accept, a recommendation to bring further items on to the Prescribed List.