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.


Consultation: actions from May CRG meeting

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

  • Fosfomycin 3g oral sachets for uncomplicated UTI in non-pregnant women – to be GREEN
  • Tezepelumab for severe asthma – to be RED

All links to MHRA drug safety updates will be added to formulary as appropriate.

To take part in this consultation, visit the consultations page. The consultation period is open until 5pm on Friday 23rd June 2023.


Links to immunisation PGDs

Patient Group Directions (PGDs) for immunisations are hosted on the Greater Manchester Integrated Care website. A link to these PGDs has been added to the GMMMG site on the Prescribing Policies page.


New Consultation: GM guidance on long-term azithromycin in adults with chronic respiratory disease

Following development in Bury and adaptation for implementation across the ICB, we now seek comments on draft guidance for long-term azithromycin for chronic respiratory conditions.

We now seek comments on the draft pathway; please visit the consultations page to take part. The consultation will run until 5pm on Wednesday 7th June 2023.


New consultation: draft hypertension pathway

The Greater Manchester Strategic Clinical Network (SCN) have developed an Adult Hypertension Medication Pathway for use in GM. We now seek comments on the draft pathway; please visit the consultations page to take part.

The consultation will run until 5pm on Tuesday 6th June 2023.


Formulary and RAG list updates

Following approval by CRG, GMMMG, and the Greater Manchester ICS Clinical Effectiveness and Governance Committee, the formulary and RAG list have been updated as follows:

  • Avatrombopag for primary chronic immune thrombocytopenia added to chapter 9 as a RED drug
  • Esketamine nasal spray for treatment-resistant depression added to DNP list

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.


Consultation: actions from April CRG meeting

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

  • Efmody modified-release hydrocortisone capsules – to add to formulary as GREEN (specialist initiation)
  • Tacalcitol lotion and ointment – not to be added to formulary
  • Dapagliflozin for CKD in children – to add to paediatric RAG list as RED
  • Long term azithromycin for chronic respiratory disease – to add to RAG list as GREEN (specialist advice)
  • Eptinezumab for preventing migraine – to add to formulary as RED
  • Cannabidiol for seizures caused by tuberous sclerosis complex – to be RED
  • Semaglutide for overweight and obesity – to add to formulary as RED, for prescribing by specialist weight management services
  • Finerenone for CKD in type 2 diabetes – to add to formulary as GREEN (specialist initiation)
  • Tocilizumab for COVID-19 – to add to formulary as RED
  • Asfotase alfa – to add to paediatric RAG list as RED

All links to MHRA drug safety updates will be added to formulary as appropriate.

To take part in this consultation, visit the consultations page. The consultation period is open until 5pm on Thursday 1st June 2023.


New consultation: GM IPMO workforce strategy

This paper provides a brief overview of the national background for pharmacy professional practice and an update on the Greater Manchester (GM) Integrating Pharmacy and Medicines Optimisation (IPMO) Workforce group, setting out next steps for the development of the NHS Greater Manchester Pharmacy Workforce Strategy. 

We would like to invite you to provide your comments on the update paper and any areas that require further consideration by the GM Pharmacy Workforce Group to include within the NHS GM Pharmacy Workforce Strategy. 

To take part in the consultation, visit the consultations page.


Formulary updates

Following approval by CRG, GMMMG, and the Greater Manchester ICS Clinical Effectiveness and Governance Committee, the formulary and RAG list have been updated to add Cyclogest pessaries as an option for management of threatened miscarriage.

The full formulary is available on the formulary page.


Consultation: actions from CRG

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

  • Upadacitinib for non-radiographic axial spondyloarthritis to be added to formulary as RED
  • Somatrogon for growth disturbance in children and young people to be added to formulary as RED
  • Vutrisiran for hereditary transthyretin-related amyloidosis to be added to RAG list as RED
  • Ataluren for Duchenne muscular dystrophy to be added to RAG list as RED
  • Chapter 2 to be updated with a note “do not routinely offer aspirin for primary prevention of CVD”, with link to NICE CG181.

All links to MHRA drug safety updates will be added to formulary as appropriate.

To take part in this consultation, visit the consultations page. The consultation period is open until midday on Tuesday 2nd May 2023.