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.



The current form to request a non-formulary medicine can be viewed here:

PACEF Bulletins

PACE Bulletin Vol 12 No 10 Nov18


Drug Assessment Summary:

Fenofibrate tablets and capsules approved as GREEN.

Bezafibrate tablets approved as GREEN.

Gemfibrozil removed from the formulary and classed as RED/RED.

Gycopyrronium 320mcg/ml oral solution (Sialanar) approved as AMBER 2.

Oxeltra prolonged release oxycodone approved as GREEN.

Yaltormin sustained release metformin approved as GREEN.


Sodium chloride 5% preservative free eye drops prescribing guide.

MHRA Drug Safety Updates:

Valproate Pregnancy Prevention Programme and required actions.

Rivaroxaban should not be used in patients who undergo transcatheter aortic valve replacement (TAVR).

Ritonavir containing products interactions with levothyroxine.

Transdermal fentanyl patches reports of life threatening and fatal opioid toxicity from accidental exposure.

PACE Bulletin Vol 12 No 9 Sep18


Drug Assessment Summary:

Ikervis 1% eye drops reclassified as AMBER 2.

Thealoz Duo Eye Drops status set as RED-RED.

Nebido approved as AMBER 2.

Midotense approved as RED-RED.

Combisal approved as GREEN.

Soltel approved as GREEN.

Vertine approved as GREEN.

Cost comparison NACSYS and carbocisteine.

PACE Bulletin Vol 12 No 8 Aug18


Prescribing Advice for Over The Counter (OTC) Medicines

Summary of NHS England Guidance - conditions for which OTC items should not routinely be prescribed.

PACE Bulletin Vol 12 No 7 Aug18


Rapid Drug Assessment:

Trelegy Ellipta approved as GREEN.

Anoro Ellipta formulary status changed from RED/RED to GREEN.

Incruse Ellipta formulary status changed from RED/RED to GREEN.

Relvar Ellipta formulary status changed from RED/RED to GREEN.

Ferric Maltol 30mg capsules Feraccru approved as GREEN.

Pentoxifylline approved as AMBER 2 for unlicensed use in treatment of Behcet’s disease.

Levosert 20mcg/24 hours IDS formulary status changed from RED/RED to GREEN.

Safinamide Tablets (Xadago®) approved as AMBER 2.

Benzbromarone tablets approved as RED.

Pipexus ( sustained release pramipexole) approved as AMBER 2.

Brancico XL® modified release quetiapine approved as GREEN.

MHRA Drug Safety Updates:

Braltus (tiotropium) (GREEN) risk of inhalation of capsule if placed in mouthpiece of inhaler.

Pressurised metered dose inhalers (pMDI): risk of airway obstruction from aspiration of loose objects.

PACE Bulletin Vol 12 No 6 May18


Rapid Drug Assessment:

Brivaracetram formulary status changed from RED/RED to AMBER 2.

Easyhaler Budesonide approved as GREEN.

Desmopressin Noqdirna approved as GREEN.

Levomepromazine formulary status changed to AMBER 2.

Vitamin K injection formulary status changed to GREEN.

Tadalafil 10mg & 20mg generic tablets formulary status changed to GREEN.

Avanafil tablets 50mg,100mg &200mg formulary status changed to RED/RED for new patients.


Zarfirlukast (Accolate) discontinued.

MHRA Drug Safety Updates:

Mycophenolate mofetil, mycophenolic acid: updated contraception advice for male patients. (AMBER 2) updated contraceptive advice for male patients.

Daclizumab (Zinbryta) suspension of marketing authorisation and recall for safety reasons.

Ulipristal acetate - Esyma: used for the treatment of uterine fibroids – do not use initiate or restart treatment, monitor liver function in current and recent users.

Valproate medicines contraindicated in women and girls of childbearing potential unless conditions of Pregnancy Prevention Programme are met.

PACE Bulletin Vol 12 No 4 Apr18


Rapid Drug Assessment:

Trimbow inhaler approved as GREEN.

Salofalk Granules approved as AMBER 2.

Pico wound care system approved as AMBER 2.

Alfentanil injection formulary status changed to AMBER 2.


Folic acid supplementation in pregnant obese women.

MHRA Drug Safety Updates:

Qunine : reminder of dose dpendent QT prolonging effects :updated medicine interactions (GREEN for nocturnal leg cramps – RED all other indications.

Oral tacrolimus products ( AMBER 1) Prescribe by brand name to avoid risk of toxicity or draft rejection.

Eluxadoline (Truberzi) risk of pancreatitis do not use in patients who have undergone cholecystectomy or those with biliary disorders (AMBER 2).

Colour change for insulin injection Fiasp (AMBER 2).

PACE Bulletin Vol 12 No 2 Jan18


Rapid Drug Assessment:

Dymista nasal spray approved as AMBER 2

Lecicarbon A suppositories approved as AMBER 2.

Epistatus 10mg in 1ml oromucosal solution – Midazolam as maleate. Licensed as a 10mg/ml 1ml oral syringe licensed only for use in children and adolescents aged 10 to less than 18 years of age. Approved as AMBER 2

Salofalk brand of mesalazine foam enema. Approved for inclusion on Joint formulary Salofalk brand of mesalazine foam enema as a replacement, classing it as AMBER 2.


Roflumilast (Daxas) 500mcg tablets. NICE TA 461 recommended use of Roflumilast for the treatment of chronic obstructive pulmonary disease. Reviewed and re-designated as Amber 2

MHRA Drug Safety Updates:

Methylprednisolone injectable medicine containing lactose (Solu-Medrone 40mg): do not use in patients with cow’s milk allergy.

Gabapentin (Neurontin): risk of severe respiratory depression.

Isotretinoin (Roaccutane):rare reports of erectile dysfunction and decreased libio.

Clozapine: reminder of potentially fatal risk of intestinal obstruction, faecal impactation and paralytic ileus

TA 471 Eluxadoline for treating irritable bowel syndrome with diarrhoea. Designated as AMBER 2.

NICE TA 480 Tofacitinib for moderate to severe rheumatoid arthritis. Designated RED.

TA 483 Nivolumab for previously treated squamous non-small-cell lung cancer. Designated RED.

TA 484 Nivolumab for previously treated non-squamous non-small-cell lung cancer. Designated RED.

NICE TA 485 Sarilumab for moderate to severe rheumatoid arthritis. Designated RED.

TA 486 Aflibercept for treating choroidal neovascularisation. Aflibercept approved as a RED drug to be used in line with recommendations. NICE have stated that ranibizumab is also a treatment option for the same condition. NICE state that the least costly drug should be used taking into account administration costs, dose and cost of the drugs.


Are you a member of our PACEF committee?

If so, please see the forthcoming dates for 2024:

2024 Meeting Dates

Wednesday 17th January 2024 - 1.15pm start

Wednesday 20th March 2024 - 1.15pm start

Wednesday 15th May 2024 - 1.15pm start

Wednesday 17th July 2024 - 1.15pm start

Wednesday 18th September 2024 - 1.15pm start

Wednesday 20th November 2024 - 1.15pm start