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 November 2024
Freestyle Libre 2 Plus approved in line with current guidance and classified as amber 2. Freestyle Libre 3 has been classified as Red Red.
NICE TA958 Ritlecitinib for treating severe alopecia areata in people 12 years and older - This was approved and given a Red classification on the formulary, with treatment and monitoring responsibilities to lie with specialist secondary care teams, as Ritlecitinib is a high-cost drug requiring Blueteq. Primary care’s role would be limited to referring patients who meet the criteria to the specialist team. For initiation, patients must have failed topical treatments, and many opt against steroidal scalp injections due to pain. Ritlecitinib is the first oral treatment available for this condition.
NICE TA996 Linzagolix for treating moderate to severe symptoms of uterine fibroids - Classified as Red on the formulary.
NICE TA 999 Vibegron for treating symptoms of overactive bladder - Classified as Green on the formulary.
NICE TA 1009 Latanoprost–netarsudil for previously treated primary open-angle glaucoma or ocular hypertension – Classified as Amber 2 on the formulary.
Ivermectin - Reclassified from Red Red to Amber 2.
Trifarotene - Reclassified from Red Red to Green.
Sodium Chloride Oral Solutions - Reclassified to Amber 2.
Mefylnate XL (Methylphenidate) – Reclassified to Amber 1 with the shared care agreement being updated to reflect this.
Kay-Cee-L alternatives -ULTH has agreed to use these three alternatives Potassium Chloride (Nova), Potassiuum Chloride (Rokshaw) and Potassium Chloride (Smartway).
Medi-derma barrier products are now green and first line choice for primary care, for moisture associated skin damage. A pathway for stepping up and stepping down treatment, produced by LCHS, is now available on the formulary.
Cavilon barrier products remain green, second line choice for primary care, for moisture associated skin damage, but first line choice for secondary care. A pathway for stepping up and stepping down treatment, produced by ULTH, is now available on the formulary.
Dressit sterile dressing packs have been changed from redred to green and are the first line choice for primary care, where procurement through NHSSC (supply chain) is unavailable.
Softdrape remains green, first line choice for secondary care and Trusts where procurement through NHSSC (supply chain) is available.
Liquid paraffin – Is now classified as Amber 2 and It was reiterated that liquid paraffin would only be initiated and recommended by the specialist gastro-paediatric teams.
Human Milk Fortifier – Has been added onto the formulary as Amber 2. The monitoring responsibility would lie with the neonatal team, including decisions on when it is appropriate to stop the treatment. However, it is expected that the specialist team may request GPs to continue prescribing in primary care after discharge. Guidance has also been uploaded onto the formulary.
Visutrax (Travoprost) P/F eye drops – Added to the formulary as Amber 2.
Guidance/Position statements/Shared care:
Diabetes Continuous Glucose Monitoring - The NHS Lincolnshire position statement has been uploaded onto the PACE website and recently updated to include an additional statement advising consideration of CGM to be provided to all pregnant women with gestational diabetes who use intensive insulin therapy, but only if they experience problematic glucose levels or severe hypoglycaemia.
Asthma guidelines for use in children has been approved by ULTH and respiratory group.
MicroGuide - All links to the Microguide, including QR codes, have been removed from the PACE website and guidance. This decision was made due to concerns that the app could be corrupted, and removing the links was considered the safest course of action.
Mycophenolate shared care agreement amended to include respiratory indication - Shared care is already in place for renal conditions but has now been expanded to include respiratory conditions (not to be used for Idiopathic pulmonary fibrosis). This expansion will specifically cover its use in treating interstitial lung disease, as previously outlined in a national shared care protocol.
Lincolnshire Guidance for the use of Anticoagulants in the management of Non-Valvular Atrial Fibrillation (NVAF) has now been approved.
Formulary meetings October and December
Alfacalcidol capsules - Alfacaless and One-Alpha are the two lowest-cost brands that prescribers should be selecting.
Dexamethasone sodium phosphate and 0.1% eye drops preservative-free 0.4ml unit dose and Dropadex 0.1% eye drops 0.4ml - Swap to Dexafree 1mg/ml eye drops 0.4ml unit dose vials as the most cost-effective brand..
