Changes to prescribed list as of 1 January 2019

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A decision made on 13 December 2018:

Decision Reference: MD-S-2018-0072
Decision Summary Title :	DS_Changes to Prescribed List as of 1 Jan 2019		Date of Decision Summary:	12 December 2018
Decision Summary Author:	Prescribing Advisor		Decision Summary: Public or Exempt?	Public
Type of Report: Oral or Written?	Written		Person Giving Oral Report:	N/A
Written Report Title :	WR_Changes to Prescribed List as of 1 Jan 2019		Date of Written Report:	12 December 2018
Written Report Author:	Prescribing Advisor		Written Report : Public or Exempt?	Public
Subject: Changes to be made to the Prescribed List (Jersey) as of 1 January 2019
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 January 2019 as set out in the accompanying report.
Reason(s) for Decision: The Pharmaceutical Benefit Advisory Committee met on 6 September 2018 and has provided the Minister with recommendations and the accompanying written report regarding amendments to the Prescribed List. Items to be added to the Prescribed List Mesalazine 2g enema Sodium chloride 5% eye drops (non-preservative free) Quetiapine 300mg tablet Xailin Night lubricating eye ointment (contains White soft paraffin 57.3% w/w, White Mineral Oil 42.5% w/w and Lanolin Alcohols 0.2% w/w) Addition of items to ensure consistency with the Dental Practitioners’ Formulary of England and Wales Items to be listed as generic only Items detailed in the written report Other amendments to the Prescribed List Lidocaine topical to be amended to read Lidocaine cream 4% Additionally, instructions regarding instalment dispensing are amended, removing conflicting advice regarding prescriptions for benzodiazepines 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 is expected to be cost neutral.
Action required: Customer and Local Services 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):

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Changes to prescribed list as of 1 January 2019

RECOMMENDATIONS OF THE

PHARMACEUTICAL BENEFIT ADVISORY COMMITTEE

29 November 2018

Summary

The Pharmaceutical Benefit Advisory Committee (PBAC) met on 29 November 2018 to consider applications for changes to the Prescribed List.

The PBAC was unanimous in its recommendations for the following changes to the Prescribed List.

Items to be added to the Prescribed List

Mesalazine 2g enema

Sodium chloride 5% eye drops (non-preservative free)

Quetiapine 300mg tablet

Xailin Night lubricating eye ointment (contains White soft paraffin 57.3% w/w, White Mineral Oil 42.5% w/w and Lanolin Alcohols 0.2% w/w)

Addition of items to ensure consistency with the Dental Practitioners’ Formulary

Items to be listed as generic only

See Appendix 1

Other amendments to the Prescribed List

Lidocaine topical to be amended to read Lidocaine cream 4%

Financial impact

The overall financial impact of the above changes is estimated to be cost neutral.

Mrs Alison Creed

Chair, PBAC

3 December 2018

Recommendations

Items to be added to the Prescribed List

Mesalazine 2g enema

The Prescribed List already includes mesalazine rectal foam for the treatment of inflammatory bowel disease. However, a small number of patients find the enema formulation of the drug to be more effective. Both the rectal foam and enema have a similar treatment cost at recommended doses so the change is expected to be cost neutral.

Sodium chloride 5% eye drops (non-preservative free)

The Prescribed List already includes sodium chloride 5% preservative-free eye drops but this product has been unavailable to community pharmacies. Adding the non-preservative free eye drops will ensure continuity in supply for those patients who need sodium chloride 5% eye drops and who are not sensitive to preservatives. Both formulations of eye drops are similarly priced so this change is expected to be cost neutral.

Quetiapine 300mg tablet

All other strengths of quetiapine tablets are included in the Prescribed List so addition of the 300mg strength ensures that patients have access to the full range. This change is expected to be cost neutral.

Xailin Night lubricating eye ointment (contains White soft paraffin 57.3% w/w, White Mineral Oil 42.5% w/w and Lanolin Alcohols 0.2% w/w)

Xailin Night eye ointment is the nearest equivalent to Lacri-Lube eye ointment, which is already included in the Prescribed List but currently out of stock for all pharmacies. Inclusion of the lower cost Xailin Night eye ointment will ensure that patients can continue to access an equivalent, effective treatment. This change is expected to provide a small cost saving.

