Prescribed List: Changes from 1 August 2017

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A decision made 30 June 2017:

Decision Reference: MD-S-2017-0040
Decision Summary Title :	Prescribed List Changes 1 August 2017		Date of Decision Summary:	26 June 2017
Decision Summary Author:	Prescribing Advisor		Decision Summary: Public or Exempt?	Public
Type of Report: Oral or Written?	Written		Person Giving Oral Report:	N/A
Written Report Title :	Changes to be made to the Prescribed List as at 1 August 2017		Date of Written Report:	26 June 2017
Written Report Author:	Prescribing Advisor		Written Report : Public or Exempt?	Public
Subject: Changes to be made to the Prescribed List (Jersey) as at 1 August 2017
Decision(s): Further to Article 15, paragraphs (11) and (12), of the Health Insurance (Jersey) Law 1967, and having consulted with the Pharmaceutical Benefit Advisory Committee, the Minister decided to make amendments to the Prescribed List with effect from 1 August 2017 as set out in the accompanying report.
Reason(s) for Decision: The Pharmaceutical Benefit Advisory Committee met on 23 May 2017 and has provided the Minister with the accompanying written report setting out its recommendations in respect of amendments to the Prescribed List. On considering these recommendations, the Minister would like to make the following amendments. New products to be added to the Prescribed List Empagliflozin tablets 10mg, 25mg; with metformin 5mg/1000mg, 12.5mg/1000mg, 5mg/850mg, 12.5mg/850mg for the treatment of type 2 diabetes Tiotropium/olodaterol for the treatment of chronic obstructive pulmonary disease (COPD) Budesonide/formoterol 160mcg/4.5mcg, 320mcg/9mcg (DuoResp Spiromax) for the treatment of asthma Cetraben ointment for use as a skin emollient Levonorgestrel intrauterine device 13.5mg (brand name Jaydess) for contraception Additional preparations of products already listed Sevelamer powder 2.4g oral powder (generic only) Dexamethasone preservative-free eye drops 0.1% 0.4mL unit dose Items to be removed from the Prescribed List Dexamethasone preservative-free eye drops 0.1% 0.5mL unit dose Other amendments to the Prescribed List Sevelamer tablets 800mg to be listed as ‘Generic Only’ All hormone replacement therapy (HRT) to be listed for up to 90 day supply and included in Schedule 4 of the Health Insurance (pharmaceutical Benefit) (General Provisions) (no.2) (Jersey) Order 2002 The changes reflect current evidence and expert advice, and ensure that patients in Jersey have access to an appropriate range of modern, safe and effective treatments from their GPs at a proportionate cost to the Fund
Resource Implications: The overall impact of the changes is expected to reduce total expenditure for Pharmaceutical Benefit by approximately £70,000.
Action required: Business Manager to issue public notice listing amendments and notify all approved medical practitioners and approved contractors.
Signature:		Position: Minister
Date Signed:		Date of Decision (If different from Date Signed):

Prescribed List: Changes from 1 August 2017

RECOMMENDATIONS OF THE

PHARMACEUTICAL BENEFIT ADVISORY COMMITTEE

23 May 2017

Summary

The Pharmaceutical Benefit Advisory Committee (PBAC) met on 23 May 2017 to consider applications for changes to the Prescribed List.

The PBAC recommended the following changes to the Prescribed List:

1 New products to be added to the Prescribed List

1.1 Empagliflozin tablets 10mg, 25mg; with metformin 5mg/1000mg, 12.5mg/1000mg, 5mg/850mg, 12.5mg/850mg for the treatment of type 2 diabetes

