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 | |
|---|---|
| PACE Bulletin Vol 2 No 19 Dec08 | |
DescriptionRapid Assessment: Dexibuprofen tablets (Seractil) Osteoarthritis, dysmenorrhoea, mild to moderate pain and dental pain. Classified RED-RED Dexketoprofen tablets (Keral) Musculoskeletal pain, dysmenorrhoea, dental pain Classified RED-RED Clopidogrel tablets 300mg (Plavix) For use as a loading dose in patients with non-ST segment elevation acute coronary syndrome (i.e. unstable angina or non-Q-wave myocardial infarction (MI)) and ST segment elevation acute MI classified RED Update on Clostridium difficile NICE TA160: Alendronate, etidronate, risedronate, raloxifene and strontium ranelate for the primary prevention of osteoporotic fragility fractures in postmenopausal women (October 2008) NICE CG71: Familial hypercholesterolaemia – Identification and management of familial hypercholesterolaemia (August 2008) |
|
| PACE Bulletin Vol 2 No 18 Nov08 | |
DescriptionMHRA imposes restrictions on the import of unlicensed melatonin Rapid Assessment: Bimatoprost/ timolol eye drops (Ganfort) Ocular hypertension or open angle glaucoma insufficiently responsive to beta blockers or prostaglandin analogues. Classified GREEN Glycopyrrolate 0.5% lotion Unlicensed topical antimuscarinic agent used in the treatment of facial hyperhidrosis and diabetic gustatory sweating. Classified AMBER NICE TA153: Entecavir for the treatment of chronic hepatitis B (August 2008) NICE TA154: Telbivudine for the treatment of chronic hepatitis B (August 2008) NICE TA155: Ranibizumab and pegaptanib for the treatment of age-related macular degeneration (August 2008) NICE TA156: Routine antenatal anti-D prophylaxis for women who are rhesus D negative (August 2008) NICE TA157: Dabigatran etexilate for the prevention of venous thromboembolism after hip or knee replacement surgery in adults (September 2008) NICE TA158: Oseltamivir, amantadine and zanamivir for the prophylaxis of influenza (September 2008) MHRA Safety Update: Fentanyl Patches; Human Papillomavirus Vaccine; Antiepileptic Drugs Shortage of prednisolone suppositories: advice to prescribers |
|
| PACE Bulletin Vol 2 No 17 Oct08 | |
DescriptionRIMONABANT (ACOMPLIA): MARKETING AUTHORISATION SUSPENDED |
|
| PACE Bulletin Vol 2 No 16 Oct08 | |
DescriptionAntibiotic Awareness Campaign NICE CG 69: Respiratory tract infections – antibiotic prescribing (July 2008) Guidelines for the Treatment of Commonly Occurring Infections in Primary Care: Winter 2008/08 – Summary table |
|
| PACE Bulletin Vol 2 No 15 Nov08 | |
DescriptionNew Drug Assessment: Fesoterodine (Toviaz) For the treatment of the symptoms of overactive bladder syndrome (OAB) (urinary frequency and/ or urgency and/or urgency incontinence). Classified RED-RED Rapid Assessment: Sodium Hyaluronate eye drops (Oxyal) for dry eyes Classified RED-RED In the News: Human Papillomavirus Vaccination Programme: Further Developments NICE TA151:Continuous subcutaneous insulin infusion for the treatment of diabetes mellitus (July 2008) NICE TA152: Drug-eluting stents for the treatment of coronary artery disease (July 2008) NICE CG 68: Stroke – Diagnosis and initial management of acute stroke and transient ischaemic attack (July 2008) NICE CG 70: Induction of labour (July 2008) New Wound Management Formulary Safety Alert: Opiates and Snoring or Sleep Apnoea |
|
| PACE Bulletin Vol 2 No 13 Aug08 | |