Products to be added to the List to ensure consistency with the Dental Practitioner’s Formulary

Following consultation with the Jersey Dental Association and dental practitioners in Jersey, PBAC recommends that the Jersey Dental List is replaced by the Dental Practitioner’s Formulary (DPF) with effect from 1 January 2019. This change will ensure that Jersey dental practitioners have access to the same range of medicines for their patients as in England and Wales. To facilitate this change, a small number of medicines will need to be added to the Prescribed List, as follows:

Product	Additional information
Artificial Saliva Gel, DPF	e.g. Biotene Oralbalance
Artificial Saliva Oral Spray, DPF	e.g. Xerotin
Artificial Saliva Pastilles, DPF	e.g. Salivix
Artificial Saliva Protective Spray, DPF	e.g. Aquoral
Artificial Saliva Substitutes as listed below:	to be prescribed ONLY for indications approved by ACBS (patients suffering from dry mouth as a result of having or, having undergone, radiotherapy or sicca syndrome
BioXtra® Gel Mouthspray
BioXtra® Moisturising Gel
Glandosane®
Saliveze®
Artificial Saliva Substitute Spray, DPF	e.g. AS Saliva Orthana Spray
Azithromycin Capsules, 250 mg, DPF
Cefalexin Tablets, BP
Cefradine Capsules, BP
Chlorhexidine Gluconate Gel, BP
Hydrogen Peroxide Mouthwash, BP, 6%
Lidocaine Spray 10%, DPF	e.g. Xylocaine Spray
Menthol and Eucalyptus Inhalation, BP 1980
Saliva Stimulating Tablets, DPF	e.g. SST brand
Sodium Chloride Mouthwash, Compound, BP
Temazepam Oral Solution, BP

2 Other changes to the Prescribed List

Lidocaine topical to be amended to read Lidocaine cream 4%

Items to be listed as ‘Generic Only’

Following a review of the Prescribed List, a number of medicines are recommended for listing as ‘Generic Only’ medicines that should only be prescribed by generic name and reimbursed in accordance with Part VIII of the Drug Tariff. This change to the medicines listed in Appendix 1 will ensure that Jersey continues to reimburse for them at the lowest price.

Reimbursement for instalment dispensing – proposed amendment to text in the Prescribed List

The preface to the Prescribed List includes the following paragraph with relation to prescribing in instalments: “When a doctor has requested dispensing at stipulated intervals, instalment-dispensing fees may be claimed if the medicine is listed in Part I, II or III of the second schedule to the Misuse of Drugs (Jersey) Law 1978. NB Benzodiazepines are not a notifiable product under the Misuse of Drugs Law. Therefore, no instalment dispensing fees can be paid for someone addicted only to benzodiazepines.”

Since Part III of the second schedule contains benzodiazepines, the second sentence in this paragraph appears to contradict the first. In addition, it is clinically appropriate for clinicians to choose to prescribe benzodiazepines for dispensing in instalments for selected patients.

PBAC, therefore, recommends amendment of the above paragraph, to remove the second sentence. The paragraph should now read “When a doctor has requested dispensing at stipulated intervals, instalment-dispensing fees may be claimed if the medicine is listed in Part I, II or III of the second schedule to the Misuse of Drugs (Jersey) Law 1978.”

Applications not supported by PBAC

Ciclesonide 80mcg, 160mcg pressurised inhaler

The Committee considered an application for ciclesonide, an inhaled corticosteroid, to be added to the Prescribed List but did not support its recommendation for the following reasons:

There are three other inhaled corticosteroids included in the List, some of which are much less expensive that ciclesonide.
There is no evidence of a significant clinical advantage of ciclesonide over other available inhaled corticosteroids
Unlike the other inhaled corticosteroids, ciclesonide is not available as a combination product.

Liquid paraffin 500mg per gram/white soft paraffin 500mg per gram ointment

The Committee considered an application for 50/50 liquid paraffin/WSP, an emollient, to be added to the Prescribed List but did not support its recommendation for the following reasons:

Other paraffin-based emollients are already available and there is no clinical evidence to support the preferential use of any one.
Paraffin-based products present a fire-hazard and this product has a higher proportion of paraffin than other products on the List

Appendix 1: Medicines to be prescribed only by generic name and reimbursed in accordance with Part VIII of the Drug Tariff (category M)

This list is based on the current list of Category M medicines included in the Drug Tariff. Most are already extensively prescribed by generic name but the proposed changes will ensure consistent reimbursement at the lowest price.

