GMMMG updates: January 2024

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

Updates to guidelines include:

Formulary and RAG updates include:

  • Tocilizumab added as RED for COVID-19. Casirivimab / imdevimab (Ronapreve) for COVID-19 removed from formulary. Other medicines for COVID-19 updated to link to current guidance.
  • DNP entry for prednisolone enteric coated tablets amended to include only the 1mg tablets
  • Mavacamten added to the RAG list as RED

Links to NICE guidance and MHRA safety advice added as appropriate. For full details of formulary and RAG updates, see the formulary change log available on the formulary page.

The following decisions await approval by the GM ICB Executive:

  • Micronised progesterone (Gepretix) to be added to formulary for HRT
  • Temporary suspension of certain conditions from GM commissioning statement on conditions for which over the counter items should not routinely be prescribed, and permanent amendments to the policy to reflect the national Pharmacy First scheme.

GMMMG updates: November 2023

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

Updates to guidelines include:

  • New guidance: Safe Management of Medicines Within GP Practices

Formulary and RAG updates include:

  • Bempedoic acid – GREEN (previously green following specialist advice)
  • Betamethasone, dexamethasone, prednisolone and fluorometholone eye drops – GREEN (following specialist initiation)
  • Semaglutide for obesity in 12-17 year olds – DNP

Links to NICE guidance and MHRA safety advice added as appropriate. For full details of formulary and RAG updates, see the formulary change log available on the formulary page.

Following approval by the GM ICB Executive, the following have also been published:

  • Rimegepant for prevention of migraine – GREEN (following specialist initiation)
  • Sodium chloride 5% eye drops for corneal oedema – GREEN (following specialist advice)
  • An updated pathway for wet AMD was also approved, and will be published shortly

More details of the published decisions are available from the decision summaries page.


Formulary and RAG updates – June 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

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

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

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

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

Updated antimicrobial guidance

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.