Summary of Prescribing Formulary Changes May 2015 to January 2017
Date
Recorded
in PAMM
minutes
Additions to Formulary
January
2017
Removed from Formulary
Gluten free products
These were agreed non-formulary through an
engagement exercise on 1st December 2016.
Medicines for self-care
These were agreed non-formulary through an
engagement exercise on 1st December 2016.
Acidex® Advance Pinewood Healthcare
Peppermint or Aniseed.
Each 10 ml contains: Sodium Alginate 1000 mg and
Potassium hydrogen carbonate 200 mg.
£2.21 for 250ml and £4.42 for 500ml.
(It is the same strength as Gaviscon Advance: £2.56
for 250ml and £5.12 for 500ml)
Will be recommended for switching from Gaviscon
Advance.
Pipexus® (Pramipexole) prolonged release tablets
Ethypharm UK Ltd
List price 50% less expensive than Mirapexin and are
cheaper than current brand preference Oprymea.
Ventra® (Esomeprazole) gastro-resistant capsules
Ethypharm UK Ltd
List price 25% less than Cat C Tariff Price Emozul®
Noqdirna® Oral Lyophilisate (desmopressin acetate)
Ferring Pharmaceuticals
50mcgx30tabs = £15.16
25mcgx30tabs = £15.16
Indicated for symptomatic treatment of nocturia due
to idiopathic nocturnal polyuria in adults.
First product licensed for this condition.
Amoxil® (Amoxicillin) capsules GlaxoSmithKline UK
500mgx21caps = £0.89 (Amoxicillin DT price = £1.26)
250mgx21caps = £0.92 (Amoxicillin DT price = £1.08)
GSK have reduced their prices, switches would
provide around a £16,000 per year saving. The
reduced price has been monitored over the last 6
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November
2016
months and has remained below drug tariff. GSK
have reassured us the reduced prices will continue
for a reasonable time.
GlucoRx safety lancets
have been added where healthcare staff are testing
patients
Braltus 10 microgram per delivered dose
inhalation powder, hard capsule
October
2016
2
Braltus (a dry powder device) was launched at the
start of December at a price of £25.80 – which is a
23% discount to Spiriva handihaler.
Braltus provides a new device each month so no
cleaning of device required etc.
Like many inhalers Braltus will need to be prescribed
by Brand due to the NHSBSA naming and
prescription pricing rules.
Levothyroxine additional strengths and lactose free
TEVA
•12.5mcg (£12.75 for 28) , 25mcg (£2.35 for 28), 50
mcg (£1.14 for 28),
75 mcg (£2.82 for 28) and 100mcg (£1.14 for 28)
•Lactose free may be useful for patients with
intolerance who currently receive liquid.
•1x75mcg tablet is cheaper than 1x50mcg +
1x25mcg – cost saving opportunity and useful for
compliance.
•12.5mg useful for slight tweaks to patient doses.
Insulin pen needles <£6 per 100
Pricing war has increased the number of low cost
options. Therefor all needle under £6 are formulary.
(exclude safety needles)
Morning side contraceptives
A new range of branded generic contraceptive pills,
a few pence cheaper than formulary recommended
Consilient branded generics.
The two added to formulary are Lizinna and Yacella.
No proposal for switching from Consilient to
Morningside brands.
Symbicort® MDI AstraZaneca
Costs £28 for 30 days represents a saving of £1.32
per device if it is initiated over Fostair pMDI. This
equates to an annual saving of £16.06 per patient
per year.
Offers greater savings against Seretide than Fostair.
This is the lowest cost ICS/LABA in a pMDI device
licensed for COPD.
Formoterol is recommended above salmeterol.
Not licensed for asthma at present – would need an
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September
2016
3
informed discussion with the patient if to be used
unlicensed for asthma.
Tricare insulin pen needles Owen Mumford
£5.36/100
4mm, 5mm, 6mm, 8mm & 12mm
Cost effective alternative insulin pen needle
Proposed to add to formulary alongside current
formulary recommendations.
Neon Verifine insulin pen needles Neon Diagnostics
£4.50/100
4mm, 5mm, 6mm & 8mm
Cost effective alternative insulin pen needle
Proposed to add to formulary alongside current
formulary recommendations.
