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

Title
PACE Bulletin Vol 11 No 15 Nov17

Description

Rapid Drug Assessment: Fiasp Insulin Aspart Designated AMBER 2.

Invita D3 soft capsules Designated GREEN.

Stexerol-D3 Designated GREEN.

Acetylcysteine 600mg effervescent tablet (NACSYS) Designated AMBER 2.

Update: Discontinuation of Bovine insulin.

MHRA Drug Safety Updates: Miconazole (Daktarin): over the counter gel contraindicated in patients taking warfarin.

MHRA Drug Safety Updates: Review of cardiovascular adverse reactions associated with loperamide.

NICE TA472 Obinutuzumab with bendamustine for treating follicular lymphoma refractory to rituximab. Designated RED.

NICE TA473 Cetuximab for treating recurrent or metastatic squamous cell cancer of the head and neck. Designated RED.

NICE TA474 Sorafenib for treating advanced hepatocellular carcinoma Designated RED.

NICE TA475 Dimethyl fumarate for treating moderate to severe plaque psoriasis. Designated RED.

NICE TA476 Paclitaxel as albumin-bound nanoparticles with gemcitabine for untreated metastatic pancreatic cancer. Designated RED.

NICE TA478 Brentuximab vedotin for treating relapsed or refractory systemic anaplastic large cell lymphoma. Designated RED.

NICE TA479 Reslizumab for treating severe eosinophilic asthma. Designated RED.
PACE Bulletin Vol 11 No 13 Oct17

Description

Drug Assessment Summary: Accrete D3 one a day Chewable Tablets. Designated GREEN.

Gaviscon Advance. Designated GREEN Green as a second line drug, after Peptac restricted for use in patients with laryngeal reflux and those not responding to treatment with Peptac.

Reviewing use of Asacol switching to Octasa.

MHRA Drug Safety Updates: Ibrutinib – The MHRA have received reports of ventricular tachyarrhythmia, risk of hepatitis reactivation and opportunistic infections, associated with its use.

MHRA Drug Safety Updates: Corticosteroids rare risk of central serous chorioretinopathy with local as well as systemic administration.

MHRA Drug Safety Updates: Adrenaline auto-injectors: updated advice after European review.

NICE TA455 Adalimumab, etanercept and ustekinumab for treating plaque psoriasis in children and young people.Designated RED.

NICE TA456 Ustekinumab for moderately to severely active Crohn’s disease after previous treatment. Designated RED.

NICE TA457 Carfilzomib for previously treated multiple myeloma. Designated RED.

NICE TA458 Trastuzumab emtansine for treating HER2-positive advanced breast cancer after trastuzumab and a taxane. Designated RED.

NICE TA460 Adalimumab and dexamethasone for treating non-infectious uveitis Designated RED.

NICE TA461 Roflumilast for treating chronic obstructive pulmonary disease. Designated RED.

NICE TA 462 Nivolumab for treating relapsed or refractory classical Hodgkin lymphoma. Designated RED.

NICE TA463 Cabozantinib for previously treated advanced renal cell carcinoma. Designated RED.

NICE TA465 Olaratumab in combination with doxorubicin for treating advanced soft tissue sarcoma. Designated RED.

NICE TA466 Baricitinib for moderate to severe rheumatoid arthritis. Designated RED.
PACE Bulletin Vol 11 No 12 Sep17

Description

Rapid Drug Assessment: Rituximab (Truxima®) 500mg vial concentrate for solution for infusion. Designated RED.

Quick Reference Guide: Prescribing specialist Infant Formulae.

Revised guideline for the diagnosis and treatment of cow’s milk protein allergy and lactose intolerance.

MHRA Drug Safety Updates:Denosumab (Prolia, Xgeva) Reports of osteonecrosis of the external auditory canal.

Brimonidine gel (Mirvaso) risk of systemic cardiovascular effects, not to be applied to broken or damaged skin.

e-cigarettes and refill containers: report suspected side effects and safety concerns.

NICE TA446 Brentuximab vedotin for treating CD30-positive Hodgkin lymphoma. Designated RED.

NICE TA447 Pembrolizumab for untreated PD-L1-positive metastatic non-small-cell lung cancer Designated RED.

NICE TA448 Etelcalcetide for treating secondary hyperparathyroidism Designated RED.

NICE TA449 Everolimus and sunitinib for treating unresectable or metastatic neuroendocrine tumours in people with progressive disease Designated RED.

NICE TA450 Blinatumomab for previously treated Philadelphia-chromosome-negative acute lymphoblastic leukaemia Designated RED.

NICE TA451 Ponatinib for treating chronic myeloid leukaemia and acute lymphoblastic leukaemia Designated RED.
PACE Bulletin Vol 11 No 11 Jun17

Description

Rapid Drug Assessments:

Treatment pathway for the use of Ulipristal acetate 5mg tablets (Esyma) for intermittent treatment of moderate to severe symptoms of uterine fibroids. Designated AMBER 2.

Sereflo - Salmeterol (as xinafoate) 25 microgram with fluticasone propionate 125 or 250 microgram, metered dose inhaler. Designated GREEN approved as low cost alternative.

Aerivio Spiromax, 50 microgram/500 microgram inhalation powder. Each metered dose contains 50 micrograms of salmeterol (as salmeterol xinafoate) and 500 micrograms of fluticasone propionate Designated GREEN approved as low cost alternative.

