Pharmaceutical Benefit Advisory Committee: Prescribed List: Amendments

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A decision made on 28 February 2019

Decision Reference: MD-S-2019-0018
Decision Summary Title :	DS_Changes to Prescribed List as of 1 April 2019		Date of Decision Summary:	26 February 2019
Decision Summary Author:	Policy Principal		Decision Summary: Public or Exempt?	Public
Type of Report: Oral or Written?	Written		Person Giving Oral Report:	N/A
Written Report Title :	WR_Changes to Prescribed List as of 1 April 2019		Date of Written Report:	26 February 2019
Written Report Author:	Policy Principal		Written Report : Public or Exempt?	Public
Subject: Changes to be made to the Prescribed List (Jersey) as of 1 April 2019
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 April 2019 as set out in the accompanying report.
Reason(s) for Decision: The Pharmaceutical Benefit Advisory Committee met on 14 February 2019 and has provided the Minister with recommendations and the accompanying written report regarding amendments to the Prescribed List. Items to be added to the Prescribed List Nadolol tablets 80mg for the treatment of irregular heart rhythms Naproxen enteric-coated (ec) tablets 250mg, 500mg [as temporary replacement for naproxen (plain) tablets] Ethinylestradiol 20mcg / Drospirenone 3mg tablets for oral contraception Metformin oral solution sugar-free 500mg/5mL, 850mg/5mL, for the treatment of type 2 diabetes Memantine tablets 20mg Memantine treatment initiation pack containing tablets 5mg/10mg/15mg/20mg 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 and community prescribers at a proportionate cost to the Fund.
Resource Implications: The overall impact of the changes is expected to be around £44,000 pa.
Action required: Health Zone Manager at Customer and Local Services to issue a 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):

Pharmaceutical Benefit Advisory Committee: Prescribed List: Amendments

RECOMMENDATIONS OF THE

PHARMACEUTICAL BENEFIT ADVISORY COMMITTEE

14 February 2014

Summary

The Pharmaceutical Benefit Advisory Committee (PBAC) met on 14 February 2019 to consider applications for changes to the Prescribed List.

The PBAC was unanimous in its recommendations for the following changes to the Prescribed List.

Items to be added to the Prescribed List

Nadolol tablets 80mg for the treatment of irregular heart rhythms
Naproxen enteric-coated (ec) tablets 250mg, 500mg [as temporary replacement for naproxen (plain) tablets]
Ethinylestradiol 20mcg / Drospirenone 3mg tablets for oral contraception
Metformin oral solution sugar-free 500mg/5mL, 850mg/5mL, for the treatment of type 2 diabetes
Memantine tablets 20mg
Memantine treatment initiation pack containing tablets 5mg/10mg/15mg/20mg

Interim consideration of changes to the Prescribed List

The Committee noted the increasing impact of medicines supply problems on patient care. In some circumstances, an effective alternative to an out-of-stock medicine may not be included in the Prescribed List; getting the List changed to include the alternative can then take 3-4 months considering the frequency of PBAC meetings. The Committee agreed the need for a process whereby recommendations could be made to the Minister in a timely fashion should items become out-of- stock.

It was agreed that the PBAC could consult and confer via email and recommend temporary additions to the prescribed list for the minister’s approval and that such a process would be in keeping with the Law.

Financial impact

The overall financial impact of the above changes is estimated to be an increase in expenditure of around £44,000 pa.

Mrs Alison Creed

Chair, PBAC

18 February 2019

Recommendations

Items to be added to the Prescribed List

Nadolol tablets 80mg for the treatment of irregular heart rhythms

Nadolol was requested by the Cardiac Specialist at Jersey General Hospital, to treat patients with irregular heart rhythms. Although there is little direct evidence that nadolol is more effective that alternatives, it has a better safety profile and has become established as the treatment of choice at specialist centres around the world, reflected in its inclusion in international treatment guidelines. Nadolol has been on the market for many years and is relatively inexpensive.

Naproxen enteric-coated (ec) tablets 250mg, 500mg

This product provides an alternative to naproxen plain tablets, already included in the List, which are in short supply. Switching patients to naproxen e/c tablets, allows them to continue to be treated effectively. However, e/c tablets are slightly more expensive.

Ethinylestradiol 20mcg / Drospirenone 3mg tablets for oral contraception

The higher strength of this product is already included in the Prescribed List. Adding the lower strength provides more options for patients at no additional cost.

Metformin oral solution sugar-free 500mg/5mL, 850mg/5mL, for the treatment of type 2 diabetes

Metformin tablets are included in the Prescribed List but there is no liquid preparation of this medicine listed as an option for patients unable to swallow tablets. Metformin oral solution is more expensive than tablets but is expected to be prescribed for only a small number of patients.

Memantine tablets 20mg
Memantine treatment initiation pack containing tablets 5mg/10mg/15mg/20mg

Memantine 10mg tablets are already included in the Prescribed List. The recommended dose is 10-20mg once daily so it is more convenient for patients, and less expensive, if a single 20mg tablet can be taken instead of 2x10mg tablets.
For patients starting treatment, following recommendation by a specialist, there is a treatment initiation pack available that includes the 4 strengths of tablet needed to escalate the dose to the recommended maintenance dose. Where the GP is asked to initiate treatment, having the initiation pack on the List will be more convenient for patients.

Estimated cost impact of PBAC recommendations 14 February 2019