REMEDY : BNSSG referral pathways & Joint Formulary

BNSSG Adult Joint Formulary
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Decisions 8th June 2021

At the meeting on the 8th June the following decisions were agreed

 

New Drug Requests

Approved

 

Dulaglutide (TLS Blue)

  • JFG confirmed that the recently released 3mg. 4.5mg pre-filled pens strengths are also approved for use on the formulary

VeraSeal® (TLS Red)

  • for improvement of haemostatis in paediatric surgery

Fondaparinux (TLS Red)

  • For systemic anticoagulation to prevent clotting in the extracorporeal circuit for patients with confirmed Type II Heparin Induced Thyrombocytopenia (HIT) who cannot achieve a satisfactory haemodialysis with anticoagulation free haemodialysis or with Citrasate® dialysate.

Shared Care Protocols/TLS changes

New SCPs:

 Nil

Updated SCPs:

Rifaximin

Mycophenolate

TLS Changes:

Mycophenolate for Interstitial Lung Disease (ILD) changed from TLS Red to TLS Amber 3 months and will be incorporated into the existing SCP for Mycophenolate

Tresiba® 200 units per mL formulation changed from TLS Red to TLS Amber no SCP for 

  • Type 2 diabetic patients to be initiated on the advice of the diabetes specialist nurse team 
  • Type 2 diabetic patients requiring pre-dialysis insulin on the advice of renal team

 

Other Formulary Decisions:

  • The introductory pages to the Joint Formulary will be updated for both Adults and Paeds to provide further clarity

  • The Endocrine Adult Chapter (excluding the 6.3 Diabetes section) has been reviewed in conjunction with local Trusts and Primary Care. Updates include: revised layout of 6.2 to separate steroid replacement therapy with steroid responsive therapy; addition of extra formulations for clarity in 6.2; identification for new drug requests for HRT treatment options; simplification of 6.8.5- links to relevant resources included only.

Further Work:

  • Testosterone (Tostran 2% gel and Testogel 50mg/5g gel sachets) will be approved as TLS Amber 3 months, pending the development of a shared care protocol for women with low libido who are on HRT who have either early menopause (age 45 and under) or surgical menopause. 

    Please note, testosterone for women outside of this indication is non formulary. Further work regarding the development of a HRT pathway is in progress

  • Glycopyrronium remains non-formulary for hypersalivation for Parkinson's Disease patients, further information is needed from the Trusts regarding patient numbers and place in treatment pathway

  • Steroid Emergency Rescue Packs- further work is needed in conjunction with the STP Medicines Optimisation Quality and Safety group to confirm/clarify the standard process across BNSSG for issuing the initial emergency rescue pack to patients with adrenal insufficiency