GMMMG decisions approved – August 2026
The decisions made at the Greater Manchester Medicines Management Group (GMMMG) and Clinical Effectiveness and Governance Committee (CEG) at their meetings in August 2026 have now been reviewed by the Strategic Commissioning Committee and can be found at https://gmmmg.nhs.uk/meetings/decision-summaries/.
Updates to formulary
- Sodium zirconium cyclosilicate – update to align with NICE TA1148, remains amber
- Fezolinetant for vasomotor symptoms of menopause – green
- Trixeo Aerosphere for COPD – green
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
- Valproate medicines guide – https://gmmmg.nhs.uk/guidance/clinical-guidance-and-pathways/
- Fezolinetant information for primary care prescribers – https://gmmmg.nhs.uk/guidance/information-leaflets-for-primary-care/
- Tirzepatide for weight management in adults – updated commissioning statement – https://gmmmg.nhs.uk/guidance/clinical-guidance-and-pathways/
The following have been approved and will be published shortly:
- Updated shared care protocol – dexamfetamine in paediatrics
- Malnutrition guidance
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/.
New consultation: CRG actions September 2026
On behalf of the GMMMG Clinical Reference Group, we now seek comments on the actions proposed at the September 2026 CRG meeting. Actions in this consultation include:
- Metformin modified-release formulations – may be considered for people at increased risk of gastrointestinal intolerance, or where standard-release metformin has been tried and not tolerated
- Orforglipron for type 2 diabetes or overweight and obesity – formulary to state that orforglipron should not be prescribed before NICE guidance is available or before a local formulary application is received for type 2 diabetes
- Finerenone for chronic heart failure with preserved or mildly reduced ejection fraction – green following specialist advice
- Donidalosen for hereditary angioedema – red
- Sublingual immunotherapy for allergic rhinitis caused by house dust mites and allergic rhinitis or conjunctivitis caused by tree pollen (12 SQ-HDM SLIT and 12 SQ-Bet SLIT) – update formulary to align eligible age groups with updated NICE guidance
- Fampridine for multiple sclerosis – red, in line with updated NHSE commissioning policy
- Discontinued medicines removed from formulary and guidance:
- Ocriplasmin (Jetrea) for vitreomacular traction
All links to NICE clinical guidelines and MHRA drug safety updates will be added to formulary as appropriate.
This consultation will run for six weeks and closes at 5pm on Monday 26th October 2026. To take part, visit the consultations page.
GMMMG decisions approved – July 2026
The decisions made at the Greater Manchester Medicines Management Group (GMMMG) and Clinical Effectiveness and Governance Committee (CEG) at their meetings in July 2026 have now been reviewed by the Strategic Commissioning Committee and can be found at https://gmmmg.nhs.uk/meetings/decision-summaries/.
Updates to formulary
- Sulfasalazine 500mg tablets, 500mg GR tablets, and 250mg.5ml oral suspension for IBD – AMBER. Added to formulary as RED, pending development of a shared care protocol
- Ruxolitinib for vitiligo – RED
- Dupilumab for COPD – RED
- Delgocitinib for chronic hand eczema – RED
- Pegzilarginase for arginase-1 deficiency – 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
- Acarizax and Itulazax primary care guidance – https://gmmmg.nhs.uk/guidance/clinical-guidance-and-pathways/
- Relugolix for prostate cancer – https://gmmmg.nhs.uk/shared-care/gmmmg-approved-shared-care-protocols/
- 7-minute briefing – propranolol overdose, toxicity and prescribing risks – https://gmmmg.nhs.uk/guidance/seven-minute-briefings/
The following have been approved and will be published shortly:
- GM narcolepsy treatment pathway for adults
- Sodium oxybate commissioning statement
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/.
GMMMG decisions approved – June 2026
The decisions made at the Greater Manchester Medicines Management Group (GMMMG) and Clinical Effectiveness and Governance Committee (CEG) at their meetings in June 2026 have now been reviewed by the Strategic Commissioning Committee and can be found at https://gmmmg.nhs.uk/meetings/decision-summaries/.
Updates to formulary
- Targeted-release budesonide for primary IgA nephropathy – red
- Carbidopa / entacapone / levodopa tablets – Sastravi and Stanek added to formulary as preferred options
- Methylphenidate for narcolepsy – amber
- Dupilumab for severe chronic rhinosinusitis with nasal polyps – red
- Obinutuzumab for lupus nephritis – red
- Discontinued items removed from formulary:
- FreeStyle Libre 3 sensors
- Peanut allergy immunotherapy (Palforzia)
- Sotrovimab for COVID-19
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
- Patient information leaflet for DOAC switch – https://gmmmg.nhs.uk/guidance/clinical-guidance-and-pathways/
- Updated shared care protocol – lisdexamfetamine for ADHD in children and adolescents – https://gmmmg.nhs.uk/shared-care/gmmmg-approved-shared-care-protocols/
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/.
