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
| Title | |
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| PACE Bulletin Vol 4 No 21 Dec10 | |
DescriptionINFLUENZA OUTBREAK 2010/11 AND ANTIVIRAL SUPPLY |
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| PACE Bulletin Vol 4 No 20 Nov10 | |
DescriptionReview: Agomelatine 25mg tablets (Valdoxan) remains RED. All prescribing should be handled by specialists in mental health; GPs are not expected to prescribe Rapid Drug Assessment: Rupatadine 10mg tablets (Rupafin) Licensed for the symptomatic treatment of allergic rhinitis and chronic idiopathic urticaria (CIU) in adults and adolescents classified RED-RED Sevelamer carbonate powder (Renvela) Licensed for the control of hyperphosphataemia in adult patients (1) receiving haemodialysis or peritoneal dialysis or (2) with Chronic Kidney Disease (CKD) not on dialysis with a serum phosphate greater than or equal to 1.78 mmol/l. Classified AMBER NICE TA198: Tocilizumab for the treatment of rheumatoid arthritis (August 2010) NICE TA199: Etanercept, infliximab and adalimumab for the treatment of psoriatic arthritis (August 2010) New Trials in Brief: Antipsychotics in early psychosis; Ivabradine in heart failure; Bisphosphonates and cancer risk Guidelines for the treatment of commonly occurring infections in Lincolnshire primary care (Winter 2010/11) |
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| PACE Bulletin Vol 4 No 19 Nov10 | |
DescriptionNATIONAL PATIENT SAFETY AGENCY (NPSA) PATIENT SAFETY ALERT: ACTIONS THAT CAN MAKE ANTICOAGULANT THERAPY SAFER (MARCH 2007) |
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| PACE Bulletin Vol 4 No 18 Oct10 | |
DescriptionNew Drug Assessment: Indacaterol (Onbrez Breezhaler) Licensed for maintenance bronchodilator treatment of airflow obstruction in adult patients with chronic obstructive pulmonary disease (COPD) classified RED-RED Dutasteride capsules (Avodart) and Dustasteride/Tamsulosin capsules (Combodart) Licensed for benign prostatic hypertrophy classified RED-RED Sativex Oromucosal Spray Licensed as an add-on treatment for symptom improvement in patients with moderate to severe spasticity due to multiple sclerosis (MS) who have not responded adequately to other anti-spasticity medication. Classified RED-RED Review: Modified Release Oral Morphine Preparations. All prescribing of modified release morphine preparations should be by brand name; preferred brands are Morphgesic SR and Zomorph NICE TA191: Capecitabine for the treatment of advanced gastric cancer (July 2010) NICE TA192: Gefitinib for the first-line treatment of locally advanced or metastatic non-small-cell lung cancer (July 2010) NICE TA193: Rituximab for the treatment of relapsed or refractory chronic lymphocytic leukaemia (July 2010) NICE TA194: Denosumab for the treatment of therapy-induced bone loss in non-metastatic prostate cancer (terminated appraisal) (July 2010) NICE TA195: Adalimumab, etanercept, infliximab, rituximab and abatacept for the treatment of rheumatoid arthritis after the failure of a TNF inhibitor (August 2010) NICE TA196: Imatinib for the adjuvant treatment of gastrointestinal stromal tumours (August 2010) New Trials in Brief: BMJ meta-analysis of calcium supplements and risk of MI and CV events MHRA, Drug Safety Update (August 2010): Modafinil; Topical ketoprofen - reminder on risk of photosensitivity reactions |
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| PACE Bulletin Vol 4 No 17 Nov10 | |
DescriptionUSE OF UNLICENSED PHARMACEUTICAL ‘SPECIALS’ |
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| PACE Bulletin Vol 4 No 16 Oct10 | |
DescriptionDISCONTINUATION OF MIXTARD 30 INSULIN PRODUCTS |
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| PACE Bulletin Vol 4 No 15 Sep10 | |
DescriptionSUSPENSION OF MARKETING AUTHORISATION OF ROSIGLITAZONE |
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| PACE Bulletin Vol 4 No 14 Sep10 | |
