Lincolnshire Prescribing and Clinical Effectiveness Forum (PACEF) was founded in 2007. It is the current strategic advisory network to NHS Lincolnshire Integrated Care Board (ICB). PACEF has the responsibility for ensuring the cost-effective use of medicines and other healthcare interventions and their functional integration into healthcare delivery across Lincolnshire.
Representation on the group is comprised of leading professionals from NHS Lincolnshire Integrated Care Board, primary care, the local acute trust United Lincolnshire Hospitals NHS Trust, Lincolnshire Partnership NHS Trust, Lincolnshire Community Health Services NHS Trust, Lincolnshire LMC and Community Pharmacy Lincolnshire.
PLEASE NOTE: The publication of PACEF bulletins is currently suspended. We will provide a brief update of formulary decisions and updates following PACEF meetings in the LICB Medicines Optimisation Newsletter and also listed below.
Please allow time for the Lincolnshire Joint Formulary to be updated.
PACEF and Formulary Meeting Updates
PACEF September 2024
Stiripentol - PACEF approved the change of formulary classification to Amber 2, restricting it’s use for the treatment of epilepsy, within its licensed indication, only at the request of an epilepsy specialist from a tertiary centre. In these circumstances Stiripentol is approved for ongoing prescribing in primary care, following approval of a named patient requests. Stiripentol remains as RED/RED for all other uses.
Phytomenadione (unlicensed) – PACEF approved this due to the shortage of Menadiol tablets, which may necessitate the use of unlicensed Phytomenadione. This has been added onto the formulary as a second-line treatment option and will state unlicensed on the formulary too.
Tadalafil (Daily dose) – Following the change in NHSE advice PACEF has approved tadalafil once daily, 5mg and 2.5mg, as a treatment option for those where use of a daily dose is considered clinically appropriate. 2.5mg strength are significantly more expensive than the 5mg strengths and should only be used when 5mg dose is not suitable. Cialis brand should not be used as significantly more expensive than the generic equivalent. Tadalafil remains as second line treatment for erectile dysfunction after sildenafil for patients that meet the SLS criteria.
Formulary meeting August 2024
- Doxazocin is more cost effective to prescribe 2 x 4mg tablets rather than 1 x 8mg tablet. This reflects what is issued at ULHT.
- Removal of Eloquis brand from Apixaban formulary entry as no longer the most cost-effective brand. Removal of Xarelto brand from Rivaroxaban as no longer the most cost-effective brand. Formulary section clarifies to ensure clarity over full course supply issued on discharge from ULHT.
- Nitrofurantoin 50mg/5ml discontinued. 25mg/5ml remains available.
PACEF Bulletins
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| PACE Bulletin Vol 13 No 12 Nov19 | |
DescriptionDrug Summary Assessment. Toujeo DoubleStar® pen approved as AMBER 2; prescribe by brand name only to avoid confusion. Sorprobec® inhaler approved for inclusion on the formulary as first line for “beclomethasone only” MDI, with a GREEN status. Kelhale® inhaler approved for inclusion on the formulary as first line for beclomethasone dipropionate (extrafine aerosol) MDI, for adults only (individuals 18 years and over), with a GREEN status. Updates. Antimicrobial guidelines. Pain Management Guidance & Quick Reference Guide. |
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| PACE Bulletin Vol 13 No 9 Sep19 | |
DescriptionDrug AssessmentSummary. Semglee® (insulin glargine biosimilar) approved as GREEN. Glycopyrronium bromide 200mcg/ml oral solution Colonis brand not approved for use, classed as RED/RED (non-formulary). Hydventia® tablets (hydrocortisone) classed as RED/RED (non-formulary) Testavan® (testoterone 20mg/g transdermal gel) approved as AMBER 2. Optive Fusion® eye drops approved as GREEN restricted for use when a combination of sodium hyaluronate 0.1%, carboxymethylcellulose 0.5% is required. Menthoderm Cream® approved as GREEN - replaces Dermacool on the formulary. Betesil® medicated plasters approved as GREEN replaces Fludroxycortide tape on the formulary. Paliperidone M/R tablets formulary classification changed from RED/RED to AMBER 2. DEKAs® (multivitamin) approved as AMBER 2. Paravit CF® capsules and liquid (multivitamin) approved as AMBER 2. Nadolol tablet approved as AMBER 2. Alkindi® (Hydrocortisone granules) approved as AMBER 2. Updates. Antimicrobial guidelines. Quick reference guide inhalers for COPD. |