1.2 Tiotropium/olodaterol for the treatment of chronic obstructive pulmonary disease (COPD)

1.3 Budesonide/formoterol 160mcg/4.5mcg, 320mcg/9mcg (DuoResp Spiromax) for the treatment of asthma

1.4 Cetraben ointment for use as a skin emollient

1.5 Levonorgestrel intrauterine device 13.5mg (brand name Jaydess) for contraception

2 Additional preparations of products already listed

2.1 Sevelamer powder 2.4g oral powder (generic only)

2.2 Dexamethasone preservative-free eye drops 0.1% 0.4mL unit dose

3 Items to be removed from the Prescribed List

3.1 Dexamethasone preservative-free eye drops 0.1% 0.5mL unit dose

4 Other amendments to the Prescribed List

4.1 Sevelamer tablets 800mg to be listed as ‘Generic Only’

4.2 All hormone replacement therapy (HRT) to be listed for up to 90 day supply and included in Scheduled 4

5 Applications deferred

5.1 Atomoxetine capsules 10mg, 18mg, 25mg, 40mg, 60mg, 80mg, 100mg for the treatment of ADHD pending views from the Child and Adolescent Mental Health (CAMHs) Team

5.2 Methylphenidate tablet 5mg, 10mg, 20mg; modified-release tablets 18mg, 27mg, 36mg, 54mg; modified-release capsules 5mg, 10mg, 20mg, 30mg, 40mg, 50mg, 60mg for the treatment of ADHD pending views from the CAMHs team

6 Financial impact

The proposed changes to the Prescribed List are estimated to reduce total annual expenditure by approximately £70,000.

Mrs Alison Creed

Chair, PBAC

21 June 2017

Recommendations

Items to be added to the Prescribed List

1.1	Empagliflozin tablets 10mg, 25mg; with metformin 5mg/1000mg, 12.5mg/1000mg, 5mg/850mg, 12.5mg/850mg for the treatment of type 2 diabetes. Evidence was presented that showed a reduction in cardiovascular risk for patients with type II diabetes treated with empagliflozin compared to placebo. While this may, in time, be shown to be a class effect, for now empagliflozin is the drug of choice in its therapeutic group. A similar price to other drugs in its group means that use of empagliflozin is not expected to increase overall expenditure. The Committee was unanimous in recommending its addition to the Prescribed List.
1.2	Tiotropium with olodaterol 2.5mcg/2.5mcg per dose pressured inhalation (brand name Spiolto Respimat) for the treatment of COPD The Committee accepted recommendations from local respiratory specialists that this product provided a helpful addition to existing therapies at no additional cost. It contains tiotropium, which is already on the Prescribed List, plus a long-acting bronchodilator. Making this product available also provides an alternative to another product, which is in limited supply to the Island. The Committee was unanimous in recommending its addition to the Prescribed List.
1.3	Budesonide/formoterol 160mcg/4.5mcg, 320mcg/9mcg (DuoResp Spiromax) for the treatment of adults with asthma or COPD The Committee accepted recommendations from the local respiratory specialists that this product is easier to use and less expensive than the originator product with the same constituent drugs. Estimates suggest total annual expenditure could be reduced by around £80,000 if this drug is used as the preferred option. The Committee was unanimous in recommending its addition to the Prescribed List.
1.4	Cetraben ointment for use as a skin emollient was unanimously recommended by the Committee to provide an alternative to the cream-based product of the same brand.
1.5	Levonorgestrel intrauterine device 13.5mg (brand name Jaydess) for contraception. Jaydess provides a smaller alternative to the established Mirena brand intrauterine device and is now the preferred option for local family planning specialists. It is no more expensive than Mirena. The Committee was unanimous in recommending its addition to the Prescribed List.

Other changes to the Prescribed List

1 All hormone replacement therapy (HRT) to be listed for up to 90 day supply and included in Scheduled 4

At its previous meeting, the Committee discussed an application from a number of local GPs for hormone-replacement therapy (HRT) to be allowed as supply for up to 90 days, the same as for oral contraceptives. The clinical reason for this is that few women taking HRT need to be reviewed within the 3-month period and so should receive the full supply. Analysis of prescriptions suggests that many women already receive all three monthly prescriptions for their HRT medicine dispensed at the same time but incurring 3 dispensing fees for the single supply. Moving this specific group of medicines to Schedule 4 to allow up to 3 months supply to be dispensed on one prescription will reduce inconvenience for patients and prescribers and reduce Pharmaceutical Benefit payments by about £30,000pa.