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Information and public services for the Island of Jersey

L'înformâtion et les sèrvices publyis pouor I'Île dé Jèrri

Health Insurance (Jersey) Law 1967: Prescribed list as of 1st April 2020

A formal published “Ministerial Decision” is required as a record of the decision of a Minister (or an Assistant Minister where they have delegated authority) as they exercise their responsibilities and powers.

Ministers are elected by the States Assembly and have legal responsibilities and powers as “corporation sole” under the States of Jersey Law 2005 by virtue of their office and in their areas of responsibility, including entering into agreements, and under any legislation conferring on them powers.

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  • demonstrating that good governance, and clear lines of accountability and authority, are in place around decisions-making – including the reasons and basis on which a decision is made, and the action required to implement a decision

  • providing a record of decisions and actions that will be available for examination by States Members, and Panels and Committees of the States Assembly; the public, organisations, and the media; and as a historical record and point of reference for the conduct of public affairs

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The Freedom of Information Law (Jersey) Law 2011 is used as a guide when determining what information is be published. While there is a presumption toward publication to support of transparency and accountability, detailed information may not be published if, for example, it would constitute a breach of data protection, or disclosure would prejudice commercial interest.

A decision made on 6 March 2020

Decision Reference:  MD-S-2020-0014

Decision Summary Title :

DS Prescribed list as of 1 April 2020

Date of Decision Summary:

27 February 2020

Decision Summary Author:

Policy Principal

Decision Summary:

Public or Exempt?

Public

Type of Report:

Oral or Written?

Written

Person Giving

Oral Report:

NA

Written Report

Title :

WR Prescribed list as of 1 April 2020

Date of Written Report:

17 February 2020

Written Report Author:

Prescribing Advisor

Written Report :

Public or Exempt?

 

Public

Subject: Changes to be made to the Prescribed List (Jersey) as of 1 April 2020

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 March 2020 as set out in the accompanying report and supporting document.

Reason(s) for Decision: The Pharmaceutical Benefit Advisory Committee met to consider  applications for changes to the Prescribed List and made the following recommendations:  

1.      Items to be added to the Prescribed List

1.1     Ticagrelor 60mg tablets (interim recommendation November 2019)

1.2     Sodium hyaluronate 0.2% eye drops preservative free

1.3     VitA-POS™֥ eye ointment preservative free

1.4     Colesevelam 625mg tablets

1.5     Colestipol 5g granules sachets sugar free

1.6     Mesalazine 1g suppositories

1.7     Trimbow™ 87micrograms/dose / 5micrograms/dose / 9micrograms/dose inhaler

1.8     Rivaroxaban 2.5mg tablets, 10mg tablets

1.9     Captopril 25mg/5ml oral solution sugar free

1.10          Aciclovir eye ointment (temporary reinstatement for 6 months only to allow for pharmacy stock to be used up)

 

  1. Items to be removed from the Prescribed List

 

 Removal from April 2021:

2.1 Pethidine tablets

2.2 Flurazepam capsules

 

Removal from July 2020:

2.3 Pethidine injection

2.4 Aminophylline injection

2.5 Danazol capsules

2.6 Demeclocycline capsules

2.7 Diethylstilbestrol 5mg tablet

2.8 Dihydrocodeine injection

2.9 Disopyramide injection

2.10 Ephedrine injection

2.11 Fentanyl injection

2.12 Pergolide tablets

2.13 Sodium cromoglicate caps 100mg

2.14 Uvistat sun screen Factor 30

2.15 Phenelzine tablets

2.16 Phenindione tablets

2.17 Phenoxybenzamine capsules

2.18          Pimozide tablets

 

  1. Other changes to the Prescribed List

The following two products were recommended for reimbursement as ‘Generic only’.

3.1 Budesonide 64micrograms/dose nasal spray

3.2 Bimatoprost 300micrograms/ml eye drops

 

The recommendation reflects 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 financial impact of the above changes is expected to be cost neutral.  

 

Action required: Work and Family Hub Manager at Customer and Local Services to issue a public notice listing amendments and notify all approved medical practitioners and approved contractors.