Cinacalcet - There are significant cost savings if swapping to multiple 30mg tablets rather than using the 60mg or 90mg tablets.
Levomepromazine - 25mg tablets are scored for doses of 12.5mg and can be quartered for doses of 6.25mg. 6mg and 6.25mg tablets are very expensive and the halving or quartering of tablets reflects current ULTH practice.
Buprenorphine once weekly patches - The lowest cost brands are Rebrikel 5mcg, 10mcg and 20mcg patches as first line choice for those strengths, Reletrans 15mcg, 25mcg, 30mcg and 40mcg patches as first line choice for those strengths (only brand that makes patches in 25mcg, 30mcg and 40mcg strength) and Sevodyne as second line choice. It is not recommended to change brands of Buprenorphine for patients, so only change brands for patients that are increasing/decreasing strength or for new patients.
Fentanyl transdermal matrix patches – Opiodur brand is now the first line choice and Matrifen as second line choice.
Oxycodone modified release tablets - Oxylan brand is now first line choice and Ixyldone as second line choice.
Discontinuations
Labetalol tablets - 400mg tablets were discontinued in Dec 24. The 50mg tablets were discontinued a few months ago, but 100mg and 200mg tablets remain available.
Capsaicin cream 0.025% and 0.075% - Following the long-term shortage of these, both licensed strengths have been discontinued and are now only available as unlicensed products.
Coal Tar 2% shampoo (T/Gel) - Will be discontinued Feb 25.
Hydrocortisone 0.1% Cream - Discontinued June 24.
Levobunolol 0.5% udv PF - Discontinued Dec 24.
Caverject (Alprostadil) powder for solution for injection - Pfizer will commence the supply of Alprostadil, a generic version of Caverject powder for solution for injection from February 2025. They will continue to offer both the branded and generic presentation, for a short period of transition, after which the brand will no longer be routinely available.
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 5 No 18 Dec11 | |
DescriptionReview: Reboxetine (Edronax) Following an MHRA re-evaluation of the risks and benefits of reboxetine (Edronax), this drug has had its designation changed from RED-RED to AMBER New Formulation Assessment: Exenatide prolonged release injection (Bydureon) approved for use as an alternative to twice daily exenatide (Byetta) where the twice daily product is poorly tolerated Rapid Drug Assessment: Modified release sodium valproate granules (Epilim Chronospheres) Licensed for all forms of epilepsy designated GREEN Drug Safety Update: Citalopram associated with dose dependent QT interval prolongation Drug Safety Update: European Medicines Agency guidance recommends restricting the role of dronedarone (Multaq) New East Midlands guidance on the use of LABA/ICS combination inhalers in chronic obstructive pulmonary disease NICE TA230: Bivalirudin for the treatment of ST-segment-elevation myocardial infarction (July 2011) New Trials in Brief: Increasing use of insulin analogues across the NHS Updated advice on supply problems with insulin glulisine (Apidra) |
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| PACE Bulletin Vol 5 No 17 Oct11 | |
DescriptionNew Indication Assessment: Dabigatran etexilate (Pradaxa) for the prevention of stroke and systemic embolism in patients with non-valvular atrial fibrillation and is designated RED-RED NICE CG26: Management of stable angina (July 2011) Review: Ivabradine 5mg and 7.5mg tablets (Procoralan) and Ranolazine 375mg, 500mg and 750mg tablets (Ranexa) re-assessed and are now designated AMBER NICE TA228: Bortezomib and thalidomide for the first-line treatment of multiple myeloma (July 2011) NICE TA229: Dexamethasone intravitreal implant for the treatment of macular oedema secondary to retinal vein occlusion (July 2011) NICE TA233: Golimumab for the treatment of ankylosing spondylitis (August 2011) NICE TA234: Abatacept for the treatment of rheumatoid arthritis after the failure of conventional disease-modifying anti-rheumatic drugs (August 2011) MHRA Drug Safety Updates (August and September 2011): Withdrawal of Onsenal (Celecoxib); Systemic fusidic acid and interaction with statins - risk of rhabdomyolysis; Antipsychotic use during third trimester of pregnancy |