Paliperidone Palmitate 3 monthly Injection TREVICTA. Designated RED.

MHRA Drug Safety Updates: Reports of depression and, in rare cases, suicidal thoughts in men taking finasteride 1 mg (Propecia) for male pattern hair loss.

NICE TA 445: Certolizumab pegol and secukinumab for treating active psoriatic arthritis after inadequate response to DMARDs. Designated RED.

PACE Bulletin Vol 11 No 10 Jun17

Description

Rapid Drug Assessment: Budesonide rectal foam (Budenofalk) for the treatment of active ulcerative colitis that is limited to the rectum and the sigmoid colon Approved GREEN.

Hydrocortisone Acetate 10% w/w (Colifoam) for Ulcerative colitis, proctosigmoiditis and granular proctitis Approved GREEN.

Prednisolone 20mg/application foam enema foam for Proctitis, ulcerative colitis Approved GREEN.

Review formulary advice Insulin Degludec (Trishiba) should only be initiated by either the community hosted specialist services or consultant diabetologists Restricted as AMBER2.

MHRA Drug Safety Update: Valproate updated drug safety alert and neurodevelopmental disorder (Apr 2017) .

Nicotine Replacement Therapy (NRT) change in provision from June 1st 2017.

NICE TA440 Pegylated liposomal irinotecan for treating pancreatic cancer after gemcitabine (Apr 2017) .

NICE TA441 Daclizumab for treating relapsing–remitting multiple sclerosis (Apr 2017).

NICE TA442 Ixekizumab for treating moderate to severe plaque psoriasis (Apr 2017).

NICE TA443 Obeticholic acid for treating primary biliary cholangitis (Apr 2017).
PACE Bulletin Vol 11 No 9 May17

Description

Rapid cost comparison: Oxycodone formulations Shortec brand Approved GREEN.

Review of aloprostadil 300mcg in 100mg cream Not Approved RED-RED.

Review of AMBER traffic light classification.

MHRA Drug Safety Update: SGLT2 inhibitors: updated advice on increased risk of lower-limb amputation (mainly toes) (Mar 2017).

Risk of medication error associated with rivastigmine patches.

NICE TA180: Ustekinumab (Stelara®) for treating psoriasis in adults (updated Mar 2017).

NICE TA340: Ustekinumab (Stelara®) for treating active psoriatic arthritis (updated Mar 2017).

NICE TA439: Cetuximab (Erbitux) and panitumumab (Vectibix) for previously untreated metastatic colorectal cancer (Mar 2017).
PACE Bulletin Vol 11 No 8 Apr17

Description

New licensed indications for Alzain formulation of pregabalin capsulesApproved GREEN.

Increasing cost of nabilone.

New Indication Assessment: AirFluSal Forspiro 50 for asthma.

Rapid Cost Comparison: Dipyridamole 200mg MR capsules (Attia) and Dipyridamole/Aspirin 200mg/25mg MR capsules (Molita) Approved GREEN.

NICE TA420: Ticagrelor for preventing atherothrombotic events after myocardial infarction (Dec 2016) .

NICE TA432: Everolimus for advanced renal cell carcinoma after previous treatment (Feb 2017) .

NICE TA433: Apremilast for treating active psoriatic arthritis (Feb 2017) .

Reformulation of Lucozade Energy Original.

Polypharmacy in the Frail Elderly.
PACE Bulletin Vol 11 No 6 Mar17

Description

New Drug Assessment:

Tiotropium (Braltus) 10 microgram inhalation powder plus delivery device (Zonda inhaler) Approved GREEN.

Guanfacine (Intuniv) 1mg, 2mg 3mg and 4mg modified release tablets Not Approved RED-RED.

Review:

Quadrivalent inactivated influenza vaccines.

Eflornithine 11.5% cream (Vaniqa) .

MHRA Drug Safety Update (December 2016): Spironolactone and renin-angiotensin system drugs in heart failure: risk of potentially fatal hyperkalaemia - clarification.

MHRA Drug Safety Update (January 2017): Apremilast (Otezla): Risk of suicidal thoughts and behaviour.

NICE TA418: Dapagliflozin in triple therapy treating type 2 diabetes (November 2016) .

NICE Update.
PACE Bulletin Vol 11 No 5 Feb17

Description

Review of gonadotropin releasing hormone agonists for prostate cancer (revised edition)
PACE Bulletin Vol 11 No 1 Feb17

Description

Rapid Cost Comparison.

Metformin modified release tablets 500mg and 1 gram (Sukkarto) Approved GREEN.

Venlafaxine modified release capsules (VenlaBlue XL and Vensir XL) Approved GREEN.

Ropinirole modified release tablets 2mg, 3mg, 4mg, 6mg and 8mg (Ipinnia XL) Approved AMBER.

Galantamine sustained release 8mg, 16mg and 24mg (Consion XL, Gazylan XL, Luventa XL) Approved AMBER.

Memantine hydrochloride 20mg orodispersible tablet (Valios) Approved AMBER.

Rivastigmine transdermal patches 4.6mg/24hour, 9.5mg/24hour (Alzest) Approved AMBER.

MHRA Drug Safety Update (October 2016): Etoricoxib (Arcoxia): revised dose recommendation for rheumatoid arthritis and ankylosing spondylitis.

MHRA Drug Safety Update (November 2016): Brimonidine gel (Mirvaso): Risk of exacerbation of rosacea.

 

 

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

Non-formulary request form

 

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