Stockport CCG



4400550-69659500ITEMS NOT TO BE PRESCRIBED AT NHS STOCKPORT CLINICAL COMMISSIONING GROUP EXPENSE (BLACK LIST) OR ONLY IN LIMITED CIRCUMSTANCES ( GREY LIST)These items are in addition to those listed in Part XVIIIA of the drug tariff. There are a number of medications and devices that the NHS Stockport CCG believes should not be used (Black List) or should only be used in limited circumstances (GREY List). GREY listed items will only be funded for patients who meet the specified criteria. These include therapies listed in the Greater Manchester Medicines Management Group (GMMMG) Do Not Prescribe (DNP) and Grey lists which the CCG fully support. Any item added to the DNP list will automatically cease to be funded within Stockport.NHS Stockport clinical Commissioning Group recognises that there may be exceptional patients or situations where prescribing of these items may be necessary and such situations should be managed through the usual exceptionality processesA patient may be deemed exceptional if the patient has a clinical picture that is significantly different to the general population of patients with that condition and, as a result of that difference; the patient is likely to derive greater benefit from the intervention than might normally be expected for patients with that condition(NTS is the New Therapies sub-group of the Greater Manchester Medicines Management Group (GMMMG))ITEMRATIONALESTATUSAlbiglutide*As per LiraglutideGREYAdvasil Conform?*See Silicone preparations to improve the appearance of scar tissue BLACKAlendronate plus vitamin D (Fosavance?) tabletsGMMMG DNP list on basis that it is not a cost effective use of NHS resourcesBLACKAlendronic acid as branded preparation*Branded preparations are significantly more expensive than the generic equivalentsBLACKAlere? INRatio test strips*Approval must be given for every patient prescribed these strips to ensure safe and effective support is in place. Use will be approved where self-monitoring is part of a structured system with support from a designated anti-coagulant monitoring service.GREYAlimemazineGMMMG DNP list on basis that it is not a cost effective use of NHS resourcesBLACKAliskiren tablets*Only for use on specialist advice due to multiple MHRA safety alerts in regard to diabetes & renal function. GREYAll products marketed for blepharitis either as lid cleansers or for symptom relief. This includes cleansers and devices*These are not considered a cost effective use of NHS resources. There is limited evidence to support the effectiveness of products over traditional eyelid hygiene methods?BLACKAloe Vera Gel *Lack of evidence base BLACKAlmotriptan as branded preparations*Branded preparations can be significantly more expensive and offer no added value over the generic. Generic prescribing is required.BLACKAlprostadil cream (Vitaros?)*For use as an alternative to intercavernosal therapy within the current CCG ED policyGREYAnastrozole as branded preparations e.g. Arimidex?*Branded preparations can be significantly more expensive than the generic. Generic prescribing is required. Seek approval for patients who cannot tolerate the generic.BLACKAnhydrol Forte*Product for Cosmetic Purpose. Use prior to referral for botulinum toxin therapy in line with EUR policy is appropriateGREYApixaban (Eliquis?)*For use as per NICE criteria. Use outside of this requires an approval request to be completed. FOR use in AF a Record of initiation needs to be completed and stored on clinical system for audit purposes.NB For Post operative thromboprophylaxis the full course will be provided by the hospital and it should not need to be prescribed by primary care for this indication.GREYArmour Thyroid PreparationsGMMMG DNP list on basis of significant safety concerns and poor evidence base.BLACKArnica Cream /Gel*Lacks evidence of efficacy BLACKAtorvastatin as a branded preparation e.g. Lipitor?*Branded preparations can be significantly more expensive and offer no added value over the generic. Generic prescribing is required.BLACKAtorvastatin preparations in the strengths 30mg or 60mgGMMMG DNP list as not a cost effective use of resources. Other strengths may be prescribed to meet clinical need.BLACKAzapropazone*Associated with the highest risk of GI side effects. BLACKBAP scar Care? all preps*See Silicone preparations to improve the appearance of scar tissue BLACKBath EmollientsGMMMG DNP list on basis that it is not a cost effective use of NHS resourcesBLACKBath Emollients with added antimicrobial agentsGMMMG listed for acute use in infected eczema only. Not to be added to repeat.GREYBCG vaccination for travelGMMMG DNP list on