DescriptionNew Drug Assessment: Melatonin Prolonged Release Tablets (Circadin) NICE TA144: Rimonabant for the treatment of overweight and obese adults (June 2008) NICE TA145: Cetuximab for the treatment of locally advanced squamous cell cancer of the head and neck (June 2008) NICE TA146: Adalimumab for the treatment of adults with psoriasis (June 2008) NICE TA147: Bevacizumab for the first-line treatment of metastatic breast cancer (terminated appraisal) (June 2008) NICE TA148: Bevacizumab for the treatment of non-small-cell lung cancer (terminated appraisal) (June 2008) NICE TA149: Carmustine implants for the treatment of recurrent glioblastoma multiforme (terminated appraisal) (June 2008) NICE TA150: Cetuximab for the treatment of metastatic colorectal cancer following failure of oxaliplatin containing chemotherapy (Terminated Appraisal) (June 2008) MHRA Safety Update: Varenicline – Suicidal Thoughts and Behaviour Bisphosphonates and Atrial Fibrillation Rotigitine patches – new prescribing and storage requirements National Patient Safety Agency: Rapid Response Report – Risks of Incorrect Dosing of Oral Anti-Cancer Medicines (January 2008) |
|
| PACE Bulletin Vol 2 No 12 Jul08 | |
DescriptionNew Drug Assessment: Paricalcitol capsules (Zemplar) Licensed for the prevention and treatment of secondary hyperparathyroidism (SHPT) associated with chronic renal insufficiency (chronic kidney disease Stages 3 and 4) and chronic renal failure (chronic kidney disease Stage 5) in patients on haemodialysis or peritoneal dialysis Classified RED-RED Ropinirole prolonged release tablets (Requip XL) New Indication Assessment: Venlafaxine (Efexor XL) for Generalised Anxiety Disorder (GAD) and Social Phobia Introduction of Human Papillomavirus (HPV) Vaccine into the National Immunisation Programme NICE TA142: Epoetin alfa, epoetin beta and darbepoetin alfa for cancer treatment-induced anaemia (May 2008) NICE TA143: Adalimumab, etanercept and infliximab for ankylosing spondylitis (May 2008) MHRA Safety Update: Nicorandil (Ikorel) (June 2008) |
|
| PACE Bulletin Vol 2 No 11 Jul08 | |
DescriptionNICE CG67: Lipid Modification (May 2008) NICE TA32: Ezetimibe for the treatment of primary (heterozygous familial and non-familial) hypercholesterolaemia (November 2007) |
|
| PACE Bulletin Vol 2 No 10 Jul08 | |
DescriptionOmacor Review New Drug Assessment: Vildagliptin (Galvus) and Vildagliptin/Metformin (Eucreas) NICE TA140: Infliximab for the subacute manifestations of ulcerative colitis (April 2008) NICE TA141: Abatacept for the treatment of rheumatoid arthritis (April 2008) NICE Public Health Programme Guidance 11: Maternal and child nutrition (March 2008) NICE CG62: Antenatal care – Routine care for the healthy pregnant woman (March 2008) NICE CG63: Diabetes in pregnancy – Management of diabetes and its complications from pre-conception to the postnatal period (March 2008) MHRA Safety Update: Rimonabant – New advice on depressive reactions; Exenatide – Risk of acute pancreatitis (May 2008) Reporting Incidents to the National Patient Safety Agency |
|
| PACE Bulletin Vol 2 No 9 Jun08 | |
DescriptionExenatide (Byetta) Review GREEN Treatment should primarily be initiated by a diabetologist or a GP with a Specialist Interest in diabetes (GPSI), although the GREEN status allows for broader GP initiation. Exenatide should only be considered within the context of the draft NICE initiation criteria (see below) Further Advice on Glitazone Use Rapid Assessment: Cocois scalp ointment (Sebco) Licensed as an adjunctive treatment of common scaly scalp disorders such as psoriasis, eczema, seborrhoeic dermatitis and dandruff. Classified GREEN NICE TA138: Inhaled corticosteroids for the treatment of chronic asthma in adults and children aged 12 years and over (March 2008) NICE TA139: Continuous positive airway pressure for the treatment of obstructive sleep apnoea/hypopnoea syndrome (March 2008) NICE CG60: Surgical management of otitis media with effusion in children (February 2008) NICE CG61: Irritable bowel syndrome in adults – Diagnosis and management of IBS in primary care (February 2008) Addendum: Calcium and Vitamin D Supplementation |
|
| PACE Bulletin Vol 2 No 7 May08 | |
DescriptionNICE CG59: Osteoarthritis - The care and management of osteoarthritis in adults (Feb 2008) Reducing Pharmaceutical Waste Campaign 2008 |
|
| PACE Bulletin Vol 2 No 6 May08 | |