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| PACE Bulletin Vol 5 No 16 Oct11 | |
DescriptionSUPPLY PROBLEMS WITH INSULIN GLULISINE (APIDRA) update on the current supply problems affecting insulin glulisine (Apidra) and on the planned discontinuation of Opticlik, Opticlik Pro 1 and Optiset insulin pen devices |
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| PACE Bulletin Vol 5 No 15 Sep11 | |
DescriptionNew Drug Assessment: Ketamine oral solution (50mg in 5ml) and Ketamine injection for palliative care designated AMBER Rapid Drug Assessment: Bilastine 20mg tablets (Ilaxten) Licensed for the symptomatic treatment of allergic rhino-conjunctivitis and urticaria. Designated RED-RED Linezolid 600mg tablets and 100mg in 5ml oral suspension (Zyvox) Licensed for the treatment of community acquired pneumonia, nosocomial pneumonia, skin infections and soft tissue infections when the causative organism is known to be a Gram-positive bacteria. Designated RED NICE TA224: Golimumab for the treatment of methotrexate-naive rheumatoid arthritis (terminated appraisal) (June 2011) NICE TA225: Golimumab for the treatment of rheumatoid arthritis after the failure of previous disease-modifying anti-rheumatic drugs (June 2011) NICE TA226: Rituximab for the first-line maintenance treatment of follicular non-Hodgkin’s lymphoma (June 2011) NICE TA227: Erlotinib monotherapy for maintenance treatment of non-small-cell lung cancer (June 2011) New Trials in Brief: Is a more prominent role for Leukotriene Receptor Antagonists justified in the treatment of asthma? Tiotropium – more on cardiovascular risks of Spiriva Respimat; Non-Steroidal Anti-Inflammatory Drugs and Atrial Fibrillation or Flutter MHRA Drug Safety Update (July 2011): Thalidomide – Risk of arterial and venous thromboembolism; Paracetamol – Updated dosing schedule for children; Addiction to benzodiazepines and codeine MHRA Drug Safety Update (August 2011): Pioglitazone and bladder cancer |
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| PACE Bulletin Vol 5 No 12 Jul11 | |
DescriptionPioglitazone and bladder cancer New Formulation Assessment: Vardenafil orodispersible tablets (Levitra) Rapid Drug Assessment: Tobramycin 3mg/ml eye drops (Tobravisc) Superficial bacterial eye infections designated RED-RED Adapalene and benzoyl peroxide gel 0.1%/2.5% (Epiduo) Treatment of acne vulgaris with comedones, papules and pustules designated GREEN NICE Technology Appraisal 223: Cilostazol, naftidrofuryl oxalate, pentoxifylline and inositol nicotinate for the treatment of intermittent claudication in people with peripheral arterial disease (May 2011) News in Brief: New guideline on atopic eczema, Are all beta blockers the same in heart failure? Updated meningococcal guidance. MHRA Drug Safety Update (June 2010): Bisphosphonates: atypical femoral fractures; Yasmin: risk of venous thromboembolism European Medicines Agency safety review of dronedarone (Multaq) |
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| PACE Bulletin Vol 5 No 11 Jun11 | |
DescriptionNew Patent Expiries: Anastrozole and Risedronate NICE TA217: Donepezil, galantamine, and memantine for the treatment of Alzheimer’s disease (March 2011) NICE TA219: Everolimus for the second-line treatment of advance renal cell carcinoma (April 2011) NICE TA220 Golimumab for the treatment of psoriatic arthritis (April 2011) NICE TA221: Romiplostim for the treatment of chronic immune (idiopathic) thrombocytopenic purpura (April 2011) NICE TA222: Trabectedin for the treatment of relapsed ovarian cancer (April 2011) New Trials in Brief: Higher Doses of Levothyroxine and Fracture Risk; Angiotensin Receptor Blockers and Cardiovascular Risk News in Brief: New advice on drug interactions and hormonal contraception; PPIs – too much of a good thing; Gabapentin for neuropathic pain; Dopamine agonists for restless legs syndrome MHRA Drug Safety Update (May 2010): Prasugrel - rare but serious hypersensitivity reactions |