Drug Name	Pack size
Acetazolamide 250mg tablets	112	tablet
Alfuzosin 2.5mg tablets	60	tablet
Alverine 60mg capsules	100	capsule
Amisulpride 100mg tablets	60	tablet
Amisulpride 200mg tablets	60	tablet
Amisulpride 50mg tablets	60	tablet
Amoxicillin 125mg/5ml oral suspension	100	ml
Amoxicillin 125mg/5ml oral suspension sugar free	100	ml
Amoxicillin 250mg/5ml oral suspension	100	ml
Amoxicillin 250mg/5ml oral suspension sugar free	100	ml
Aqueous cream	500	gram
Aqueous cream	100	gram
Aspirin 300mg dispersible tablets	100	tablet
Aspirin 300mg dispersible tablets	32	tablet
Aspirin 75mg dispersible tablets	28	tablet
Aspirin 75mg dispersible tablets	100	tablet
Azithromycin 250mg capsules	6	capsule
Baclofen 5mg/5ml oral solution sugar free	300	ml
Beclometasone 50micrograms/dose nasal spray	200	dose
Benzydamine 0.15% mouthwash sugar free	300	ml
Benzydamine 0.15% oromucosal spray sugar free	30	ml
Betamethasone valerate 0.1% cream	100	gram
Betamethasone valerate 0.1% cream	30	gram
Betamethasone valerate 0.1% ointment	30	gram
Betamethasone valerate 0.1% ointment	100	gram
Bezafibrate 200mg tablets	100	tablet
Bisoprolol 1.25mg tablets	28	tablet
Bisoprolol 10mg tablets	28	tablet
Bisoprolol 2.5mg tablets	28	tablet
Bisoprolol 3.75mg tablets	28	tablet
Bisoprolol 5mg tablets	28	tablet
Bisoprolol 7.5mg tablets	28	tablet
Brimonidine 0.2% eye drops	5	ml
Brinzolamide 10mg/ml eye drops	5	ml
Buspirone 10mg tablets	30	tablet
Buspirone 5mg tablets	30	tablet
Carbimazole 20mg tablets	100	tablet
Carbimazole 5mg tablets	100	tablet
Carbocisteine 375mg capsules	120	capsule
Cefalexin 250mg tablets	28	tablet
Cefalexin 250mg/5ml oral suspension	100	ml
Cefalexin 500mg tablets	21	tablet
Cefradine 250mg capsules	20	capsule
Cefradine 500mg capsules	20	capsule
Celecoxib 100mg capsules	60	capsule
Celecoxib 200mg capsules	30	capsule
Chlorpromazine 100mg tablets	28	tablet
Chlorpromazine 25mg tablets	28	tablet
Chlorpromazine 50mg tablets	28	tablet
Cinnarizine 15mg tablets	84	tablet
Citalopram 40mg/ml oral drops sugar free	15	ml
Clarithromycin 125mg/5ml oral suspension	70	ml
Clarithromycin 250mg/5ml oral suspension	70	ml
Clindamycin 150mg capsules	24	capsule
Clotrimazole 1% cream	20	gram
Clotrimazole 1% cream	50	gram
Clotrimazole 500mg pessaries	1	pessary
Co-amoxiclav 125mg/31mg/5ml oral suspension sugar free	100	ml
Co-amoxiclav 250mg/62mg/5ml oral suspension sugar free	100	ml
Co-codamol 30mg/500mg effervescent tablets	100	tablet
Co-codamol 30mg/500mg effervescent tablets	32	tablet
Co-codamol 30mg/500mg tablets	30	tablet
Co-codamol 30mg/500mg tablets	100	tablet
Co-codamol 8mg/500mg effervescent tablets	100	tablet
Co-codamol 8mg/500mg effervescent tablets	32	tablet
Cyclizine 50mg tablets	100	tablet
Dapsone 50mg tablets	28	tablet
Desmopressin 10micrograms/dose nasal spray	60	dose
Desmopressin 200microgram tablets	30	tablet
Dexamethasone 2mg tablets	50	tablet
Dexamethasone 500microgram tablets	28	tablet
Diamorphine 10mg powder for solution for injection ampoules	5	ampoule
Diamorphine 30mg powder for solution for injection ampoules	5	ampoule
Duloxetine 30mg gastro-resistant capsules	28	capsule
Duloxetine 60mg gastro-resistant capsules	28	capsule
Eplerenone 25mg tablets	28	tablet
Eplerenone 50mg tablets	28	tablet
Erythromycin ethyl succinate 125mg/5ml oral suspension sugar free	100	ml
Erythromycin ethyl succinate 250mg/5ml oral suspension sugar free	100	ml
Exemestane 25mg tablets	30	tablet
Fenofibrate micronised 160mg tablets	28	tablet
Fenofibrate micronised 200mg capsules	28	capsule
Fenofibrate micronised 267mg capsules	28	capsule
Ferrous gluconate 300mg tablets	28	tablet
Ferrous sulfate 200mg tablets	28	tablet
Flucloxacillin 125mg/5ml oral solution	100	ml
Flucloxacillin 125mg/5ml oral solution sugar free	100	ml
Flucloxacillin 250mg/5ml oral solution sugar free	100	ml
