Prescribing Advice for GPs

An NHS Prescribing Advisers' Blog

SMC Update - May 2016

The Scottish Medicines Consortium (SMC) has issued its monthly advice on newly licensed medicines.

Emtricitabine, elvitegravir, cobicistat and tenofovir alafenamide (Genvoya®) has been accepted for use in the treatment of adults and adolescents (aged 12 years and older with body weight at least 35kg) infected with human immunodeficiency virus-1 (HIV-1) without any known mutations associated with resistance to the integrase inhibitor class, emtricitabine or tenofovir.

Ivacaftor (Kalydeco®) has been rejected for use in the treatment of children with cystic fibrosis (CF) aged 2 years and older and weighing less than 25kg who have a specified gating mutation in the cystic fibrosis transmembrane conductance regulator (CFTR) gene. The submitting company’s justification of the treatment’s cost in relation to its health benefits was not sufficient and in addition the company did not present a sufficiently robust clinical and economic analysis to gain acceptance by SMC.

Lumacaftor and ivacaftor (Orkambi®) has been rejected for use in the treatment of cystic fibrosis (CF) in patients aged 12 years and older who are homozygous for the F508del mutation in the CF transmembrane conductance regulator (CFTR) gene. The submitting company’s justification of the treatment’s cost in relation to its health benefits was not sufficient and in addition the company did not present a sufficiently robust clinical and economic analysis to gain acceptance by SMC.

Action: Clinicians should be aware of the recommendations of the SMC. Routine use of rejected and restricted medicines should be avoided.

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Prescription Charges for 2016

The Department of Health announced in March that the price for an NHS prescription in England will increase by 20p to £8.40 with effect from April 2016.

The prices for 3 and 12 month pre-payment certificates have remained the same at £29.10 and £104 respectively. For anyone requiring more than 3 items in 3 months or more than 12 in a year these certificates can provide significant savings.

Other NHS charges such as for dental work, wigs and fabric supports are also being increased.

Action: Clinicians should be aware of the current prescription charge and also the value for money represented by pre-payment certificates.

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NICE Guidance - April 2016

The National Institute of Health and Care Excellence (NICE) have published new or updated guidance for the month of April 2016. This month there is one clinical guideline, one guideline and two technology appraisals that impact upon primary care.

The Depression in adults: recognition and management clinical guideline covers identification and management of depression in adults aged 18 years and older, in primary and secondary care. It aims to improve care for people with depression by promoting improved recognition and treatment. This guideline was updated to contain a link to the guidance on repetitive transcranial magnetic stimulation for depression

The Controlled drugs: safe use and management guideline covers systems and processes for using and managing controlled drugs safely in all NHS settings except care homes. It aims to improve working practices to comply with legislation and have robust governance arrangements. It also aims to reduce the safety risks associated with controlled drugs.

The Abiraterone technology appraisal reviews the place of this drug in treating metastatic hormone-relapsed prostate cancer before chemotherapy. Abiraterone in combination with prednisone or prednisolone is recommended, within its marketing authorisation, as an option in people who have no or mild symptoms after androgen deprivation therapy has failed, and before chemotherapy is indicated. This recommendation is made only when the manufacturing company rebates the drug cost of abiraterone from the 11th month until the end of treatment for people who remain on treatment for more than 10 months.

The Sacubitril / Valsartan technology appraisal reviews the place of this drug treating symptomatic chronic heart failure with reduced ejection fraction. Treatment is recommended as an option for people with New York Heart Association (NYHA) class II to IV symptoms and a left ventricular ejection fraction of 35% or less and who are already taking a stable dose of angiotensin‑converting enzyme (ACE) inhibitors or angiotensin II receptor‑blockers (ARBs).

Action: Clinicians should be aware of this month's new guidance and implement any necessary changes to practice.

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SMC Update - April 2016

The Scottish Medicines Consortium (SMC) has issued its monthly advice on newly licensed medicines.

Alendronic acid effervescent tablets (Binosto®) have been accepted for restricted use in the treatment of postmenopausal osteoporosis. The restriction limits use to patients who are unable to swallow tablets where alendronic acid is the appropriate treatment choice.

Camellia sinensis (Catephen®) has been accepted for restricted use in the cutaneous treatment of external genital and perianal warts (condylomata acuminata) in immunocompetent patients from the age of 18 years. The restriction limits use to patients not suitable for podophyllotoxin or who have not responded to treatment with podophyllotoxin.

Action: Clinicians should be aware of the recommendations of the SMC. Routine use of rejected and restricted medicines should be avoided.

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NICE Guidance - March 2016

The National Institute of Health and Care Excellence (NICE) have published new or updated guidance for the month of March 2016. This month there is one clinical guideline and one guideline that impact upon primary care.

The Antenatal care for uncomplicated pregnancies clinical guideline has been updated to remove two recommendations regarding gestational diabetes because this is now contained in the NICE guideline on Diabetes in pregnancy.

The Community engagement: improving health and wellbeing and reducing health inequalities guideline covers community engagement approaches to reduce health inequalities, ensure health and wellbeing initiatives are effective and help local authorities and health bodies meet their statutory obligations.

Action: Clinicians should be aware of this month's new guidance and implement any necessary changes to practice.

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