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
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| PACE Bulletin Vol 1 No 8 Dec07 | |
DescriptionNew Drug Assessment: Aliskiren (Rasilez) for teatment of essential hypertension classified AMBER Rotigotine Transdermal Patch (Neupro) licensed as monotherapy for the treatment of the signs and symptoms of early stage idiopathic Parkinson’s disease and as an adjunct to levodopa with a dopa-decarboxylase inhibitor classified AMBER Glucosamine (Alateris) relief of symptoms in mild to moderate osteoarthritis of the knee classified RED-RED Human Papillomavirus Vaccine (Cervarix and Gardasil) prevention of high-grade intraepithelial neoplasia and cervical cancer causally related to HPV types 16 and 18. classified RED-RED Product Withdrawals Reminder: Co-proxamol and Lumiracoxib (Prexige) NICE TA129: Bortezomib monotherapy for relapsed multiple myeloma NICE TA130: Adalimumab, etanercept and infliximab for the treatment of rheumatoid arthritis |
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| PACE Bulletin Vol 1 No 7 Nov07 | |
DescriptionGuidance on the Use of Antibacterial Drugs in Lincolnshire Primary Care: Winter 2007/8 NICE CG54: Urinary Tract Infection in Children |
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| PACE Bulletin Vol 1 No 6 Nov07 | |
DescriptionPaliperidone (Invega) licensed for the treatment of schizophrenia classified RED-RED Penflurido an unlicensed once weekly oral antipsychotic agent used for the treatment of schizophrenia RED (only to be initiated and prescribed by LPT clinicians) Tiotropium Bromide (Spiriva Respimat) GREEN (N.B. Take care to prescribe by brand to avoid confusion between the Respimat and the HandiHaler) Symbicort SMART (SYMBICORT FOR MAINTENANCE AND RELIEF THERAPY) NICE TA111: Donepezil, galantamine, rivastigmine (review) and memantine for the treatment of Alzheimer’s disease NICE CG 51 & 52: Drug misuse: psychosocial interventions and opioid detoxification NICE CG 53: Chronic Fatigue Syndrome/Myalgic Encephalomyelitis (or Encephalopathy) Shared Care Guidelines: Fulvestrant, Ibandronic acid, Cinacalcet, Lanthanum and Sevelamer |
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| PACE Bulletin Vol 1 No 5 Oct07 | |
DescriptionSafety concerns associated with rosiglitazone New Drug Assessment: Exenatide (Byetta) for treatment of type 2 diabetes in combination with metformin and sulphonylureas classified RED-RED (N.B. This decision will be reviewed in early 2008 following the publication of the updated NICE Clinical Guideline on the management of type 2 diabetes)Sitagliptin (Januvia) indicated for use with metformin or a glitazone in type 2 DM inadequately controlled by diet , exercise and either metformin or a glitazone Classified RED-RED (N.B. This decision will be reviewed in early 2008 following the publication of the updated NICE Clinical Guideline on the management of type 2 diabetes and the launch of vildagliptin)Lidocaine Medicated Plaster (Versatis) the treatment of postherpetic neuralgia classified AMBER for post-herpetic neuralgia subject to specialist initiation after all other alternatives have been tried. Designated as RED-RED for neuropathic pain (unlicensed). Rapid Assessments: Emollin Spray, Sensicare Emollient licensed for topical application to dry, scaly, sensitive or sore skin. Classified GREEN Beclometasone 5mg tablets (Clipper) Licensed for use in combination with aminosalicylates for mild to moderate ulcerative colitis in patients unresponsive to aminosalicylates Classified RED-RED pending specialist review NICE TA124: Pemetrexed for non-small cell lung cancer NICE TA125: Adalimumab licensed for the treatment of active and progressive psoriatic arthritis that has not responded adequately to other disease modifying anti-rheumatic drugs (DMARDs) NICE TA126: Rituximab for rheumatoid arthritis NICE TA127: Natalizumab for highly active relapsing-remitting multiple sclerosis |
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| PACE Bulletin Vol 1 No 4 Sep07 | |
DescriptionEplerenone (Inspra) for stable patients with left ventricular dysfunction (LVD) with evidence of heart failure (HF) following myocardial infarction classified AMBER (Specialist initiation, but no shared care guideline required) Ranibizumab (Lucentis) for treatment of neovascular (wet) age-related macular degeneration (AMD) classified RED-RED Varenicline (Champix) smoking cessation in adults classified GREEN. NB Should be considered as a potential second line alternative to bupropion in patients committed to stopping smoking that have tried and failed to quit using NRT support. NICE CG49: FAECAL INCONTINENCE |
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| PACE Bulletin Vol 1 No 3 Aug07 | |
DescriptionDRAFT NICE CLINICAL GUIDELINE ON LIPID MODIFICATION FOR THE PRIMARY AND SECONDARY PREVENTION OF CARDIOVASCULAR DISEASE |
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| PACE Bulletin Vol 1 No 2 Jul07 | |
DescriptionKatya tablets oral contraception classified GREEN Natalizumab inf (Tysabri) for highly active relapsing remitting multiple sclerosis (N.B. It has been agreed that following the imminent publication of a new NICE TA, natalizumab will be reclassified as RED) Omacor capsules for hypertriglyceridaemia and secondary prevention after MI classified RED-RED Omalizumab 150mg inj (Xolair) for severe persistent allergic asthma in patients 12 years and over classified RED-RED Subject to a favourable NICE TA, omalizumab is likely to be re-classified as RED later in the year. Sodium valproate MR capsules (Episenta) are classified as GREEN Sunya tablets oral contraception classified GREEN Testosterone 2% gel (Tostran) testosterone replacement in male hypogonadism with confirmed testosterone deficiency classified GREEN NICE TA122: ALTEPLASE FOR THE TREATMENT OF ACUTE ISCHAEMIC STROKE NICE CG48: MI: SECONDARY PREVENTION |
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| PACE Bulletin Vol 1 No 1 Jun07 | |
DescriptionPACEF Decisions: June Update Exforge tabs (amlodipine/valsartan) for hypertension classified as RED-RED Natalizumab (Tysabri) for Highly active relapsing remitting multiple sclerosis is classified as RED-RED Lanthanum Carbonate (Fosrenol) for Hyperphosphataemia in chronic renal failure is classified as AMBER Sevelamer tabs (Renagel) Hyperphosphataemia in chronic renal failure is classified as AMBER Testosterone patch (Intrinsa) Women with hypoactive sexual desire disorder classified as RED-RED Human Papillomavirus Vaccine (Gardasil) Prevention of cervical cancer classified as RED-RED NICE Update: CG 46 Venous Thromboembolism CG 47 FEVERISH ILLNESS IN CHILDREN |
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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