Fluoxetine 20mg/5ml oral solution	70	ml
Fluvastatin 20mg capsules	28	capsule
Fluvastatin 40mg capsules	28	capsule
Frovatriptan 2.5mg tablets	6	tablet
Glyceryl trinitrate 400micrograms/dose pump sublingual spray	180	dose
Glyceryl trinitrate 400micrograms/dose pump sublingual spray	200	dose
Glyceryl trinitrate 500microgram sublingual tablets	100	tablet
Hydrocortisone 10mg tablets	30	tablet
Hydroxocobalamin 1mg/1ml solution for injection ampoules	5	ampoule
Hydroxychloroquine 200mg tablets	60	tablet
Hypromellose 0.3% eye drops	10	ml
Ibuprofen 100mg/5ml oral suspension sugar free	100	ml
Ibuprofen 5% gel	100	gram
Ibuprofen 5% gel	50	gram
Ipratropium bromide 500micrograms/2ml nebuliser liquid unit dose vials	20	unit dose
Ivabradine 5mg tablets	56	tablet
Ivabradine 7.5mg tablets	56	tablet
Ketoprofen 2.5% gel	50	gram
Ketoprofen 2.5% gel	100	gram
Labetalol 100mg tablets	56	tablet
Labetalol 200mg tablets	56	tablet
Lactulose 3.1-3.7g/5ml oral solution	500	ml
Lercanidipine 10mg tablets	28	tablet
Lercanidipine 20mg tablets	28	tablet
Losartan 100mg tablets	28	tablet
Losartan 12.5mg tablets	28	tablet
Losartan 25mg tablets	28	tablet
Losartan 50mg tablets	28	tablet
Lymecycline 408mg capsules	28	capsule
Memantine 10mg tablets	28	tablet
Memantine 20mg tablets	28	tablet
Metoprolol 100mg tablets	28	tablet
Morphine sulfate 10mg/5ml oral solution	300	ml
Naftidrofuryl 100mg capsules	84	capsule
Nefopam 30mg tablets	90	tablet
Nicorandil 10mg tablets	60	tablet
Nicorandil 20mg tablets	60	tablet
Nitrofurantoin 100mg tablets	28	tablet
Nitrofurantoin 50mg tablets	28	tablet
Norethisterone 5mg tablets	30	tablet
Nortriptyline 10mg tablets	100	tablet
Nortriptyline 25mg tablets	100	tablet
Nystatin 100,000units/ml oral suspension	30	ml
Paracetamol 250mg/5ml oral suspension	100	ml
Phenoxymethylpenicillin 125mg/5ml oral solution	100	ml
Phenoxymethylpenicillin 125mg/5ml oral solution sugar free	100	ml
Phenoxymethylpenicillin 250mg/5ml oral solution	100	ml
Phenoxymethylpenicillin 250mg/5ml oral solution sugar free	100	ml
Prednisolone 5mg soluble tablets	30	tablet
Pregabalin 100mg capsules	84	capsule
Pregabalin 150mg capsules	56	capsule
Pregabalin 200mg capsules	84	capsule
Pregabalin 225mg capsules	56	capsule
Pregabalin 25mg capsules	56	capsule
Pregabalin 300mg capsules	56	capsule
Pregabalin 50mg capsules	84	capsule
Pregabalin 75mg capsules	56	capsule
Propylthiouracil 50mg tablets	56	tablet
Quetiapine 100mg tablets	60	tablet
Quetiapine 150mg tablets	60	tablet
Quetiapine 200mg tablets	60	tablet
Quetiapine 25mg tablets	60	tablet
Quetiapine 300mg tablets	60	tablet
Raloxifene 60mg tablets	28	tablet
Ranitidine 75mg/5ml oral solution sugar free	300	ml
Rasagiline 1mg tablets	28	tablet
Rosuvastatin 10mg tablets	28	tablet
Rosuvastatin 20mg tablets	28	tablet
Rosuvastatin 40mg tablets	28	tablet
Rosuvastatin 5mg tablets	28	tablet
Senna 7.5mg tablets	60	tablet
Sotalol 80mg tablets	28	tablet
Sulfasalazine 500mg tablets	112	tablet
Tadalafil 10mg tablets	4	tablet
Tadalafil 20mg tablets	4	tablet
Tadalafil 5mg tablets	28	tablet
Telmisartan 20mg tablets	28	tablet
Telmisartan 40mg tablets	28	tablet
Telmisartan 80mg tablets	28	tablet
Temazepam 10mg tablets	28	tablet
Temazepam 20mg tablets	28	tablet
Thiamine 100mg tablets	100	tablet
Thiamine 50mg tablets	100	tablet
Timolol 0.25% eye drops	5	ml
Timolol 0.5% eye drops	5	ml
Tolterodine 1mg tablets	56	tablet
Tolterodine 2mg tablets	56	tablet
Tranexamic acid 500mg tablets	60	tablet
Trazodone 50mg/5ml oral solution sugar free	120	ml
Ursodeoxycholic acid 250mg capsules	60	capsule
Valaciclovir 500mg tablets	10	tablet
Vitamin B compound strong tablets	28	tablet
Warfarin 1mg tablets	28	tablet
Warfarin 3mg tablets	28	tablet
Warfarin 500microgram tablets	28	tablet
Warfarin 5mg tablets	28	tablet