Formulary and subgroup decision updates

Following approval by CRG, GMMMG, the Greater Manchester ICS Clinical Effectiveness and Governance Committee, and Greater Manchester Management Executive, the following decisions have been approved and published:

  • Dapagliflozin for chronic kidney disease added to formulary as a GREEN drug
  • Edoxaban approved as first-line DOAC in atrial fibrillation, and DOAC statement published.
  • Sitagliptin approved as first-choice DPP-4 inhibitor
  • Romosozumab for severe osteoporosis added to formulary as a RED drug, as an alternative first-choice option alongside teriparatide
  • Simple eye ointment assigned a Do Not Prescribe status

Decision summaries from the July, August, and September meetings of GMMMG are also available, with further details on these and other decisions from those meetings. The formulary and RAG list change log has been updated accordingly and is available on the formulary page.


Formulary and subgroup decision updates

Following the first meeting of the Greater Manchester ICS Clinical Effectiveness and Governance Committee on Thursday 22nd September, the website and formulary have been updated to reflect decisions made by GMMMG and the Clinical Reference Group (CRG). This includes:

  • Empagliflozin for heart failure added as GREEN (specialist advice)
  • Pitolisant and solriamfetol for obstructive sleep apnoea added to DNP list (criterion 1)
  • Nirmatrelvir / ritonavir (Paxlovid) added as RED
  • Micronised progesterone vaginal capsules for management of miscarriage added as GREEN (specialist initiation)
  • Emollient section of chapter 13 updated to align with primary care emollient ladder
  • Minoxidil foam added to DNP list (criterion 3). Formulary updated to clarify that other minoxidil preparations are included in the Drug Tariff part XVIIIA (the “black list”).
  • Anti-reflux milks added to paediatric DNP list (criterion 3)
  • Phenazone / lidocaine eardrops for acute otitis media added to paediatric RAG list as GREEN, for use only if an immediate oral antibiotic prescription is not given, and there is no eardrum perforation or otorrhoea
  • Pegcetacoplan for paroxysmal nocturnal haemoglobinuria added to RAG list as RED
  • Atidarsagene autotemce for metachromatic leukodystrophyl added to RAG list as RED
  • Selumetinib for inoperable plexiform neurofibromas associated with type 1 neurofibromatosis added to RAG list as RED
  • Lixisenatide removed from formulary for new patients following discontinuation of the 10 microgram pen and initiation pack. Patients who are clinically stable on lixisenatide may continue and should not be switched without clinical reason

The formulary has also been updated to reflect relevant NICE guidelines and safety alerts. For full details of the changes, please see the Formulary Change Log.

Outstanding decisions

Outstanding decisions expected to have a financial impact for the ICS are pending approval by GM Directors of Finance, and will be published once approved:

  • Dapagliflozin for chronic kidney disease
  • Sitagliptin formulary position following patent expiry
  • Romosozumab for severe osteoporosis
  • Simple eye ointment DNP status

Consultation: actions from March meeting of CRG

On behalf of the GMMMG Clinical Reference Group, we now seek comments on the actions proposed at the March 2022 CRG meeting.

Actions in this consultation include:

  • Moxonidine – GREEN following specialist initiation
  • Ponesimod for relapsing-remitting multiple sclerosis – RED
  • Upadacitinib for active psoriatic arthritis – RED
  • Palforzia for peanut allergy in children and young people – RED on the paediatric RAG list, and GREY and RED on the adult RAG list, only for use in people aged 18 and over if treatment is started between the ages of 4 and 17, as per NICE guidance
  • Odevixibat for progressive familial intrahepatic cholestasis – RED

To take part in this consultation, visit the consultations page. The consultation period is open until 5pm on Thursday 21st April 2022.

Formulary and subgroup decision updates

Following the February meeting of GMMMG, the formulary has been updated to reflect decisions made by the Clinical Reference Group (CRG) and Medicines and Guidelines Subgroup (MGSG). Changes include:

  • Addition of NICE guidance and MHRA drug safety updates to formulary
  • Duloxetine 90mg and 120mg capsules added to grey list as a GREEN drug
  • Insulin degludec added to grey list as a GREEN (specialist initiation) drug
  • Isoniazid for tuberculosis prophylaxis in renal patients added to RAG list as GREEN (specialist initiation)
  • Dapsone 50mg and 100mg tablets for PCP prophylaxis added to RAG list as GREEN (specialist initiation)

For full details of the changes, please see the Formulary Change Log.

Formulary and subgroup decision updates

Following the November meeting of GMMMG, the formulary has been updated to reflect decisions made by the Clinical Reference Group (CRG) and Medicines and Guidelines Subgroup (MGSG). Changes include:

  • Addition of NICE technology appraisals and MHRA drug safety updates to formulary
  • Ustekinumab dose escalation in inflammatory bowel disease commissioning statement updated to include latest evidence

For full details of the changes, please see the Formulary Change Log.

Consultation: actions from November meeting of CRG

On behalf of the GMMMG Clinical Reference Group, we now seek comments on the actions proposed at the November 2021 CRG meeting.

Actions in this consultation include:

  • Insulin aspart Sanofi (Trurapi) to be added to formulary as a GREEN drug and first line option for rapid acting insulin.
  • Haloperidol 500 microgram tablets to be DNP (criterion 2)
  • Berotralstat for hereditary angioedema to be added to the RAG list as a RED drug
  • Casirivimab/imdevimab (Ronapreve)® to be added to formulary as a RED drug, with link to NG191

To take part in this consultation, visit the consultations page. The consultation period is open until 5pm on Thursday 23rd December 2021.

Updated leaflet: sacubitril/valsartan (Entresto®) information for primary care

Following technical review and approval by the Clinical Reference Group, the GM leaflet on sacubitril/valsartan for prescribers in primary care has been updated. The updated leaflet is available from the Information Leaflets for Primary Care Prescribers page.

Consultation: actions from September meeting of CRG

On behalf of the GMMMG Clinical Reference Group, we now seek comments on the actions proposed at the September 2021 CRG meeting.

Actions in this consultation include:

  • Insulin degludec for T1DM and T2DM: to be GREEN following specialist initiation and GREY (criterion 3)
  • Dapsone 50mg & 100mg tablets as second line option for Pneumocystis carinii pneumonia (PCP) prophylaxis to be GREEN following specialist initiation
  • Isoniazid 100mg tablets for TB prophylaxis in renal patients considered to be at high risk of developing TB to be GREEN following specialist initiation
  • Duloxetine 90mg & 120mg capsules to be GREEN and GREY (criterion 2), only to be used where the prescriber believes that patient’s pill burden is high enough to justify the extra cost associated with the use of these formulations.
  • The following NICE guidelines will be added to formulary:
    • NICE NG201: antenatal care
    • NICE NG202: obstructive sleep apnoea/hypopnoea syndrome and obesity hypoventilation syndrome in over 16s
    • NICE NG203: Chronic kidney disease: assessment and management

To take part in this consultation, visit the consultations page. This consultation period is open until 5pm Tuesday 2nd November 2021