Nutricomp Drink Plus BBraun
chocolate / strawberry / banana / vanilla
£1.12 per bottle (200ml) / £4.48 per pack
Additional low cost item to be added to formulary
preferences as an alternative option.
Enstilar Cutaneous Foam (equivalent to Dovobet)
Leo Laboratories
Brought back to PAMM after receiving information
from specialist dermatologists.
Dermatologists were keen on this product.
Priced the same as Dovobet.
Insulin Degludec (Tresiba ®) Novo Nordisk A/S
Tresiba®▼ 100 unit/mL FlexTouch® 5 pen pack
£46.60
Tresiba®▼ 200 unit/mL FlexTouch® 3 pen pack
£55.92
Tresiba®▼ 100 unit/mL Penfill® 5 cartridge £46.60
Previously approved on a name patient basis
with Taunton specialists.
Some audit data which shows benefit for
patients unable to tolerate other insulins.
Non-inferior to other insulins
Recent price reduction brings it in line with
other formulary insulins.
Monuril 3g sachet (Fosfomycin) granules for oral
solution Profile Pharma
£4.86/sachet (vs £75.45 AMco generic)
Significant discount to currently available
product
Cholurso 250mg film coated tablets HFA Healthcare
30% cheaper than generic and other branded
Ursodeoxycholic acid 250mg capsules.
Low savings as low usage.
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July 2016
June 2016
Glycopyrronium Bromide 1 mg/5 ml Oral Solution is
indicated for use in adults as an add-on therapy in
the treatment of peptic ulcer
New product launch.
Off License use of a licensed product is safer
than using an unlicensed special.
Strivit-D3® 800iu (colecalciferol) capsules
 £2.34/30 caps
 Current formulary choices: Fultium D3 800iu
& Desunin 800iu – BOTH £3.60/30 caps
Lots of D3 products becoming available. It has been
proposed that all are added to formulary with the
proviso that GP’s choose the most cost effective
option when prescribing.
Naproxen 250mg effervescent tablets (Stirlescent®)
(Stirling Anglian Pharmaceuticals LTD)
 £7.90/20 tabs
 Liquid special Naproxen Oral Susp
125mg/5ml £131.32/400ml
 Sodium content 341.89mg per tablet
Proposed as an alternative to liquid special for
patients with swallowing difficulties
Co-dydramol and co-codamol 8/500 – nonformulary proposal

TST have approved making codydramol and co-codamol 8/500mg
non formulary within their trust.
 Considered no more effective than
paracetamol alone.
 Evidence suggests these don’t
improve pain relief but contribute
constipation side effects.
 BNF states Co-dydramol is less
suitable for prescribing.
 Co-codamol 8/500 are available over
the counter and could be considered
suitable for self-care.
There was a discussion around the usefulness
of these as an option when treating patients.
Although non-formulary it would still be
possible for GP’s to prescribe them but by
being non-formulary it helps to flag these
preparations as less favourable.
Mylife Clickfine Autoprotect 5mm and 8mm
(Ypsomed)
 £19.00/box of 100
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ZT-W January 2017


Current formulary choice £30 per box.
For prevention of needle stick injuries when
insulin administered by health professionals,
helps compliance with EU directive.
Carbocisteine 750mg/10ml oral solution, 10ml
sachets, sugar free
(Intrapharm Laboratories)
 £3.85 / 15 sachets
 offers 38% saving over current liquid prep
approx £1,500, Q4 15-16
May 2016
April 2016
March 2016
Brought back from previous PAMM where
approved as RED. MHRA have agreed to remove
the 5 days restriction for Carbocisteine Sachets,
this brings the product into line with all other
Carbocisteine preparations in the UK market and
can now be used long term.
Stanek
Teva spotlight brand- Received confirmation that
Stanek is Bioequivalent to Stalevo.
CALCI-D® chewable tablets Consilient Health Ltd
(calcium carbonate/colecalciferol 1000mg/1000IU)
£2.25 / 28 tabs
·
Another option proposed to add to other
formulary recommendations.
·
Once daily dosing.
