Recent Updates

COVID-19 updates

For the latest updates and advice on coronavirus (COVID-19), please visit the NHS website.

For a summary of Formulary updates specific to the COVID-19 pandemic, please click here.

For Clinical Referral Guideline (CRG) updates specific to the COVID-19 pandemic, please click here.

September 2023

Drug changes and additions

Insulins

  • Two biosimilar insulins have been added to the Devon Formulary. These are cost saving compared to the originator insulins. All insulins should be prescribed by brand.
    • Trurapi (biosimilar insulin aspart) has been added to the Devon Formulary as a green (first line) option. Trurapi is recommended for new patients requiring insulin aspart. If the patient requires an alternative device, refer to NovoRapid.
      • NovoRapid (insulin aspart) is an option for existing patients and patients who require a NovoRapid device. For other patients requiring insulin aspart, Trurapi is recommended.
    • Admelog (biosimilar insulin lispro) has been added to the Devon Formulary as a green (first line) option. Admelog is recommended for new patients requiring insulin lispro. If the patient requires an alternative device, refer to Humalog.
      • Humalog (insulin lispro) is an option for existing patients who require a Humalog device. For other patients requiring insulin lispro, Admelog is recommended.
  • Lantus (insulin glargine) has been reclassified from blue (second line) to green (first line) as Lantus is now similar in price to the biosimilar Abasaglar and accounts for the majority of prescribing of insulin glargine in primary care in Devon.
  • Short-acting soluble insulins have been reclassified from green (first line) to blue (second line).
  • Pens for insulin cartridges have been added for North & East Devon to align with South & West Devon. This section has been updated to include pens for Trurapi and Admelog cartridges.
  • Click here for the formulary entry for insulins and pens for insulin cartridges.
Revised formulary guidance

Atrial fibrillation: The formulary guidance has been updated in line with NICE guidance NG196.

  • The HAS-BLED bleeding risk score has been replaced with the ORBIT bleeding risk score. The formulary guidance includes a link to an online calculator for the ORBIT risk score.
  • The section on anticoagulation has been updated to focus on treatment with direct-acting oral anticoagulants (DOACs) in line with NG196.
  • Click here for the formulary guidance.

July 2023

Drug changes and additions
  • Tiogiva DPI inhalation powder capsules (tiotropium) 18 micrograms have been added to the formulary as a green (first line) option for the maintenance treatment of chronic obstructive pulmonary disease
    • This replaces Braltus Zonda DPI inhalation powder capsules 10micrograms which have been removed from the formulary.
    • Click here for the formulary entry.
  • Avenor pMDI inhaler (fluticasone propionate and salmeterol) 50micrograms/25micrograms, 125micrograms/25micrograms, and 250micrograms/25micrograms have been added to the formulary as a blue (second line) option for the treatment of asthma
    • This replaces AirFluSal MDI inhaler 125micrograms/25micrograms and 250micrograms/25micrograms and Seretide pMDI Evohaler 50micrograms/25micrograms which have been removed from the formulary
    • Click here for the formulary entry.
  • Update to prostaglandin analogue eye drops:
    • Bimatoprost / timolol single use eye drops 300micrograms/ 5mg/ml preservative free have been added as an amber (specialist input) option
    • Tafluprost single unit eye drops 15 micrograms/ml preservative free have been added as an amber (specialist input) option
    • Tafluprost / timolol single unit dose eye drops 15 micrograms/ 5mg/ml preservative free have been added as an amber (specialist input) option
    • Click here for the formulary entry.
  • SKYCovion COVID-19 vaccine has been added to the formulary as a green (first line) option for use as a primary vaccination in those aged 18 and over. It is given as two injections, four weeks apart
  • Zostavax shingles vaccine has been discontinued and removed from the formulary. Shingrix vaccine remains available in the formulary for prevention of herpes zoster (shingles) as per The Green Book; Chapter 28a.
Revised sections
  • Following new and updated guidance by Specialised Pharmacy Service (SPS) and Faculty of Sexual and Reproductive Healthcare (FSRH) respectively, the subsection on drug interactions with hormonal contraception has been updated
"Shared Care" / Specialised Medicines Service (SMS) prescribing guidelines

New guidelines

  • Dexamfetamine for patients within adult services
    • This is a new Devon-wide SMS guideline; it covers the use of dexamfetamine for the treatment of ADHD, or excessive daytime sleepiness caused by narcolepsy (with or without cataplexy), in patients within adult services
    • This guideline broadly aligns with the recent guideline for dexamfetamine for ADHD in children and young people
    • Monitoring is the same as that required for atomoxetine, lisdexamfetamine, and methylphenidate in adults
    • This guideline will be remunerated at tier 2
    • The Devon-wide prescribing guideline can be found on the NHS Devon ICB website, or via the individual drug entry in the Devon Formulary (click here for the formulary entry).

