REMEDY : BNSSG referral pathways & Joint Formulary

BNSSG Adult Joint Formulary
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Decisions 6th February 2024

New Drug Requests: 



Shared Care Protocols

  • Dapsone for dermatoses and oral ulceration - new SCP approved, now TLS Amber 3 months with shared care protocol

  • Valproate - combined adult and paediatric SCP approved


Traffic light status changes

  • Anastrozole, exemestane, letrozole and tamoxifen - change to TLS Amber - need for shared care protocol being reviewed. 

  • Ivermectin (oral) for treatment resistant classical scabies - change to TLS blue. For outbreaks and crusted / Norwegian scabies, TLS remains red. 

  • Novorapid - change TLS to blue

  • Semaglutide (oral) - change to TLS blue

  • Rimegepant for migraine prevention – TLS change to Amber Specialist Initiated


Contraception chapter review changes

  • Add Bimizza brand ethinylestradiol 20 mcg/ desogestrel 150mcg as TLS Green

  • Add Cilique and Lizinna brand ethinylestradiol 35mcg / norgestimate 250 mcg as TLS Blue

  • Remove Cilest brand as discontinued

  • Add Brevinor brand ethinylestradiol 35 mcg / norethisterone 500mcg as TLS Green

  • Add Norimin brand ethinylestradiol 35 mcg / norethisterone 1000mcg as TLS Green

  • Add Microgynon ED ethinylestradiol 30 mcg / levonorgestrel 150 mcg as TLS blue

  • Cerelle change from TLS green to blue due to lower price brand Zelleta.

  • Add Zelleta brand desogestrel 75mcg as TLS Green


Other decisions and discussions:

  • Removal of discontinued products agreed:

    • betamethasone 0.1% eye ointment

    • polymyxin B sulphate eye ointment (Polyfax®)

  • High strength fluoride toothpaste (Duraphat 5000ppm) - can be prescribed by GP for patients with head and neck cancer for patients who do not have an NHS dentist or where patients cannot access this in a timely manner. NHS Dentist remains the first point of contact. 

  • Methoxyflurane (Penthrox) for acute pain relief of moderate to severe pain for use in the emergency department may also be used within Sirona MIU and UTCs.

  • Hypertonic saline

    • remove reference to brands from formulary for 6% and 7% products

    • 3% strength added as Amber Specialist Initiated

  • Efmody (hydrocortisone) add to the adult joint formulary as TLS Amber Specialist Recommended for congenital adrenal hyperplasia in adult patients who were established on Efmody whilst under the care of paediatric endocrinology to support continuity of care. 

  • Clobazam - 10mg/5ml is the recommended strength for use in BNSSG

  • Aflibercept LA - further work required.