Signature:

 

 

 

Deputy J A Martin

Position:

 

Minister for Social Security

 

Date Signed:

 

 

Date of Decision (If different from Date Signed):

 

Hide report
Health Insurance (Jersey) Law 1967: Prescribed list as of Ast April 2020

RECOMMENDATIONS OF THE

PHARMACEUTICAL BENEFIT ADVISORY COMMITTEE

 

Summary

 

The Pharmaceutical Benefit Advisory Committee (PBAC) met on 13 February 2020 to consider applications for changes to the Prescribed List.

 

The PBAC was unanimous in its recommendations for the following changes to the Prescribed List to be implemented from 1 April 2020, unless stated otherwise.

 

1.      Items to be added to the Prescribed List

 

1.1    Ticagrelor 60mg tablets (interim recommendation November 2019)

1.2    Sodium hyaluronate 0.2% eye drops preservative free

1.3    VitA-POS™֥ eye ointment preservative free

1.4    Colesevelam 625mg tablets

1.5    Colestipol 5g granules sachets sugar free

1.6    Mesalazine 1g suppositories

1.7    Trimbow™ 87micrograms/dose / 5micrograms/dose / 9micrograms/dose inhaler

1.8    Rivaroxaban 2.5mg tablets, 10mg tablets

1.9    Captopril 25mg/5ml oral solution sugar free

1.10 Aciclovir eye ointment (temporary reinstatement for 6 months only to allow for pharmacy stock to be used up)

 

2.      Items to be removed from the Prescribed List

 

1

 


Removal from March 2021:

2.1   Pethidine tablets

2.2   Flurazepam capsules

Removal from June 2020:

2.3   Pethidine injection

2.4   Aminophylline injection

2.5   Danazol capsules

2.6   Demeclocycline capsules

2.7   Diethylstilbestrol 5mg tablet

2.8   Dihydrocodeine injection

2.9   Disopyramide injection

2.10                    Ephedrine injection

2.11                     Fentanyl injection

2.12                     Pergolide tablets

2.13                     Sodium cromoglicate caps 100mg

2.14                     Uvistat sun screen Factor 30

2.15                     Phenelzine tablets

2.16                     Phenindione tablets

2.17                     Phenoxybenzamine capsules

2.18                     Pimozide tablets

 

 


 

  1. Other changes to the Prescribed List

The following two products were recommended for reimbursement as ‘Generic only’.

3.1  Budesonide 64micrograms/dose nasal spray

3.2  Bimatoprost 300micrograms/ml eye drops

 

 

 

  1. Other considerations
    1.    An application for the addition of imiquimod 5% cream, for the treatment of a number of skin conditions, was supported at the meeting in September 2019 on the condition that it was supported by the hospital dermatologist, with appropriate training for primary care prescribers and development of shared care guidance. However, the hospital dermatology team were not supportive of the product being available in primary care, stating that it required specialist initiation and follow-up. The consultant dermatologist was also concerned that it might be used without specialist input. The Committee considered this new information and agreed not to pursue the addition of imiquimod to the List.

 

4.2   Nepafenac 3mg/ml eye drops was not recommended for addition to the Prescribed List. This anti-inflammatory eye drop is used following cataract surgery and not thought to be appropriate for ongoing prescribing in primary care. In addition, ophthalmic surgeons at JGH use another anti-inflammatory product as their drug of choice.

 

4.3   An application for the FebriDx point of care test to be added to the Prescribed List was considered but not recommended. The Committee agreed that the product was potentially helpful in the management of patients with suspected upper respiratory tract infections and could help to avoid the unnecessary prescribing of antibacterials. They, therefore, supported efforts to identify possible sources of funding but did not feel that restricting access through prescription was the right approach.    

 

4.4   Acetic acid 2% ear spray was not recommended for addition to the Prescribed List. This product is recommended in local guidelines as an option in the treatment of otitis externa, which causes pain in the ear canal. Since acetic acid ear drops avoid the need to use antibiotics, its use was supported by the Committee. However, the Committee also noted that the ear drops can be bought over the counter from pharmacies and prescribers should be encouraged to recommend the product to patients.

 

 

 

 

Financial impact

 

The overall financial impact of the above changes is expected to be cost neutral.  

