Author: Nancy Kane

The decisions made at the Greater Manchester Medicines Management Group (GMMMG) and Clinical Effectiveness and Governance Committee (CEG) at their meetings in July 2026 have now been reviewed by the Strategic Commissioning Committee and can be found at https://gmmmg.nhs.uk/meetings/decision-summaries/.

Updates to formulary

• Sulfasalazine 500mg tablets, 500mg GR tablets, and 250mg.5ml oral suspension for IBD – AMBER. Added to formulary as RED, pending development of a shared care protocol
• Ruxolitinib for vitiligo – RED
• Dupilumab for COPD – RED
• Delgocitinib for chronic hand eczema – RED
• Pegzilarginase for arginase-1 deficiency – RED

Available at https://www.greatermanchesterformulary.nhs.uk/. Links to NICE guidance and MHRA safety advice added as appropriate. For full details of formulary and RAG updates, see the decision summaries available at https://gmmmg.nhs.uk/meetings/decision-summaries/.

Pathways and guidelines

• Acarizax and Itulazax primary care guidance – https://gmmmg.nhs.uk/guidance/clinical-guidance-and-pathways/
• Relugolix for prostate cancer – https://gmmmg.nhs.uk/shared-care/gmmmg-approved-shared-care-protocols/
• 7-minute briefing – propranolol overdose, toxicity and prescribing risks – https://gmmmg.nhs.uk/guidance/seven-minute-briefings/

The following have been approved and will be published shortly:

• GM narcolepsy treatment pathway for adults
• Sodium oxybate commissioning statement

For full details of new and updated pathways, see the decision summaries available at https://gmmmg.nhs.uk/meetings/decision-summaries/.

Colleagues are asked disseminate for implementation within your organisations.

All approved CRG and GMMMG meeting minutes can be found at: https://gmmmg.nhs.uk/meetings/clinical-reference-group/ and https://gmmmg.nhs.uk/meetings/gmmmg-meetings/.

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The decisions made at the Greater Manchester Medicines Management Group (GMMMG) and Clinical Effectiveness and Governance Committee (CEG) at their meetings in June 2026 have now been reviewed by the Strategic Commissioning Committee and can be found at https://gmmmg.nhs.uk/meetings/decision-summaries/.

Updates to formulary

• Targeted-release budesonide for primary IgA nephropathy – red
• Carbidopa / entacapone / levodopa tablets – Sastravi and Stanek added to formulary as preferred options
• Methylphenidate for narcolepsy – amber
• Dupilumab for severe chronic rhinosinusitis with nasal polyps – red
• Obinutuzumab for lupus nephritis – red
• Discontinued items removed from formulary:
  • FreeStyle Libre 3 sensors
  • Peanut allergy immunotherapy (Palforzia)
  • Sotrovimab for COVID-19

Available at https://www.greatermanchesterformulary.nhs.uk/. Links to NICE guidance and MHRA safety advice added as appropriate. For full details of formulary and RAG updates, see the decision summaries available at https://gmmmg.nhs.uk/meetings/decision-summaries/.

Pathways and guidelines

• Patient information leaflet for DOAC switch – https://gmmmg.nhs.uk/guidance/clinical-guidance-and-pathways/
• Updated shared care protocol – lisdexamfetamine for ADHD in children and adolescents – https://gmmmg.nhs.uk/shared-care/gmmmg-approved-shared-care-protocols/

For full details of new and updated pathways, see the decision summaries available at https://gmmmg.nhs.uk/meetings/decision-summaries/.

Colleagues are asked disseminate for implementation within your organisations.

All approved CRG and GMMMG meeting minutes can be found at: https://gmmmg.nhs.uk/meetings/clinical-reference-group/ and https://gmmmg.nhs.uk/meetings/gmmmg-meetings/.

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On behalf of the GMMMG Clinical Reference Group, we now seek comments on the actions proposed at the August 2026 CRG meeting. Actions in this consultation include:

• Methylphenidate chewable tablets – AMBER
• Lacosamide tablets – grey status removed; cost criterion no longer applies.
• Glycopyrronium cream for axillary hyperhidrosis – GREEN (specialist initiation)
• Teplizumab for delaying type 1 diabetes – RED
• Deuruxolitinib for alopecia areata – RED
• Aficamten for obstructive hypertrophic cardiomyopathy – RED
• Discontinued medicines removed from formulary and guidance:
  • Clenil Modulite 50 microgram & 250 microgram
  • Calcitriol 3 micrograms/gram ointment

All links to NICE clinical guidelines and MHRA drug safety updates will be added to formulary as appropriate.

This consultation will run for six weeks and closes at 5pm on Friday 25th September 2026. To take part, visit the consultations page. 

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Six new consultations have opened for comments on the GMMMG website. Including consultations opened yesterday, the following are now accepting comments.

To take part in these or any other consultations, visit https://gmmmg.nhs.uk/consultations/.

• Commissioning statement: shower protection pouches / vascular access protection (VAP) dressings
• Primary immune thrombocytopenia (ITP) in adults treatment pathway
• CRG actions – July 2026
  • Sotatercept for pulmonary arterial hypertension – RED
  • Nusinersen and risdiplam for spinal muscular atrophy – RED
  • Mepolizumab for COPD – RED
  • Seladelpar for primary biliary cholangitis – RED
  • Atogepant for treating migraine – GREEN

These consultations will run for six weeks and close at 5pm on Thursday 10th or Friday 11th September. Please see individual consultations for detail.

