News summary

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

Updates to formulary

• Fenofibrate for diabetic retinopathy – green (specialist advice)
• Fluticasone / azelastine nasal spray – grey and green, prescribe generically
• Mometasone / olopatadine nasal spray – grey and green, alternative to fluticasone / azelastine
• Sacubitril / valsartan – green (specialist advice)
• Cabotegravir for HIV PrEP – 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 at https://gmmmg.nhs.uk/guidance/clinical-guidance-and-pathways/:

• Interim position statements for incretin therapies and GM implementation of updates to NICE NG28
• SGLT2 inhibitor pathway and position statement
• Lipid management primary prevention pathway
• Statin intolerance pathway
• Safety pen needles and lancets position statement
• Update to adult hypertension medication overview table

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/.

On behalf of the GMMMG Clinical Reference Group, we now seek comments on the actions proposed at the April 2026 CRG meeting. Actions in this consultation include:

• Sulfasalazine 500mg tablets, 500mg GR tablets, and 250mg.5ml oral suspension – amber (shared care) for Crohn’s disease and ulcerative colitis in patients aged 2 and older
• Ruxolitinib for vitiligo – red
• Dupilumab for COPD – red
• Fezolinetant for vasomotor symptoms of menopause – green following specialist initiation / advice
• Pegzilarginase for arginase-1 deficiency – red

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 29th May 2026. To take part, visit the consultations page. 

Guidelines and pathways

The following guidelines and pathways are also open for consultation:

• Primary Care Quick Reference Sheet: Acarizax® and Itulazax®
• Shared care protocol: dexamfetamine in children and adolescents

These consultations will run for six weeks and close at 5pm on Friday 29th May 2026. To take part, visit the consultations page. 

On behalf of the GMMMG Clinical Reference Group, we now seek comments on the actions proposed at the March 2026 CRG meeting. Actions in this consultation include:

• Carbidopa / entacapone / levodopa tablets – add Sastravi and Stanek to formulary
• Methylphenidate for narcolepsy – AMBER
• Budesonide for primary IgA nephropathy – update formulary to reflect TA1128
• Obinutuzumab for lupus nephritis – RED
• Dupilumab for severe chronic rhinosinusitis with nasal polyps – RED
• Discontinued products to be removed from formulary:
  • FreeStyle Libre 3 sensor (replaced by FSL3+)
  • Peanut allergy immunotherapy (Palforzia)
  • Sotrovimab for COVID-19

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 Thursday 30th April 2026. To take part, visit the consultations page. 

As you will be aware, UKHSA and NHS England have declared the MenB outbreak in Kent a major incident.

GM ICB have received an update today from UKHSA advising the following:

GPs across the country will be asked to prescribe antibiotics to anyone who visited Club Chemistry between 5 and 7 March, as well as to University of Kent students who have been advised to seek preventative treatment. This measure is intended to ensure that individuals who have since travelled home or relocated from Kent can quickly and easily access this important prophylactic treatment locally.

Please refer to the guidance for full details: Cases of invasive meningococcal disease notified in Kent – latest updates from the ongoing outbreak.

Formulary has been amended to add information on chemoprophylaxis, which reflects BNF advice and UKHSA guidance for public health management of meningococcal disease in the UK.

Full copies of the guidance are available from the UKHSA website or from the GMMMG antimicrobial guidance and resources page.

Following the June meetings of GMMMG and CEGC, the following actions have been published to the GMMMG website. This includes the recommendations made by GMMMG in June 2025 and NICE Technology appraisals published in February 2025. A summary of approved decisions can be found at https://gmmmg.nhs.uk/meetings/decision-summaries/.

Updates to formulary

• Medicines for tuberculosis – restrictions placed in July 2025 (due to supply issues) removed
• Garadacimab for hereditary angioedema
• Discontinued medicines removed from formulary:
  • Terbutaline 0.5mg/ml ampoules
  • Bydureon BCise
  • Rybelsus 3mg, 7mg & 14mg 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

Updated shared care protocol:

• Atomoxetine shared care protocol for children and adolescents – https://gmmmg.nhs.uk/shared-care/gmmmg-approved-shared-care-protocols/

Colleagues are asked to disseminate for implementation within your organisations.

Items awaiting review by the ICB executive will be published once approved:

• Fenofibrate for diabetic retinopathy and diabetic maculopathy
• Fluticasone / azelastine nasal spray – generic first line, Ryaltris (mometasone / olopatadine) second line, branded Dymista non-formulary

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/.

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

Updates to formulary

• Alteplase for acute ischaemic stroke between 4.5-9 hours after onset – RED
• Allopurinol 200mg tablets – DNP
• Tirzepatide for T2DM – first choice weekly GLP-1 / agonist, alongside semaglutide
• Denosumab biosimilar – branded prescribing required. Existing patients to receive Prolia, and new patients as per specialist advice.
• Generic tadalafil – updated to remove SLS restrictions
• Benralizumab for eosinophilic granulomatosis with polyangitis – RED
• Discontinued products removed from formulary:
  • Admelog (March 2026)
  • Dexcom One

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/.

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/.

We now seek comments on a draft shared care protocol for lisdexamfetamine for children and adolescents. This is an update to an existing GMMMG shared care protocol.

This consultations will run for six weeks and close at 5pm on Friday 3rd April 2026. To take part, visit the consultations page.

On behalf of the GMMMG Clinical Reference Group, we now seek comments on the actions proposed at the February 2026 CRG meeting. Actions in this consultation include:

• High dose semaglutide (7.2mg) for weight loss – interim position pending NICE guidance
• Loperamide 2mg capsules for management of high-output stoma – green (specialist advice)
• Emtricitabine / tenofovir alafenamide for HIV-1 PrEP – red
• Acoramidis for transthyretin amyloidosis with cardiomyopathy – red
• Natalizumab for highly active relapsing-remitting MS after disease-modifying therapy – red
• Discontinued medicines to be removed from formulary:
  • Emerade (adrenaline) auto-injectors
  • Asenapine

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 Thursday 26th March 2026. To take part, visit the consultations page.