DescriptionRapid Drug Assessment: Bimatoprost 0.01% eye drops (Lumigan) As monotherapy or as an adjunct to beta-blockers (BBs) in chronic open angle glaucoma (COAG) or ocular hypertension (OHT) classified RED-RED NICE TA187: Infliximab (review) and adalimumab for the treatment of Crohn’s disease (May 2010) NICE TA188: Human growth hormone (somatropin) for the treatment of growth failure in children (May 2010) NICE TA189: Sorafenib for the treatment of advanced hepatocellular carcinoma (May 2010) NICE TA190: Pemetrexed for the maintenance treatment of non-small-cell lung cancer (June 2010) New Trials in Brief: Proton Pump Inhibitors (PPIs) and the risk of Clostridium difficile infection: Antibiotic resistance; Side effects and unintended benefits of statin therapy; Angiotensin 2 receptor antagonists (A2RAs) and cancer risk; Non-Steroidal Anti-inflammatory Drugs and cardiovascular risk MHRA, Drug Safety Update (July 2010): Orciprenaline sulphate (Alupent) reminder of withdrawal from the market National Patient Safety Agency: Rapid Response Report – Safer Administration of Insulin (June 2010) |
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| PACE Bulletin Vol 4 No 13 Aug10 | |
DescriptionREVIEW OF LIPID MODIFICATION GUIDELINES |
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| PACE Bulletin Vol 4 No 12 Aug10 | |
DescriptionRapid Review: Oxycodone/Naloxone prolonged release tablets (Targinact) Licensed for the treatment of severe pain. Classified RED-RED Rapid Drug Assessment: Degarelix acetate injection (Firmagon) Licensed for the treatment of advanced hormone dependent prostate cancer Classified RED-RED Sitagliptin/Metformin 50mg/1000mg tablets (Janumet) Licensed as an adjunct to diet and exercise to improve glycaemic control in patients with type 2 diabetes mellitus inadequately controlled on their maximal dose of metformin alone or those already being treated with the combination of sitagliptin and metformin. Licensed for triple therapy in combination with either a sulphonylurea or thiazolidinedione (glitazone); also licensed for use with insulin. Classifed GREEN Review of glucosamine. Prescribers are reminded that all glucosamine and glucosamine/chondroitin preparations are not recommended for prescribing MHRA, Drug Safety Update (June 2010): Rivastigmine (Exelon) transdermal patch - risk of medication errors; Quinine not to be used routinely for nocturnal leg cramps; Bevacizumab (Avastin) - hypersentivity and infusion reactions |
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| PACE Bulletin Vol 4 No 11 Aug10 | |
DescriptionMHRA DRUG SAFETY UPDATE: SIMVASTATIN 80MG AND MYOPATHY |
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| PACE Bulletin Vol 4 No 9 Jun10 | |
DescriptionRapid Drug Assessment: Doxycycline 40mg modified release capsules (Efracea) Licensed to reduce papulopustular lesions in adult patients with facial rosacea without ocular involvement. Classified RED-RED Febuxostat tablets (Adenuric) Licensed for chronic hyperuricaemia where deposition has occurred. Classified GREEN Sulphamethoxypyridazine 500mg tablets (unlicensedUsed for IgA related bullous diseases in patients intolerant of dapsone. Classified RED New Drug Assessment: Lacosamide tablets, syrup and infusion (Vimpat) Ranolazine modified release tablets (Ranexa) Rapid Review: Prasugrel 5mg tablets (Efient) NICE CG95: Chest pain of recent onset (March 2010) MHRA, Drug Safety Update (May 2010): SSRIs and SNRIs - risk of persistent pulmonary hypertension in the new born; Antidepressants - risk of fractures; Oral tacrolimus products - measures to reduce risk of medication errors |
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| PACE Bulletin Vol 4 No 8 May08 | |
DescriptionNATIONAL PATIENT SAFETY AGENCY (NPSA) RAPID RESPONSE REPORT 012 – REDUCING RISK OF HARM FROM ORAL BOWEL CLEANSING SOLUTIONS |
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| PACE Bulletin Vol 4 No 7 May10 | |
DescriptionRapid Drug Assessment: Paracetamol 1g tablets (Panadol OA) Licensed for the relief of pyrexia and mild to moderate pain including that associated with osteoarthritis Classified RED-RED Pramipexole prolonged release tablets (Mirapexin Prolonged Release) Licensed for monotherapy or in combination with levodopa in the treatment of Parkinson’s disease classified RED-RED NICE CG92: Venous thromboembolism: Reducing the risk of venous thromboembolism (deep vein thrombosis and pulmonary embolism) in patients admitted to hospital (January 2010) NICE CG94: Unstable Angina and NSTEMI - The early management of unstable angina and non-ST-segment-elevation myocardial infarction (March 2010) New Trials in Brief: Antipsychotic use in elderly patients; Blood pressure control in type 2 diabetes; Compliance with bisphosphonates; Non-Steroidal Anti-Inflammatory Drugs and cardiovascular risk MHRA, Drug Safety Update (April 2010): Yasmin: update on the risk of venous thromboembolism (VTE); Clopidogrel and proton pump inhibitors: updated advice; Intravenous zoledronic acid; adverse effects on renal function |