 

Mrs Alison Creed

Chair, PBAC

 

17 February 2020

 


Recommendations

 

  1. Items to be added to the Prescribed List

 

1.1   Sodium hyaluronate 0.2% eye drops preservative free

1.2   VitA-POS™֥ eye ointment preservative free

 

These two eye products are used for the treatment of dry eye. They provide alternatives to products included in the Prescribed List, many of which have been in short supply. Although the unit cost of these two products is more than existing products, they have a 6-month in use expiry (compared with a 1-2 month expiry for other products) and so offer the potential for less waste and fewer units to be needed throughout the year, reducing treatment costs overall.

 

1.3   Colesevelam 625mg tablets

1.4   Colestipol 5g granules sachets sugar free

 

These two products, indicated for the reduction of high cholesterol levels, have been recommended as they offer an alternative to a product, colestyramine, that is already included in the Prescribed List but currently unavailable. Switching to these two products in expected to be cost neutral.

 

1.5   Mesalazine 1g suppositories

 

Mesalazine 500mg suppositories are already included in the List. Adding this higher strength product increases treatment options for patients at no additional cost.

 

1.6   Trimbow™ 87micrograms/dose / 5micrograms/dose / 9micrograms/dose inhaler

 

Trimbow metered dose inhaler contains a combination of 3 medicines for the treatment of chronic obstructive pulmonary disease. It is therapeutically equivalent to the Trelegy inhaler, already included in the Prescribed List, which also contains a combination of 3 medicines. However, Trelegy is a dry powder inhaler device, which may not be suitable for all patients so Trimbow metered dose inhaler offers an alternative type of inhaler device at no additional cost.

 

1.7   Rivaroxaban 2.5mg tablets, 10mg tablets

 

Higher strengths of rivaroxaban are already included in the Prescribed List. Since their inclusion, lower strength products have been made available, at the same flat price, but with specific indications of their own.

 

1.8   Captopril 25mg/5ml oral solution sugar free

 

This higher strength of captopril oral solution provides a less expensive alternative to the 5mg/5ml strength solution already included in the Prescribed List. For the very small number of older children who require higher doses of captopril in the form of an oral solution, switching to the 25mg/5mL solution could substantially reduce treatment costs. 

  1. Items to be removed from the Prescribed List

 

PBAC recommends the removal of the following products from the Prescribed List. These products are either no longer prescribed or are less suitable for prescribing in primary care. Since a few patients are currently receiving prescriptions for pethidine tablets and flurazepam capsules, and are likely to be dependent on these products, prescribers will be given 12 months’ notice of their removal. All other products, that are not currently prescribed, will be subject to the usual 3 months’ notice before removal. 

 

Items proposed for removal from the List

Rationale for removal

Number of items dispensed in last 6 months

Pethidine tablets

Low use. Faculty of Pain Medicine guidance describes pethidine as particularly unsuitable for patients with persistent pain. Its short duration of action may predispose patients to problem drug use and its metabolite, norpethidine, can cause serious central nervous system effects. Pethidine has no clinical advantage over other opioid analgesics

38

Pethidine injection

Low use. Faculty of Pain Medicine guidance describes pethidine as particularly unsuitable for patients with persistent pain. Its short duration of action may predispose patients to problem drug use and its metabolite, norpethidine, can cause serious central nervous system effects. Pethidine has no clinical advantage over other opioid analgesics

0

Flurazepam capsules

Black-listed in the NHS. Flurazepam has a long duration of action so its sedating effects can persist the next day.

162

Aminophylline injection

Low use. No need for use in primary care

0

Danazol capsules

No use

0

Demeclocycline capsules

No use

0

Diethylstilbestrol 5mg tablet

No use

0

Dihydrocodeine injection

No need for use in primary care

0

Disopyramide injection

No need for use in primary care

0

Ephedrine injection

No need for use in primary care

0

Fentanyl injection

No need for use in primary care

0

Pergolide tablets

Specialist use

 0

Sodium cromoglicate capsules 100mg

 Licensed for the management of food allergy but weak evidence of benefit.

3

Uvistat sunscreen Factor 30

(SPF 50 to remain)

Only indicated for skin protection against UV radiation in abnormal cutaneous photosensitivity when the highest SPF should be prescribed. The BNF advises that products with SPF less than 30 should not normally be prescribed.

41

Phenelzine tablets

No use. BNF notes that this product is less suitable for prescribing.

0

Phenindione tablets

No use. High cost (£21 per tablet)

0

Phenoxybenzamine capsules

Specialist use. 

0

Pimozide tablets

No use

0

 

 

1

 

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