Prescribing Advice for GPs

An NHS Prescribing Advisers' Blog

SLS List Amendments

The September issue of the Drug Tariff will contain several amendments to the Selected List Scheme (SLS) for drug used in the treatment of erectile dysfunction.

The SLS lists items that may only be prescribed under certain conditions. Changes in legislation made in August have removed sildenafil from the SLS list but added avanafil and Viagra®.

These changes essentially mean that generic sildenafil can now be prescribed to all men with erectile dysfunction. Patients who are prescribed avanafil (Spedra®), tadalafil (Cialis®), vardenafil (Levitra®) or the Viagra® brand must still meet the SLS criteria and the prescription must be endorsed 'SLS' by the prescriber.

Action: Clinicians should be aware of these changes. Men who are currently prescribed sildenafil can be transferred to NHS prescriptions. Men currently prescribed an alternative on a private prescription may present requesting an NHS prescription for sildenafil.

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12 Comments to “SLS List Amendments”

  1. I would just add that when my previous GP reduced the prescription she did offer Generic Sildenafil in addition to those prescribed on NHS, on a Private Prescription at the cost of £15.00. This was the reason for changing GP plus the fact she had made the change in prescription without consulting me.

    Comment by Shaun Donovan — January 21, 2019 #
    Reply

  2. I wish there was a clear and reliable guidance on the prescription of Generic Sildenafil. Between November 2018 and January 2019 I have been prescribed 8, 12, 16 and 20 100mg tablets per month. My GP then reduced this to 4 tablets without any consultation at all. I have now changed my GP who is now prescribing 8 100 mg tablets every 4 weeks because of "current guidelines". The only guidelines I can find from NICE, BNF and NHS Nottinghamshire Area Prescribing Committee give a 'greenlight' to maximum prescribing daily. Can you help; I really object to our sexual relationship being restricted like this.

    Comment by Shaun Donovan — January 21, 2019 #
    Reply

    1. @Shaun,

      The original advice on this was a Health Service Circular from 1999 (HSC 1999/148). So, perhaps not surprising 20 years later that many are unaware of this original guidance.

      At that time there was genuine concern that the newly available Viagra® posed a significant financial risk to the NHS so limitations were imposed upon prescribing.

      However, the results of a survey were used to indicate that the average frequency of intercourse among those aged 40-60 years old was once per week, hence 4 tablets per month. However, it also noted that if it was felt clinically justified, more could be issued and if someone was entitled to NHS treatment, a top up private script could not be issued.

      The quantity issued per prescription is therefore still a clinical decision. Bear in mind though that whoever signs that script needs to be satisfied that the quantity they are authorising is justified. It is well worth booking to see a GP at the surgery at a time suitable for you and your partner to attend to discuss this issue and hopefully get it resolved to everyone's satisfaction.

      Comment by Matthew Robinson — January 22, 2019 #
      Reply

  3. As the Tariff is considered to be one of the most unreadable & bizarrely referenced publications ever produced - is there a plan for GPs to actually be informed of the change?

    Traditionally we are informed several days or weeks after the press (in some instances such as changes to vaccination policy not at all!) - it would be nice to know officially that some of the ridiculous rules have been changed!

    Comment by John Elder — August 28, 2014 #
    Reply

    1. @John,

      The launch of generic sildenafil prompted a consultation earlier this year by the DH which closed in June. The government has published a response to the consultation that may provide some of the additional information you seek.

      Comment by Matthew Robinson — August 28, 2014 #
      Reply

  4. It does not appear that the removal of silenafil from column 1 in Part XVIIIB of Drug Tariff applies to Wales

    Comment by Trevor Batt — August 27, 2014 #
    Reply

    1. @Trevor,

      Indeed, the change in legislation linked above appears to only mention NHS England so I suspect that the arrangements in Wales and Scotland are currently unchanged.

      Comment by Matthew Robinson — August 27, 2014 #
      Reply

  5. Does anyopne know if there any guidance re how many can be prescribed?
    Is it still x 4 per month as per DoH guidelines unless clinical reason why pt should get more? Many thanks!

    Comment by TP — August 27, 2014 #
    Reply

    1. @TP,

      The original advice contains in HSC 148 recommends one treatment per week being appropriate for most patients but notes that clinical judgement is required and that if a greater quantity that this is deemed to be appropriate then it should be prescribed.

      Comment by Matthew Robinson — August 27, 2014 #
      Reply

      1. Thanks Matthew, Sorry, I didn't make the question clear, what I meant was, does that still stand for sildenafil now it is not SLS? Many thanks!

        Comment by TP — August 28, 2014 #
        Reply

        1. Found answer in the response document, no guidance as to how many generic sildenafil should be prescribed...

          Comment by TP — August 28, 2014 #
          Reply

        2. @TP,

          My personal interpretation would be that the original advice regarding the quantity to prescribe still stands. As stated before, this would suggest that 4 tablets per month is a reasonable starting point and this can be adjusted based on the clinical judgement of the prescriber.

          Comment by Matthew Robinson — August 28, 2014 #
          Reply

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