·
May be more palatable for some patients.
Otovent nasal balloon for otitis media with effusion
abigo
Drug Tariff price £4.90, Retail price £7.84
·
ENT specialists also approve of it.
·
NICE have reviewed and approve the use of
this device, it has good evidence to show improved
outcomes for children with middle ear / glue ear
problems. Not much evidence in adults.
·
Propose to add to formulary linked to
antibiotic use in children and the grommet policy.
Teva cost effective branded generics:
Dretine® equivalent to Yasmin®
Gazylan®XL: Galantamine prolonged release
Mariosea®XL: Tolterodone M/R
Monomil®XL: Isosorbine mononitrate M/R
Nasofan®: Fluticasone nasal spray
Sondate®XL: Quetiapine M/R
Spiroco®XL: Ropinirole M/R
Daylette- Combined Oral Contraceptive. Cost
effective alternative to Eloine®. £10.50 for 3 x 28
tabs.
Cilique- Combined Oral Contraceptive. Cost
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effective alternative to Cilest®. £4.65 for 3 x 21 tabs
Eperzan® (Albiglutide) GSK UK
• £71 for 4 pens
• 30mg and 50mg powder and solvent for solution
for injection.
•
Long acting once weekly GLP-1 Receptor
Agonist licensed in T2 diabetes.
BD Viva Insulin Pen Needles.
•Price per 100 needles is the same as other
formulary options.
•May help with switching BD needle users to a
cheaper option.
February 16
Tretinoin + clindamycin (Treclin™) gel for facial
acne
Indicated for the topical treatment of acne vulgaris
when comedones, papules and pustules are present
in patients 12 years or older.
£11.94 for 30g tube
Butec® patches (buprenorphine)
 pack of 4 patches.
 5mcg = £15.84, 10mcg = £28.40, 20mcg =
£51.71.
Identical to Butrans® but about 10% cheaper.
Microdot® lancets and droplet insulin pen needles.
Midrodot droplet needles:
4mm/32G, 6mm/31G, 8mm/31G
qty 100
£5.95
Microdot Lancets:
30G
qty 200 £6
Microdot Lite lancets
Microdot Superlite
Microdot Universal lancets and
Microdot Professional lancets
30G, 28G, 26G, 23G
qty 200 £10.75
Emerade Adrenaline solution for injection in
prefilled pen
Has a longer shelf life than current formulary choice
Epipen®, 30 months for Emerade®, 18 months for
Epipen®.
The 150mcg and 300mcg devices are suitable for
patients to self-administer. The 500mcg device
should only be used by health professionals –
although in the main most practices use vials to
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ZT-W January 2017
administer doses of 500mcg.
January
2016
November
2015
October
2015
September
2015
7
Added to formulary for new patients or existing
Epipen patient who are happy to change to
Emerade®. Not recommended for general switch as
training on using the device will need to be given.
Stexerol-D3 25,000iu (£17.00/12 tablets) & 1,000iu
(£2.95/28 tablets). 1,000iu strength not currently on
formulary.
GlucoRx Safety Lancets
(£5.50/100 lancets)
Ibandronic acid (50mg daily): approved for use off
license to reduce the fracture risk in patients
prescribed Aromatase Inhibitors.
Vortioxetine Now recommended by NICE for
treating major depressive episodes that have failed to
respond to 2 different antidepressants in the same
episode.
£27.72/28 tabs in 5, 10 and 20mg
AirFluSal Forspiro 50/500® (salmeterol/fluticasone)
Dry Powder Inhaler. Cost= £32.74 compared to
Seretide Accuhaler® 50/500 = £40.92. Not licensed in
asthma or for use in under 18 year olds
Ivermectin Cream (Soolantra®). Licensed for the
treatment of the inflammatory lesions of rosacea.
Treatment is for up to 4 months, if no improvement
after 3 months it should be stopped. It should be
used after other more established therapies (e.g.
metronidazole gel and azelaic acid) have failed.
Price =£18.29/ 30g
Trulicity® (dulaglutide) 1.5mg and 0.75mg prefilled
pen. £73.25 for 4 doses.