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| PACE Bulletin Vol 5 No 9 May11 | |
DescriptionRapid Drug Assessment: Nicorette Quickmist oromucosal spray designated GREEN Review: Quetiapine tablets (Seroquel) and Quetiapine Modified Release tablets (Seroquel XL) AMBER Venlafaxine Modified Release Formulations should be prescribed as one of the low cost brands: Depefex XL capsules, Ranfaxine XL capsules, Venaxx XL capsules or Venlalic XL tablets where possible Angiotensin 2 Receptor Blocker Choice for Hypertension NICE TA213: Aripiprazole for the treatment of schizophrenia in people aged 15 to 17 years (January 2011) NICE TA218: Azacitidine for the treatment of myelodysplastic syndromes, chronic myelomonocytic leukaemia and acute myeloid leukaemia (March 2011) New Trials in Brief: Olmesartan and fatal cardiovascular events; ACEI and A2RA combination therapy; Tiotropium versus salmeterol in COPD MHRA Drug Safety Update (April 2011): Atypical antipsychotics: monitoring of weight, glucose and lipid levels |
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| PACE Bulletin Vol 5 No 8 May11 | |
DescriptionRapid Drug Assessment: Calcipotriol 50 microgram/g and betamethasone 500 microgram/g gel (Dovobet) Licensed for scalp psoriasis and for mild to moderate non-scalp plaque psoriasis designated GREEN Moxifloxacin hydrochloride 0.5% eye drops (Moxivig) Licensed for the topical treatment of purulent bacterial conjunctivitis designated RED-RED Nicorette Fresh Mint Lozenges in adults and children over 12 years. It is also indicated for use in pregnant and lactating women designated GREEN Review Prescribing of Dipipanone Licensed for moderate to severe pain designated RED-RED New Trials in Brief: The ACCORD Study: Long term effects of intensive glucose lowering on cardiovascular outcomes Donation of Patient-Returned Medicines to Charitable Organisations Evaluation of the Scale, Causes and Costs of Waste Medicines MHRA Drug Safety Update (March 2011): Modafinil (Provigil) NICE TA212: Bevacizumab in combination with oxaliplatin and either fluorouracil plus folinic acid or capecitabine for the treatment of metastatic colorectal cancer (December 2010) NICE TA214: Bevacizumab in combination with a taxane for the first-line treatment of metastatic breast cancer (February 2011) NICE TA215: Pazopanib for the first-line treatment of advanced renal cell carcinoma (February 2011) NICE TA216: Bendamustine for the first-line treatment of chronic lymphocytic leukaemia (February 2011) NICE CG108: Chronic heart failure – Management of chronic heart failure in adults in primary and secondary care (August 2010) |
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| PACE Bulletin Vol 5 No 7 Apr11 | |
DescriptionReview: Rasagiline (Azilect) tablets Licensed for the treatment of Parkinson’s disease used alone or as an adjunct to levodopa with dopa-decarboxylase inhibitor designated AMBER New Drug Assessment: Amifampridine phosphate (Firdapse) tablets Licensed for the treatment of Lambert-Eaton Myasthenic Syndrome (LEMS) in adults up to a maximum daily dose of 60mg. designated RED-RED Rapid Drug Assessment: Pigmanorm cream An unlicensed product used for the treatment of melanin-induced hyperpigmentation of the skin. Designated RED Fenticonazole (Ginoxin) vaginal capsules 200mg, 600mg and 2% vaginal cream licensed for the treatment of vaginal candidiasis designated GREEN Combined oral contraceptive pills - Rigevidon, Gedarel 20/150, Gedarel 30/150, Millinette 20/75, Millinette 30/75 and TriRegol Designated GREEN NICE TA207 Temsirolimus for the treatment of relapsed or refractory mantle cell lymphoma (terminated appraisal) (October 2010) NICE TA208: Trastuzumab for the treatment of HER2-positive metastatic gastric cancer (November 2010) NICE TA209: Imatinib for the treatment of unresectable and/or metastatic gastrointestinal stromal tumours (November 2010) NICE TA211: Prucalopride for the treatment of chronic constipation in women (December 2010) NICE CG111: Nocturnal enuresis – The management of bedwetting in children and young people (October 2010) New Trials in Brief: Statins for primary prevention of cardiovascular disease MHRA Drug Safety Update: Daptomycin, Lenalidomide, Omalizumab, Peritoneal Dialysis Solutions |