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| PACE Bulletin Vol 4 No 6 May10 | |
DescriptionReview of Glaucoma Treatments NICE TA185: Trabectedin for the treatment of advanced soft tissue sarcoma (February 2010) NICE TA186: Certolizumab pegol for the treatment of rheumatoid arthritis (February 2010) New Trials in Brief: Insulin glargine/ insulin determir and diabetic ketoacidosis; Do statins increase the risk of developing diabetes? MHRA, Drug Safety Update (March 2010): Natalizumab (Tysabri) and progressive multifocal leukoencephalopathy; Fluoxetine and congenital cardiac defects |
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| PACE Bulletin Vol 4 No 3 Mar10 | |
DescriptionNew Drug Assessment: Liraglutide injection (Victoza) has been approved for use in type 2 diabetes mellitus. It should only be used as an alternative to exenatide where exenatide is either not tolerated or inappropriate Rapid Drug Assessment: Fentanyl nasal spray (Instanyl) Licensed for the management of breakthrough pain in adults already receiving maintenance opioid therapy for chronic cancer pain. Classified RED-RED Final withdrawal of beclometasone CFC containing metered dose inhalers, remaining patients should be switched to CFC free equivalents New Trials in Brief: Improving statins adherance; Survival as a function of HbA1c in people with type 2 diabetes mellitus; Motor vehicle crashes in diabetic patients with tight blood glucose control MHRA, Drug Safety Update (February 2010): Tacrolimus granules for oral suspension (Modigraf) - formulations are not interchangeable without careful therapeutic monitoring; Orlistat (alli) safety update Department of Health Alert: The use of medicines in care homes for older people (January 2010) National Patient Safety Agency Rapid Response Report: Vaccine Cold Storage (February 2010) |
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| PACE Bulletin Vol 4 No 2 Mar10 | |
DescriptionNew Drug Assessment: Nicotinic acid/ laropiprant modified release tablets (Tredaptive) Clarification of the role of ezetimibe (Ezetrol) New Drug Assessment: Saxagliptin 5mg tablets (Onglyza) is not approved for the treatment of type 2 diabetes mellitus Rapid Drug Assessment: Ketoprofen/ omeprazole modified release capsules (Axorid) New Trials in Brief: Efficacy and safety of varenicline for smoking cessation in patients with cardiovascular disease; Does higher usage of low cost statins correlate with poorer achievement in cholesterol quality markers for secondary prevention? MHRA, Drug Safety Update (January 2010): Risk of Stevens Johnson syndrome with phenytoin; New patient information with methylphenidate |
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| PACE Bulletin Vol 4 No 1 Jan10 | |
DescriptionSuspension of marketing authorisation of sibutramine (Reductil) New Drug Assessment: Ulipristal 30mg tablet (Ellaone) is reviewed and designated GREEN for women presenting between 72 and 120 hours after unprotected intercourse or contraceptive failure Key Patent Expiries 2010 New Trials in Brief: Prescribing and over-the-counter sale of chloramphenical eye preparations for conjunctivitis; Medicines and falls; Long-Acting Beta-2 Agonist (LABA) and Inhaled Corticosteroid (ICS) combination therapy in asthma NICE TA184: Topotecan for the treatment of relapsed small-cell lung cancer (November 2009) MHRA, Drug Safety Update (December 2009): Ciclosporin must be prescribed and dispensed by brand name; Potential risk of male breast cancer with finasteride Medicines, side effects and the risk of falls in the elderly: An aid to medication review The NHS Bowel Cancer Screening Programme has been launched in Lincolnshire |
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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