Updated guidelines

  • Somatropin for the treatment of growth hormone deficiency in adults
    • Following the discontinuation of some brands of somatropin injection, the North & East Devon and West Devon Shared Care guidelines for somatropin has been updated to remove reference to specific brands. For clarity, additional notes have been added to remind clinicians to prescribe by brand in line with the specialist recommendation. Contact details have also been updated
    • Click here for the formulary entry.

June 2023

Drug changes and additions
  • Emerade adrenaline auto-injectors have been recalled due to the potential for device failure. In response to a National Patient Safety Alert and a recommendation from the MHRA to provide an alternative auto-injector preparation to Emerade, Jext adrenaline auto-injectors 150micrograms and 300micrograms have been added to the formulary as a green (first line) option for emergency treatment of acute anaphylaxis
    • Emerade adrenaline auto-injectors 150micrograms, 300micrograms, and 500micrograms have been removed
    • Click here for the formulary entry.
  • Sodium cromoglicate 2% preservative free eye drops have been added to the formulary as a blue (second line) option
  • Fidaxomicin oral suspension sugar free 40mg/ml has been added to the formulary as an amber (specialist input) option for adults and children with swallowing difficulties/enteral feeding requirements

Update to silver dressings:

All silver dressings are now amber (specialist input). Click here for the formulary entry.

  • Acticoat 5x5cm, 10x10cm, 10x20cm, and 20x40cm silver dressings have been added as an amber (specialist input) option for partial and full-thickness wounds that show signs and symptoms of infection
  • Acticoat Flex 3 5x5cm, 10x10cm, 10x20cm, and 20x40cm silver dressings have been added as an amber (specialist input) option for partial and full-thickness wounds that show signs and symptoms of infection
  • Aquacel Ag+ Extra 4x10cm, 4x20cm, 4x30cm, 20x30cm silver dressings have been added as an amber (specialist input) option for moderate to high exuding wounds that show signs and symptoms of infection
    • Square sizes already listed have been reclassified to amber (specialist option)
  • UrgoTul Silver 10x12cm and 15x20cm silver dressings have been added to the formulary as an amber (specialist input) option for non to low exuding wounds that show signs and symptoms of infection
Specialised Medicines Service (SMS) guidelines
Updated guidelines:

The following guidelines have been agreed for attention deficit hyperactivity disorder (ADHD) in children and young people aged 6 years and above:

  • Atomoxetine (click here for guideline)
  • Lisdexamfetamine (click here for guideline)
  • Methylphenidate (click here for guideline)
    • These three Devon-wide guidelines update and replace the previous versions
    • Key updates:
      • service transition guidance has been included
      • specialist baseline assessment updated
      • the frequency of weight measurements for children under 10 years of age has been increased from 6 monthly to 3 monthly
      • The frequency of blood pressure and pulse measurements have been decreased from 3 monthly to 6 monthly for all children
      • drug specific supporting information has been updated
      • new template shared care agreement letters have been included
    • There is no change to the SMS tier for remuneration for these guidelines (tier 2)
    • The updated Devon-wide prescribing guidelines can be found on the NHS Devon ICB website (hyperlinks above), or via the individual drug entry in the Devon Formulary (click here for the formulary entry).

New guidelines:

  • Dexamfetamine for attention deficit hyperactivity disorder (ADHD) in children and young people aged 6 years and above
    • This is a new guideline, which has been produced in line with NICE Guideline NG87 and aligns with the three guidelines above
    • Dexamfetamine is recommended for children and young people whose ADHD symptoms are responding to lisdexamfetamine but who cannot tolerate the longer effect profile
    • Monitoring is the same as that required for atomoxetine, lisdexamfetamine and methylphenidate in children and young people
    • This guideline will be remunerated at tier 2
    • The Devon-wide prescribing guideline can be found on the NHS Devon ICB website, or via the individual drug entry in the Devon Formulary.
  • Solriamfetol for the treatment of excessive daytime sleepiness in adults with narcolepsy with or without cataplexy
    • This is a new guideline
    • Solriamfetol is recommended as an option for treating excessive daytime sleepiness in adults with narcolepsy with or without cataplexy, in line with NICE TA758. This is only is modafinil and either dexamfetamine or methylphenidate have not worked well enough or are not suitable
    • This guideline will be remunerated at tier 2
    • The Devon-wide prescribing guideline can be found on the NHS Devon ICB website, or via the individual drug entry in the Devon Formulary.

Please be advised that from June 2023 (for claims from 1st May onwards) practices will see the following changes on the commissioning intelligence portal:

  • Solriamfetol will be added to the portal for all Devon practices
  • South Devon practices have previously been able to claim for dexamfetamine, but this will be activated on the portal for North, East and West Devon practices also
  • The updated LES specifications for GP Specialised Medicines Services will be available for practices to download via the portal.

 

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