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| PACE Bulletin Vol 5 No 5 Mar11 | |
DescriptionRapid Drug Assessment: Aluminium chloride 15%/ salicylic acid 2% gel (Hydrosal) Treatment of axillary hyperhidrosis (unlicensed) designated RED-RED Sodium Chloride Nebuliser Solution 7% (Nebusal) (Hypertonic Saline) used to mobilise lower respiratory tract secretions in mucous consolidation (e.g. cystic fibrosis) Designated AMBER Naproxen 500mg/esomeprazole 20mg tablets (Vimovo) Licensed for the symptomatic treatment of osteoarthritis (OA), rheumatoid arthritis and ankylosing spondylitis in patients at risk of NSAID associated gastric and or duodenal ulcers in whom lower doses of naproxen or other NSAIDs are not sufficient designated RED-RED Etonogestrel (Nexplanon) 68mg subdermal implant designated GREEN NICE TA197: Dronedarone for the treatment of non-permanent atrial fibrillation (August 2010) NICE TA210: Clopidogrel and modified release dipyridamole for the prevention of occlusive vascular events (December 2010) New Trials in Brief: Review of orlistat prescribing; Cardiovascular safety of NSAIDs MHRA Drug Safety Update: Fibrates – not recommended first line (December 2010) |
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| PACE Bulletin Vol 5 No 3 Feb11 | |
DescriptionReview: Pramipexole prolonged release tablets (Mirapexin) and Ropinirole modified release tablets (ReQuip XL) for Parkinson’s Disease designated AMBER NICE TA200: Peginterferon alfa and ribavirin for the treatment of chronic hepatitis C (September 2010) NICE TA201: Omalizumab for the treatment of severe persistent allergic asthma in children aged 6 to 11 years (October 2010) NICE TA203: Liraglutide for the treatment of type 2 diabetes mellitus (October 2010) NICE TA204 Denosumab for the prevention of osteoporotic fractures in postmenopausal women (October 2010) New Trials in Brief: Reboxetine –an ineffective antidepressant?; Omacor and the OMEGA study; Glucosamine – the final chapter? MHRA Drug Safety Update: Tamoxifen drug interactions; Memantine pump device (Ebixa) – risk of medication erros; Oral bisphosphonates and oesophageal cancer; Tiotropium –safety studies of Spiriva Respimat |
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| PACE Bulletin Vol 5 No 2 Feb 11 | |
DescriptionReview: Atorvastatin 80mg and Acute Coronary Syndrome approved for use in patients at high risk subject to cardiologist initiation and review and step-down at six months Review: Standard prednisolone tablets versus enteric coated prednisolone tablets. Prescribers are urged to use standard prednisolone tablets first line and to consider switching existing patients on EC to standard prednisolone Rapid Drug Assessment: Prednisone modified release tablets (Lodotra) classified RED-RED NICE TA202: Ofatumumab for the treatment of chronic lymphocytic leukaemia refractory to fludarabine and alemtuzumab (October 2010) NICE TA205: Eltrombopag for the treatment of chronic immune (idiopathic) thrombocytopenic purpura (October 2010) NICE TA206: Bendamustine for the treatment of indolent (low grade) non-Hodgkin’s lymphoma that is refractory to rituximab (terminated appraisal) (October 2010) MHRA Drug Safety Update (September 2010): Isotretinoin - risk of serious skin reactions; Risk of psychological and behavioural side effects with inhaled and intranasal corticosteroids; Long-acting beta 2 agonists in asthma MHRA Drug Safety Update (October 2010): Implanon contraceptive implant - changing to Nexplanon; Codeine-containing liquid over-the-counter medicines – no longer recommended for cough in the under 18s |
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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