New consultation: CRG actions August 2026
On behalf of the GMMMG Clinical Reference Group, we now seek comments on the actions proposed at the August 2026 CRG meeting. Actions in this consultation include:
- Methylphenidate chewable tablets – AMBER
- Lacosamide tablets – grey status removed; cost criterion no longer applies.
- Glycopyrronium cream for axillary hyperhidrosis – GREEN (specialist initiation)
- Teplizumab for delaying type 1 diabetes – RED
- Deuruxolitinib for alopecia areata – RED
- Aficamten for obstructive hypertrophic cardiomyopathy – RED
- Discontinued medicines removed from formulary and guidance:
- Clenil Modulite 50 microgram & 250 microgram
- Calcitriol 3 micrograms/gram ointment
All links to NICE clinical guidelines and MHRA drug safety updates will be added to formulary as appropriate.
This consultation will run for six weeks and closes at 5pm on Friday 25th September 2026. To take part, visit the consultations page.
New consultations: shared care, safety briefings, CRG actions
Six new consultations have opened for comments on the GMMMG website. Including consultations opened yesterday, the following are now accepting comments.
To take part in these or any other consultations, visit https://gmmmg.nhs.uk/consultations/.
- Commissioning statement: shower protection pouches / vascular access protection (VAP) dressings
- Primary immune thrombocytopenia (ITP) in adults treatment pathway
- CRG actions – July 2026
- Sotatercept for pulmonary arterial hypertension – RED
- Nusinersen and risdiplam for spinal muscular atrophy – RED
- Mepolizumab for COPD – RED
- Seladelpar for primary biliary cholangitis – RED
- Atogepant for treating migraine – GREEN
These consultations will run for six weeks and close at 5pm on Thursday 10th or Friday 11th September. Please see individual consultations for detail.
Shared care
There are five ongoing consultations relating to shared care for medicines:
- Shared care for undocumented patients and shared care for medicines principles
- Shared care protocol: guanfacine for children and adolescents
- Shared care protocol: sulfasalazine for patients in paediatric services
- Shared care protocol: azathioprine for patients in paediatric services
- Shared care protocol: domperidone for GORD for patients in paediatric services
These consultations will run for six weeks and close at 5pm on Thursday 10th or Friday 11th September. Please see individual consultations for detail.
7-minute briefings
Two 7-minute briefings have been developed by the Medicines Safety Subroup:
- Learning from a Medication Incident: Rivastigmine Patches
- Learning from a Methotrexate-Related Death: Preventing Future Harm
These consultations will run for two weeks and close at 5pm on Friday 14th August
To take part in these or any other consultations, visit https://gmmmg.nhs.uk/consultations/.
New consultations: shared care, shower pouches / VAP dressings, ITP pathway
Four new consultations have opened on the GMMMG website:
- Shared care protocol: guanfacine in children and adolescents
- Commissioning statement: shower pouches and VAP dressings
- Primary immune thrombocytopenia (ITP) treatment pathway
- Shared care of medicines principles and position statement for undocumented patients
These consultations will all run for six weeks and close at 5pm on Thursday 10th September.
To take part in these or any other consultations, visit https://gmmmg.nhs.uk/consultations/.
GMMMG decisions approved – May
The decisions made at the Greater Manchester Medicines Management Group (GMMMG) and Clinical Effectiveness and Governance Committee (CEG) at their meetings in May 2026 have now been reviewed by the Strategic Commissioning Committee and can be found at https://gmmmg.nhs.uk/meetings/decision-summaries/.
Updates to formulary
- High dose semaglutide (7.2mg) for weight loss – should not be prescribed until NICE guidance is published
- Loperamide 2mg for high-output stoma – green (following specialist advice)
- Emtricitabine . tenofovir alafenamide for HIV-1 PrEP – red
- Acoramadis for transthyretin amyloidosis – red
- Natalizumab (originator and biosimilar) for highly active relapsing-remitting multiple sclerosis – red
- Discontinued medicines removed from formulary:
- Emerade adrenaline auto-injector
- Asenapine 5mg & 10mg sublingual tablets
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 approved and will be published following final quality checks:
- Methylphenidate for ADHD in children and adolescents shared care protocol
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/.
New consultations: deprescribing guidance, and norethisterone for delaying menstruation
Following development by GMMMG subgroups, we now seek comments on two drafts:
- Medicines Optimisation Guidance for Targeted Deprescribing, including NSAIDs, PPIs and propranolol. This consultation will run for two weeks and closes on Wednesday 29th July
- Commissioning statement for norethisterone 5mg tablets when used for postponement of menstruation for non-clinical purposes. This consultation will run for six weeks and closes at 5pm on Wednesday 26th August.
To take part in these or any other GMMMG consultations, visit the consultations page.
New consultation: incretin therapies summary position and prescribing guidance
We now seek comments on a draft incretin therapies summary position and prescribing guidance. It includes guidance on use in type 2 diabetes, weight management, cardiovascular disease secondary prevention, and use in combination with insulin.
This consultation will run for six weeks and close at 5pm on Friday 31st July 2026. To take part, visit the consultations page.