Changes to be made to the Prescribed List (Jersey) as at 1 October 2008.

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A decision made (12/09/20089) regarding: Changes to be made to the Prescribed List (Jersey) as at 1 October 2008.

Decision Reference: MD-S-2008-0047
Decision Summary Title :	Prescribed List (Jersey) 1 October 2008		Date of Decision Summary:	14/8/08
Decision Summary Author:	R. Goulding Policy Principal		Decision Summary: Public or Exempt?	Public
Type of Report: Oral or Written?	Written		Person Giving Oral Report:
Written Report Title :	Changes to be made to the Prescribed List (Jersey) as at 1 October 2008		Date of Written Report:	14/8/08
Written Report Author:	R. Goulding Policy Principal		Written Report : Public or Exempt?	Public
Subject: Changes to be made to the Prescribed List (Jersey) as at 1 October 2008
Decision(s): The Minister approved the changes to the Prescribed List (Jersey) as recommended by the Pharmaceutical Benefits Advisory Committee from the meeting held on the 19 March 2008. To be included: 17 items - Please refer to attachment (appendix two) To be deleted 86 items – Please refer to attachment (appendix three) To give notice that the following item will be deleted from the Prescribed List on 31st March 2009 Gabapentin 600mg tablets, 800mg tablets
Reason(s) for Decision: The Pharmaceutical Benefits Advisory Committee met on 19 March 2008 and provided the Minister with the recommended changes to the Prescribed List (Jersey), effective from 1 October 2008. The changes included modifications and clarifications to the single Island formulary (implemented in October 2007) as well as an update of the list to remove discontinued products. The Minister has postponed a decision on contraception medication and devices (appendix one) pending a Health and Social Services report on the current provision Family Planning Services.
Resource Implications: The implementation of the single Island formulary resulted in an additional annual cost of £1.3 million (approximate) cost to the Health Insurance fund and the recommendations are part of this cost. The Fund has sufficient resources.
Action required: The Minister approved the recommendations made by the Pharmaceutical Benefits Advisory Committee for implementation on 1 October 2008.
Signature:		Position:
Date Signed:		Date of Decision (If different from Date Signed):

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Changes to be made to the Prescribed List (Jersey) as at 1 October 2008.

Recommendations of the Pharmaceutical benefit Advisory Committee

March 2008

1. SUMMARY

The Pharmaceutical Benefit Advisory Committee met on 19th March 2008 to consider the inclusion and/or deletion of certain products from the Prescribed List. The PBAC recommended the inclusion of 66 products and the deletion of 86 products detailed in this report. This also includes work to update the list by removing discontinued preparations and clarify issues resulting from the implementation of a single Island formulary.

BACKGROUND

Items for inclusion

2.1. Contraception – (refer to appendix 1)

The likely cost to the Health Fund for these items is estimated at £130,000 per annum (net drug cost). All currently available long acting reversible contraception (LARC) methods (intrauterine devices [IUDs], the intrauterine system [IUS], injectable contraceptives and implants) are more cost effective than the combined oral contraceptive pill even at 1 year of use. Increasing the uptake of LARC methods will reduce the numbers of unintended pregnancies.

The Health and Social Services Department is commissioning a review of Family Planning Services through the Sexual Health Strategy Group. Thus, Public Health have requested a postponement until this review is completed. A further report will be prepared for the Minister to consider including the recommendations of this Review.

2.2. Mycophenolate capsule 250mg/ tablet 500mg/ oral suspension 1g/5mL; mycophenolic acid tablet 180mg, 360mg. (Amber Classification)

Mycophenlate is licensed for use in combination with ciclosporin and corticosteroids for the prophylaxis of acute transplant rejection in patients receiving allogeneic renal transplants. Other options for immunosuppression are available on the Prescribed List (as AMBER drugs). Where these options are not suitable, mycophenolate is an appropriate and is currently prescribed from the hospital. Prescribing in primary care should only be within a shared-care framework following initiation and stabilisation in secondary/tertiary care.

2.3. Sevelamer tablets 800mg (Renagel, Genzyme) (Amber Classification)

Sevelamer is licensed for the treatment of hyperphosphataemia in patients on haemodialysis. It is a poly[allylamine] hydrochloride polymer that acts by binding phosphate molecules in the gut and so lowering serum phosphate levels. It is suitable for prescribing in primary care with the guidance of a shared care agreement once it has been initiated and the dose stabilised in secondary care.

2.4. Bimatoprost 300mcg/mL eye drops (*Lumigan – Allergan); bimatoprost 300mcg/mL/timolol 5mg/mL eye drops (*Ganfort – Allergan) (Green Classification)

Treatment of raised intra-ocular pressure in open-angle glaucoma; ocular hypertension Treatment with these products should be initiated by an ophthalmologist but long-term prescribing may be referred to the patient’s GP once treatment is established.

2.5. Metformin 850mg/pioglitazone 15mg tablet (*Competact - Takeda)

For the treatment of patients with type 2 diabetes that is not controlled by metformin alone.

2.6. Menthol 0.5%, 1%, 2% in aqueous cream 500g

Menthol and aqueous cream are available separately on the Prescribed List but the the availability of a proprietary product containing these constituents avoids the need for extemporaneous preparation.

3.0 Items to be deleted from the Prescribed List

Gabapentin tablets 600mg, 800mg

There is a substantial difference in price of gabapentin capsules 300mg/400mg and gabapentin tablets 600mg/800mg. Using multiples of the lower strength capsules (ie 2x300mg capsule instead of 1x600mg tablet) would reduce total expenditure.

Continued development of a single Island formulary

The Committee accepted the attached amendments and clarifications to the current list (appendix 2 and 3). These arise from the ongoing work to develop a single Island formulary and the need to delete discontinued products

RECOMMENDATION

The Minister is asked to postpone approval for contraception pending the H&SS review of family planning services and approve all other changes to take effect from 1st October 2008.