Category: Formulary & RAG

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 update: metformin 1g tablets

June 12, 2023

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

  • Metformin 1g immediate-release tablets have been added to the Do Not Prescribe list, criterion 2 (Products which are clinically effective but where more cost-effective products are available, including products that have been subject to excessive price inflation).

For more information on this decision see the May 2023 decision summary, available here.

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.

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.

Formulary and subgroup decision updates

September 26, 2022

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

Updated antimicrobial guidance

June 17, 2022

Following routine quarterly review, the GMMMG antimicrobial guidelines have been updated and is now available on the Clinical Guidance and Pathways page.

Formulary and subgroup decision updates

Following approval by GMMMG, the website and formulary have been updated to reflect decisions made by GMMMG and the Clinical Reference Group (CRG). This includes:

  • Restriction to macrogol 3350 removed, and statement added directing prescribers to choose the most cost-effective macrogol
  • Moxonidine: GREEN (following specialist initiation). Clarification of previous position.
  • Palforzia for peanut allergy: RED, and GREY, only for use in adults if treatment was started between the ages of 4 & 17.
  • Ponesimod for multiple sclerosis: RED.
  • Brand name & formulation for calcipotriol/betamethasone removed and replaced with advice to choose the most cost-effective option.
  • Strength of Epiduo gel removed, to align with primary care acne pathway.
  • Odevixibat (RAG list only): RED,

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 and GMMMG decision summaries.

Formulary and subgroup decision updates

May 20, 2022

Following the May meeting of GMMMG, the website and formulary have been updated to reflect decisions made by GMMMG and the Clinical Reference Group (CRG). This includes:

  • Bempedoic acid: GREEN following specialist advice (previously specialist initiation)
  • Sotrovimab for COVID-19: RED
  • Liraglutide for obesity in people aged 12-17: Do Not Prescribe
  • Dupilumab for severe asthma: RED
  • Belimumab for SLE: RED
  • Cenobamate for epilepsy: GREEN following specialist initiation (by a tertiary epilepsy service)
  • Risdiplam for spinal muscular atrophy: RED
  • Solriamfetol for narcolepsy: RED
  • Fostamatinib for chronic ITP: Do Not Prescribe

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 and GMMMG decision summaries.

Formulary and subgroup decision updates

March 11, 2022

Following the March 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
  • Insulin aspart biosimilar (Trurapi) added to formulary as the first choice rapid acting insulin analogue, as a GREEN drug
  • Haloperidol 500 microgram tablets added to the DNP list (criterion 2)
  • Berotralstat added to the RAG list as a RED drug

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