Once weekly dose and price comparable to
exenatide
Synjardy (empagliflozin/metformin) Boehringer
Ingelheim Limited 12.5mg/1000mg, 12.5mg/850mg,
5mg/1000mg, 5mg/850mg, All strengths £36.59 for
56 tablets. This combination product costs the same
as Empagliflozin alone.
Binosto 70mg (alendronic acid) effervescent tablets,
approx £22.50 for 4 tablets. Approved as alternative
for patients with swallowing difficulties.
Abasaglar (insulin Glargine) 100 units/mL solution
for injection in cartridge & pre-filled pen (£35.25 for
5x3ml) - This biosimilar insulin is approximate £6 per
5 cartridges cheaper than non biosimilar insulin
glargine. It has the same amino acid sequence as
Lantus.
ZT-W January 2017
July 2015
June 2015
Spiolto Respimat 2.5 microgram/2.5 microgram,
inhalation solution - This is tiotropium bromide
monohydrate and olodaterol hydrochloride
(LAMA/LABA) inhaler for adults with COPD. Cost
effective combination inhaler which may improve
compliance.
Alzain® (pregabalin) capsules - Rewisca® (Consilient
brand) is currently the formulary choice of
pregabalin for patients with epilepsy and generalised
anxiety disorder but the requirement for pharmacies
to provide redacted copies of prescriptions has
caused some problems. Dr Reddy’s are now offering
Alzain a price at least 30% below the category C drug
tariff price and at least 5% below any category M
guaranteed for 2 years. This makes the product the
most cost effective of the choices currently on offer.
There is no requirement to fax scripts to the
manufacturer. Teva have also launched a product
which is 30% cheaper than the category C Drug Tariff
price. Agreed to add both Alzain and Teva
pregabalin to the formulary for GAD and Epilepsy
indications ONLY alongside Rewisca brand.
Glucoject® lancets PLUS 33G (200) £5.50 - These
lancets are more cost effective than other lancets on
the market. They are ultrafine and compatible with
most type A lancing devices. It was agreed to add to
the formulary as the preferred option.
Nutriplen Compact – suggested as a switch from
Fortisip Compact as 25% cheaper
Fultium D3 oral drops 2,740 IU/ml and Invita D3
2,400 IU/ml oral drops solution – similar products
offering slightly different strengths, suggested to add
to formulary but not actively promote
Laxido Paediatric Plain – suggested to add to
formulary as it offers a cost saving over Movicol
Fosfomycin Trometamol 3g sachets
This licensed product has become available. Use of
FP10 to prescribe fosfomycin can replace the historic
practice of faxing the hospital for supply. To go onto
formulary as green on the recommendation of
microbiologists
Upostelle® – contains 1500mcg levonorgestrel
Consilient brand emergency contraception:
Upostelle – contains 1500mcg levonorgestrel and is
licensed for the same indications as Levonelle®
Nutilis® Clear- Added to formulary- similar to Thick
& Easy® clear and Resource® ThickenUp® clear but
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ZT-W January 2017
has a larger scoop and lower cost per scoop.
May 2015
Sirdupla® MDI 25/125mcg and 25/250mcg MDI Contains the same active ingredients (fluticasone
and salmeterol) as Seretide. It is NOT licensed in
patients under the age of 18. The 25/125 is
approximately £10 cheaper than Seretide and the
25/250 approximately £15 cheaper. – Approved
Prednisolone Dompe 1mg/ml oral solution single
dose (5ml) vialsAlternative option to soluble prednisolone tablets
for patients who are unable to take solid
prednisolone tablets. There is a 35% cost saving
versus soluble tablets. Honey and Vanilla cream
flavour
NICE TA 336: Empagliflozin in combination therapy
for treating type 2 diabetes (added to formulary as
per NICE)
TA 335: Rivaroxaban for preventing adverse
outcomes after acute management of acute
coronary syndrome(added to formulary as per NICE)
Branded Generic Pregabalin- Rewisca® added to
formulary for licensed indications of Generalised
Anxiety Disorder (GAD) and epilepsy ONLY.
Also, please note that perindopril erbumine is classed as green. Please make sure this is
included in your practice formularies.
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