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| PACE Bulletin Vol 13 No 7 Jul19 Lidocaine Plasters | |
DescriptionPrescribing Advice for Lidocaine Plasters - NHS England Recommendations. |
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| PACE Bulletin Vol 13 No 6 Jul19 | |
DescriptionDrug Assessment Summary. Gabapentin 6% gel – unlicensed product approved as RED. Invicorp® (Solution for injection Aviptadil 25micrograms / Phentolamine 2mg approved as AMBER 2. Ciprofloxacin 2mg/ml ear drops approved as GREEN, Updates: Clozapine – classed as RED on formulary. LPFT updated advice ensure use documented on primary care record. MHRA Drug Safety Update: GLP-1 receptor agonists- reports of diabetic ketoacidosis when concomitant insulin rapidly reduced or discontinued. |
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| PACE Bulletin Vol 13 No 5 Jun19 COPD | |
DescriptionPrescribing Advice for COPD - changes to guidance, initial management and managing stable COPD patients. |
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| PACE Bulletin Vol 13 No 4 May19 | |
DescriptionDrug Assessment Summary: Marol & Zytram – sustained release tramadol tablets approved as GREEN for use within primary care. Semaglutide (Ozempic ®) once weekly GLP-1 approved as GREEN. Ertugliflozin (Steglatro®) new SGLT- 2 inhibitor approved as GREEN. Fusacomb® Easyhaler® (salmeterol/fluticasone) approved as GREEN. Stalpex® (salmeterol/fluticasone) approved as GREEN. Haloperidol 200 microgram/ml sugar-free oral solution - Halkid® not approved for routine use classed as RED/RED. Naloxegol (Moventig) changed from RED to AMBER 2. Updates: Otovent – Removed from Drug Tariff, re-classed as RED/RED. Review of venlafaxine MR capsules. Vensir XL approved for first-line use. Venlablue XL retained as second line option. NICE/PHE Summary of antimicrobial prescribing guidance now on PACEF website. MHRA Drug Safety Updates: Fluoroquinolone antibiotics – new restrictions due to reports disabling and potentially long lasting and irreversible side effects. Yellow fever vaccines and fatal adverse reactions. Valproate medicines and serious harm in pregnancy. |
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| PACE Bulletin Vol 13 No 3 Mar19 | |
DescriptionDrug Assessment Summary: Rivaroxaban 2.5mg tablets (Xarelto ®) approved as AMBER 2. Hydrocortisone 0.335% Single use eye drops () approved as AMBER 2. Insulin Lispro Sanofi approved as GREEN. Mexiletine (Namuscula®) 167mg capsules approved as AMBER 2 for unlicensed use for treatment of life threatening arrhythmias. Akizza brand of combined pill (Ethinylestradiol/gestodene) not approved for formulary classed as RED/RED. Sodium Valproate sustained release – Epival CR® tablets not approved for use classed as RED/RED. Solifenacin oral suspension 1mg/ml (Vesicare®) approved as GREEN. Updates: Enoxaparin (Inhixa) pre-filled syringes - deployment of the needle guard, difference to that of clexane brand. MHRA Drug Safety Update: Tapentadol - risk of seizures and reports of serotonin syndrome Ipilimumab – reports of cytomegalovirus (CMV). Carbimazole – increased risk of congenital malformations. Carbimazole - risk of acute pancreatitis. SGLT2 inhibitors – reports of Fournier’s gangrene. |
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| PACE Bulletin Vol 13 No 1 Jan19 | |
DescriptionDrug Assessment Summary: Licensed Pentosan capsules (Elmiron) approved as AMBER 2. Unlicensed pentosan capsules removed from formulary, classed as RED/RED. Oxypro® prolonged release oxycodone approved as GREEN. Updates: Discontinuation of Zovirax® Eye ointment. MHRA Drug Safety Updates: Hydrochlothiazide, risk of non- melanoma skin cancer. Fluroquinolones - small increased risk of aortic aneurysm. MHRA reminder of Valproate Pregnancy Prevention Programme and required actions. Emollients new information increased risk of severe and fatal burns. Hydrocortisone buccal tablets should not be used for adrenal insufficiency in children. |
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The current form to request a non-formulary medicine can be viewed here:
Are you a member of our PACEF committee?
If so, please see the forthcoming dates for 2025:
2025 Meeting Dates
Wednesday 22nd January 2025 - 1.15pm start
Wednesday 19th March 2025 - 1.15pm start
Wednesday 21st May 2025 - 1.15pm start
Wednesday 16th July 2025 - 1.15pm start
Wednesday 17th September 2025 - 1.15pm start
Wednesday 19th November 2025 - 1.15pm start