Shared care

There are five ongoing consultations relating to shared care for medicines:

• Shared care for undocumented patients and shared care for medicines principles
• Shared care protocol: guanfacine for children and adolescents
• Shared care protocol: sulfasalazine for patients in paediatric services
• Shared care protocol: azathioprine for patients in paediatric services
• Shared care protocol: domperidone for GORD for patients in paediatric services

These consultations will run for six weeks and close at 5pm on Thursday 10th or Friday 11th September. Please see individual consultations for detail.

7-minute briefings

Two 7-minute briefings have been developed by the Medicines Safety Subroup:

• Learning from a Medication Incident: Rivastigmine Patches
• Learning from a Methotrexate-Related Death: Preventing Future Harm

These consultations will run for two weeks and close at 5pm on Friday 14th August

To take part in these or any other consultations, visit https://gmmmg.nhs.uk/consultations/.

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Four new consultations have opened on the GMMMG website:

• Shared care protocol: guanfacine in children and adolescents
• Commissioning statement: shower pouches and VAP dressings
• Primary immune thrombocytopenia (ITP) treatment pathway
• Shared care of medicines principles and position statement for undocumented patients

These consultations will all run for six weeks and close at 5pm on Thursday 10th September.

To take part in these or any other consultations, visit https://gmmmg.nhs.uk/consultations/.

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The decisions made at the Greater Manchester Medicines Management Group (GMMMG) and Clinical Effectiveness and Governance Committee (CEG) at their meetings in May 2026 have now been reviewed by the Strategic Commissioning Committee and can be found at https://gmmmg.nhs.uk/meetings/decision-summaries/.

Updates to formulary

• High dose semaglutide (7.2mg) for weight loss – should not be prescribed until NICE guidance is published
• Loperamide 2mg for high-output stoma – green (following specialist advice)
• Emtricitabine . tenofovir alafenamide for HIV-1 PrEP – red
• Acoramadis for transthyretin amyloidosis – red
• Natalizumab (originator and biosimilar) for highly active relapsing-remitting multiple sclerosis – red
• Discontinued medicines removed from formulary:
  • Emerade adrenaline auto-injector
  • Asenapine 5mg & 10mg sublingual tablets

Available at https://www.greatermanchesterformulary.nhs.uk/. Links to NICE guidance and MHRA safety advice added as appropriate. For full details of formulary and RAG updates, see the decision summaries available at https://gmmmg.nhs.uk/meetings/decision-summaries/.

Pathways and guidelines

The following are approved and will be published following final quality checks:

• Methylphenidate for ADHD in children and adolescents shared care protocol

For full details of new and updated pathways, see the decision summaries available at https://gmmmg.nhs.uk/meetings/decision-summaries/.

Colleagues are asked disseminate for implementation within your organisations.

All approved CRG and GMMMG meeting minutes can be found at: https://gmmmg.nhs.uk/meetings/clinical-reference-group/ and https://gmmmg.nhs.uk/meetings/gmmmg-meetings/.

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Following development by GMMMG subgroups, we now seek comments on two drafts:

• Medicines Optimisation Guidance for Targeted Deprescribing, including NSAIDs, PPIs and propranolol. This consultation will run for two weeks and closes on Wednesday 29th July
• Commissioning statement for norethisterone 5mg tablets when used for postponement of menstruation for non-clinical purposes. This consultation will run for six weeks and closes at 5pm on Wednesday 26th August.

To take part in these or any other GMMMG consultations, visit the consultations page.

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We now seek comments on a draft incretin therapies summary position and prescribing guidance. It includes guidance on use in type 2 diabetes, weight management, cardiovascular disease secondary prevention, and use in combination with insulin.

This consultation will run for six weeks and close at 5pm on Friday 31st July 2026. To take part, visit the consultations page.

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GMMMG have issued an update on incretin therapies in Greater Manchester. Please cascade to your colleagues and relevant networks.

Other GMMMG advice on incretin therapies is available on the Clinical Guideance and Pathways page.

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On behalf of the GMMMG Clinical Reference Group, we now seek comments on the actions proposed at the May 2026 CRG meeting. Actions in this consultation include:

• Rivastigmine twice-weekly patches – add statement to formulary that products are not interchangeable and recommend prescribing by brand
• Trixeo Aerosphere for COPD – GREEN
• NICE TA1148 – sodium zirconium cyclosilicate – AMBER; existing shared care protocol to be reviewed

All links to NICE clinical guidelines and MHRA drug safety updates will be added to formulary as appropriate.

This consultation will run for six weeks and closes at 5pm on Wednesday 15^th July 2026. To take part, visit the consultations page. 

Guidelines and pathways

The following guidelines and pathways are also open for consultation:

• CKD toolkit for primary care – this consultation will run for six weeks and closes at 5pm on Wednesday 15^th July
• Valproate guide – this consultation will run for two weeks and closes at 5pm on Wednesday 17^th June

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