Author: Nancy Kane

On behalf of the GMMMG Clinical Reference Group, we now seek comments on the actions proposed at their November 2023 meeting. Actions in this consultation include:

• Carbimazole 10mg & 15mg tablets – Do Not Prescribe (criterion 2)
• Acetylcysteine 600mg effervescent tablets to be GREEN and first choice mucolytic for people with COPD. Carbocisteine 375mg capsules to be GREEN, and placed as an alternative choice.
• Bimekizumab for psoriatic arthritis and axial spondyloarthritis – RED
• Rimegepant for treating migraine – GREEN following specialist advice.
• Tofacitinib for ankylosing spondylitis – RED
• Daridorexant for long-term insomnia – to add to formulary as a GREEN or GREEN following specialist advice medicine in this indication.
• Tirzepatide for type 2 diabetes – GREEN
• Mirikizumab for ulcerative colitis – RED
• Baricitinib for alopecia areata – Do Not Prescribe (criterion 1) in this indication

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

The consultation will run for six weeks and closes at 5pm on Friday 29th December 2023. To take part, visit the consultations page.

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In response to the National supply shortage of prescribed medication for ADHD, a GM task and finish group led the development of the following supporting guidance:

• National Supply Shortage of prescribed medication for ADHD – A Guide for Secondary Care
• GM Pathway for the management of patients prescribed medicines for ADHD during the national shortage – primary care guidance
• Patient information – “National Supply Shortage of your prescribed medication for ADHD”

This guidance is now available through the GMMMG website here.  

Thanks go to the GM working group who developed this guidance who are detailed below. Also to GMMMG and the wider GM pharmacy and medicines system for supporting this accelerated development and approval process to enable the rapid dissemination of this information intended to support patients through this medicines shortage. Please cascade this information across your systems.

GM task and finish group:

–              Sana Alam – Senior Clinical Pharmacist |Lead CAMHS Pharmacist (GMMH)

–             Arifa Azmi – Clinical Pharmacist CAMHS/Antimicrobial and Infection Control  (Pennine Care)

–             Khadija Mansoorali – Paediatric Mental Health Pharmacist (MFT)

–             Nicola Smith – Senior Medicines Optimisation Pharmacist (Trafford)

–             Zoe Paine – Senior Medicines Optimisation Pharmacist – Women and Children Lead (Manchester)

–             Leigh Lord – Head of Medicines Optimisation and Governance (MFT)

–             Jennifer Seal – Senior Medicines Optimisation Pharmacist (Bury)

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The decisions made at the Greater Manchester Medicines Management Group (GMMMG) October 2023 meeting have now been reviewed by GM Executive and can be found at https://gmmmg.nhs.uk/meetings/decision-summaries/. This includes the recommendations made by GMMMG in October 2023 and NICE Technology appraisals published in June 2023.

The following decisions were approved and can be found at:

• Updates to formulary and RAG list – https://gmmmg.nhs.uk/joint-formulary/gmmmg-formulary-chapters/ and https://gmmmg.nhs.uk/rag-category/adult/
• Commissioning statement: Unlicensed use of omalizumab for severe chronic inducible urticarias –
• High Cost Drugs Inflammatory Bowel Disease pathway – https://gmmmg.nhs.uk/guidance/clinical-guidance-and-pathways/  
• Long-Term Azithromycin in Adults with Chronic Respiratory Disease: Guidance for Primary Care – https://gmmmg.nhs.uk/guidance/clinical-guidance-and-pathways/

Please could you disseminate for implementation within your organisations.

Drugs with a NICE recommendation published in July have been considered by CRG at its October 2023 meeting, and will be considered for approval by GMMMG and CEGC at their November 2023 meetings. 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 the October meetings of GMMMG and CEGC, the following actions have been published to the GMMMG website.

Updates to guidelines include:

• High Cost Drug pathway for inflammatory bowel disease updated
• Guidance on Long Term Use of Azithromycin in Adults with Chronic Respiratory Disease published

Formulary updates include:

• Bulvertide for chronic hepatitis D added as RED, as per NICE TA
• Do Not Prescribe entry for esketamine nasal spray amended to include major depressive disorder with imminent risk of suicide, as per NICE TA896
• Paediatric Do Not Prescribe entry for emollient bath additives amended to include a link to NICE Do Not Do advice from CG57.

For full details of formulary and RAG updates, see the formulary change log available on the formulary page.

Outstanding decisions from the October meetings of GMMMG and CEGC will be published following approval by the GM ICB Executive:

• NICE TA902: Dapagliflozin for treating chronic heart failure with preserved or mildly reduced ejection fraction
• NICE TA905: Upadacitinib for previously treated moderately to severely active Crohn’s disease
• NICE TA907: Deucravacitinib for treating moderate to severe plaque psoriasis
• GM ICB commissioning statement on omalizumab for chronic inducible urticaria

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On behalf of the GM Medicines Value subgroup, we now seek comments on the proposal to change the threshold at which primary care rebate schemes are considered.

The consultation will run for six weeks and closes at 5pm on Thursday 30th November 2023. To take part, visit the consultations page.

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On behalf of the GMMMG Clinical Reference Group, we now seek comments on the actions proposed at their October 2023 meeting. Actions in this consultation include:

• Prednisolone enteric coated 2.5mg and 5mg tablets – remove from DNP list
• Micronised progesterone 100mg capsules (Gepretix®) to be added to formulary for adjunctive use in postmenopausal women
• Mavacamten added to formulary as RED

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

The consultation will run for six weeks and closes at 5pm on Monday 27th November 2023. To take part, visit the consultations page.

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Following the September meetings of GMMMG and CEGC, the following actions have been published to the GMMMG website.

Updates include:

• Tranexamic acid solution for injection added to formulary as RED, for management of head injuries as per NICE NG232.
• Difelikefalin added as RED, as per NICE TA890
• Voclosporin added as RED, as per NICE TA882
• Valproate easy read leaflet for people who can become pregnant published.
• Minutes of the GMMMG August 2023 meeting published.

All outstanding actions will be actioned following approval by GM Executive.

Update 06/10/23

The remaining decisions have now been published:

• Risankizumab for Crohn’s disease added as RED
• Hydrocortisone 0.5% cream and 2.5% cream and ointment added to DNP list
• Guidance on managing GLP1 receptor agonist shortages published.

The formulary has also been updated to reflect relevant safety alerts and NICE guidelines. For full details, see the GMMMG decision summary for September 2023, or the formulary change log available on the formulary page.

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Following development by a working group of healthcare professionals from Manchester and Trafford, we now seek comments on the draft document: ‘DOAC switch to edoxaban for NVAF patients – protocol’.

Please note that this consultation will run for 3 weeks; please visit the consultations page to take part. The consultation will run until 5pm on Monday 9th October 2023.

Update 02/10/2023: this consultation is now paused following the updated tariff price for apixaban. Comments will be held, and will not need to be re-submitted if the consultation re-opens.

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