DescriptionRapid Assessment: Retapamulin Ointment 1% (Altargo) is an expensive agents in comparison to alternatives. Classified RED-RED Actonel Combi for treatment of postmenopausal osteoporosis in assessed patients for whom the amount of calcium and vitamin D3 included is considered to provide adequate supplementation. Classified RED-RED Calcium and Vitamin D Supplementation Cozaar Comp for hypertension in patients whose BP is not controlled by hydrochlorothiazide or losartan monotherapy. Reduction in risk of stroke in hypertensive patients (except black patients) with left ventricular hypertrophy Classified RED-RED U-500 Insulin (Humulin R) unlicensed RED NICE TA136: Structural neuroimaging in first-episode psychosis NICE TA137: Rituximab for the treatment of relapsed or refractory stage III or IV follicular non-Hodgkin’s lymphoma NICE CG58: Prostate Cancer - Diagnosis and treatment MHRA Safety Update: Ketoconazole and Modafinil |
|
| PACE Bulletin Vol 2 No 5 Apr08 | |
DescriptionGUIDELINES FOR THE TREATMENT OF UNDER NUTRITION IN THE COMMUNITY |
|
| PACE Bulletin Vol 2 No 4 Apr08 | |
DescriptionPRESCRIBING RECOMMENDATIONS FOR HAY FEVER: SPRING / SUMMER 2008 |
|
| PACE Bulletin Vol 2 No 3 Apr08 | |
DescriptionNew Drug Assessment: Colesevelam (Cholestagel) Classified RED-RED Rapid Assessment: Fostair (Beclometasone and Formoterol) Metered Dose Inhaler Classified GREEN Future Supply of CFC Containing Beclometasone Dipropionate Metered Dose Inhalers Product Discontinuation: Coversyl and Coversyl Plus Smoking Cessation and Varenicline Review of Bicalutamide Traffic Light Classification NICE TA134: Infliximab for the treatment of adults with psoriasis NICE TA135: Pemetrexed for the treatment of malignant pleural mesothelioma MHRA Safety Updates: Carisoprolol and Meprobamate, Rosiglitazone, Statins Amendment: NICE CG57: Atopic Eczema in Children |
|
| PACE Bulletin Vol 2 No 2 Feb08 | |
DescriptionNew Drug Assessment: Rufinamide (Inovelon) Licensed as an adjunctive therapy in the treatment of seizures associated with Lennox-Gastaut syndrome (LGS) in patients 4 years and older. Classified AMBER Tacrolimus 0.03% ointment and 0.1% ointment (Protopic) Licensed for the second line short term treatment of moderate or severe atopic dermatitis unresponsive or intolerant to topical steroids. For use in adults (0.1% ointment) and children aged 2 and over (0.03% ointment).Classified AMBER Pimecrolimus 1% cream (Elidel) Licensed for the second line short term treatment of mild or moderate atopic dermatitis where the use of topical steroids is inadvisable or not possible. For use in adults and children aged 2 and over. Classified AMBER Zoledronic acid infusion (Aclasta) Licensed for the treatment of osteoporosis in postmenopausal women at increased risk of fracture Classified RED-RED Mesalazine (Mezavant XL) Licensed for the induction and maintenance of remission in patients with mild to moderate active ulcerative colitis. Classified GREEN NICE CG57: Atopic Eczema in Children Clostridium difficile reminder |
|
| PACE Bulletin Vol 2 No 1 Jan08 | |
DescriptionNew Drug Assessment: Lenalidomide (Revlimid) for use in combination with dexamethasone for the treatment of multiple myeloma in patients who have received at least one prior therapy. Classified RED-RED Rivastigmine Transdermal Patch (Exelon) symptomatic treatment of mild to moderately severe Alzheimer’s dementia classified AMBER Grazax grass pollen induced rhinitis and conjunctivitis diagnosed with a positive skin prick test and/or specific IgE test classified RED-RED Lantus SoloStar and Apidra SoloStar Insulin Pens both classified GREEN Product Withdrawals: Co-proxamol Update NICE TA131: Inhaled corticosteroids for the treatment of chronic asthma in children NICE TA132: Ezetimibe for the treatment of primary hypercholesterolaemia NICE TA133: Omalizumab for severe persistent allergic asthma MHRA Safety Updates: Fibrates and Glitazones |
|
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
