Category: Decision summaries

GMMMG decisions approved – April 2026

May 21, 2026

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

Updates to formulary

  • Azatioprine 10mg/ml oral suspension for inflammatory bowel disease – AMBER shared care
  • Vutrisiran for transthyretin amyloidosis with cardiomyopathy – 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

The following are also approved:

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/.

December decisions approved

January 27, 2026

The decisions made at the Greater Manchester Medicines Management Group (GMMMG) and Clinical Effectiveness and Governance Committee (CEG) at their meetings in December 2025 have now been reviewed by GM Executive and can be found at https://gmmmg.nhs.uk/meetings/decision-summaries/.

Updates to formulary

  • Betula verrucosa for allergic rhinitis or conjunctivitis – green (specialist initiation)
  • Guselkumab for ulcerative colitis and Crohn’s disease – red
  • Relugolix / estradiol / norethisterone and linzagolix for uterine fibroids and endometriosis – green (specialist initiation)
  • Idebenone for Leber’s hereditary optic neuropathy – 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

The following are also available:

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/.

Decisions approved by GM ICB Executive – July 2024

August 21, 2024

The decisions made at the Greater Manchester Medicines Management Group (GMMMG) July 2024 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 July 2024 and NICE Technology appraisals published in March 2024.

The following decisions were approved and can be found at:

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/.

Decisions approved by GM ICB Executive – May 2024

June 13, 2024

The decisions made at the Greater Manchester Medicines Management Group (GMMMG) May 2024 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 May 2024 and NICE Technology appraisals published in January 2024.

The following decisions were approved and can be found at:

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/.

Formulary and RAG updates – June 2023

June 29, 2023

Following approval by CRG, GMMMG, and the Greater Manchester ICS Clinical Effectiveness and Governance Committee, the following updates have been made to GMMMG guidelines, formulary, and RAG list.

  • Note added to entry for aspirin in chapter 2 : “do not routinely offer aspirin for primary prevention of CVD”, with link to NICE CG181.
  • Upadacitinib for non-radiographic axial spondyloarthritis added as RED as per NICE TA861
  • Somatrogon added as RED (pending shared care) as per NICE TA863
  • Vutisiran added as RED, as per NICE TA868
  • Ataluren added as RED, as per NICE HST22

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

Formulary and RAG list updates – May 2023

May 26, 2023

Following approval by CRG, GMMMG, and the Greater Manchester ICS Clinical Effectiveness and Governance Committee, the following updates have been made to GMMMG guidelines, formulary, and RAG list.

  • GMMMG antimicrobial guidelines have been updated
  • Upadacitinib for Crohn’s disease added as RED
  • IQoro neuromuscular training device added to DNP list
  • Colestyramine and colesevelam for CVP prevention in hypercholesterolaemia added to GREY list as Green (specialist advice), only for use when there is no alternative treatment option due to intolerance, or ineligibility for PCSK9i or inclisiran treatment
  • Maribavir for refractory CMV post-transplant added as RED
  • Discontinued Insuman preparations removed from formulary
  • Potassium permanganate tablets for solution assigned a status of RED
  • Trifarotene for acne added as GREEN

The formulary has also been updated to reflect relevant safety alerts and NICE guidelines. For full details, see the formulary change log available on the formulary page.

New and updated resources

February 21, 2023

Following approval by CRG, GMMMG, and the Greater Manchester ICS Clinical Effectiveness and Governance Committee, the following documents have been approved and published.

The GMMMG Inappropriate Polypharmacy Review and Treatment Optimisation: Resource Pack has been reviewed and updated. The updated resource pack is available on the Clinical Guidelines and Pathways page.

Terms of reference for the Workforce subgroup have also been approved, and are available on the Membership and Terms of Reference page.

The formulary and RAG list have been updated to remove fostamatinib from the RAG list and assign a RED RAG status, and to reflect updated NICE guidelines and MHRA advice. See formulary change log for more details.

Outstanding decisions

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

  • Dexamethasone intravitreal implant for diabetic macular oedema
  • Avacopan to severe active granulomatosis with polyangitis or microscopic polyangitis
  • Ozanimod for moderately to severely active ulcerative colitis
  • Upadacitinib for active ankylosing spondylitis
  • Relugolix–estradiol–norethisterone acetate for treating moderate to severe symptoms of uterine fibroids
  • Implementation of NICE guidance on Continuous Blood Glucose Monitoring (CGM)
  • Dexcom ONE rtCGM device
  • GMMMG antimicrobial guidance

Formulary and subgroup decision updates

January 23, 2023

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

  • Insuman Comb 50 removed from formulary – product discontinued
  • Abrocitinib, tralokinumab & upadacitinib added for formulary as RED drugs in chapter 13

The formulary has also been updated to reflect relevant NICE guidelines and safety alerts. For full details please see the formulary change log, which is available on the formulary page.

For more information on these and other decisions, please see GMMMG decision summaries.

Formulary and subgroup decision updates

December 19, 2022

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

  • The RAG status for modafinil for excessive sleepiness in narcolepsy or Parkinson’s disease has been updated to GREEN (following specialist initiation), and an information leaflet for primary care prescribers has been published.
  • Famotidine added to formulary as GREEN, in place of ranitidine
  • Metolazone – recommendation added to prescribe by brand
  • Icosapent ethyl – GREEN (specialist advice)
  • Fenfluramine – RED for Dravet syndrome
  • Imlifidase – RED
  • Roxadustat – RED
  • Setmelanotide – RED

The formulary has also been updated to reflect relevant NICE guidelines and safety alerts.

For more information on these and other decisions, please see GMMMG decision summaries.

Formulary and subgroup decision updates

November 7, 2022

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.