basis that it is not a cost effective use of NHS resourcesBLACKBenzoyl Benzoate*Less effective than Malathion or permethrin BLACKBio-Oil?Cosmetic product for the treatment of minor scars, not an appropriate use of NHS resourcesBLACKBioXtra? toothpaste & mouth rinse (this does not include BioXtra? oral gel)GMMMG DNP list on basis that it is not a cost effective use of NHS resourcesBLACKBranded preparations containing latanoprost as a single active ingredient*Branded preparations are significantly more expensive and offer no added value over the generic. Generic prescribing is required. Preservative free drops should be considered before requesting approval to prescribe a brandBLACKBrimonidine (Mirvaso? )* Gel*Cosmetic treatment is not routinely commissioned by NHS Stockport CCG. Use prior to laser therapy requires approval with photographic evidence to demonstrate the clinical need for such treatment.BLACKBrinzolamide eye drops as branded preparation (Azopt?)*Branded preparations are significantly more expensive than generic preparationsBLACKCalamine*(all preps)No evidence of effectivenessBLACKCalcium 500mg /colecalaferol 200iu e.g.Calcichew D3?. GMMMG DNP list on basis that it is not a cost effective use of NHS resourcesBLACKCamouflage products (amended)NHS Stockport does not routinely fund cosmetic treatments. Approval must be sought before prescribing. Photographs to show the extent of the condition to be masked should be submitted with the approval.Exceptional needs will be considered for approval such as severe facial vitiligo or in cases of psychological distress where there is documented evidence e,g severe bullying BLACKCandesartan, as branded preparations (Amias?)* Branded preparations are significantly more expensive than the generic equivalentsBLACKCannabis extracta- All preparations e.g. (Sativex?)GMMMG DNP list – Poor Evidence baseBLACKCariprazineGMMMG DNP list on basis that it is not a cost effective use of NHS resourcesBLACKCelecoxib as branded preparations (Celebrex?)* Branded preparations can be significantly more expensive than the generic equivalentsBLACKChloral Hydrate (all preps)*Not to be used in the elderly Appropriate for short term use only on the advice of a specialistGREYChlorpropamideGMMMG DNP list- safety concernsBLACKCica-Care?*See Silicone preparations to improve the appearance of scar tissue BLACKCiclesonide InhalerProphylaxis of asthma in adults and children over 12 years on specialist recommendation only where other lower cost inhalers have failed or the individual has had significant oropharyngeal side effects on other first line devices.GREYCilostazolGMMMG DNP list – Poor Evidence baseBLACKCiltech?*See Silicone preparations to improve the appearance of scar tissue BLACKCircadin? M/R tablets 2mg*Only for use within an approved shared care protocolGREYCitalopram as branded preparations (Cipramil?)Branded preparations can be significantly more expensive and offer no added value over the generic. Generic prescribing is required.BLACKClopidogrel as branded preparation (Plavix?)*Branded preparations are significantly more expensive than the generic equivalentsBLACKClonidine*For initiation by a hypertension specialist in resistant cases. Sudden withdrawal/ missed doses can precipitate hypertensive crisis.GREYCo-careldopa intestinal gel (Duodopa?)GMMMG DNP list on basis that it is not a cost effective use of NHS resourcesBLACKCo-Agucheck? Test Strips*Approval must be given for every patient prescribed these strips to ensure safe and effective support is in place. Use will be approved where self-monitoring is part of a structured system with support from a designated anti-coagulant monitoring service. GREYCo-codamol 15mg / 500mg*Single dose compound preps do not allow for effective dose titration and the advantages of using a compound formulation have not been substantiated. This is a fixed dose combination is particularly poor value to the NHS. Prescribe drugs individually BLACKCo-enzyme Q10 including ubiquinine and ubicdecarenoneGMMMG GREY List only permits use in mitochondrial disorders under the care of a specialist (NICE CG 181)GREYCo- flumactone(Aldactide?)*For use under specialist supervision in hyperaldosteronism onlyGREYCo-proxamol tabletsGMMMG DNP list- safety concernsBLACKCodeine linctus, all strengthsSee cough remediesBLACKCod liver oilLimited evidence of effectiveness. For OTC use patients should be advised that if not effective after a 3 month trial no benefit is likely to be gained.BLACKColesevelam* ( amended)Only for use in chronic diarrhoea while bile salt acids are implicated and the medication resolves all symptoms.GREYCompound preos of aspirin –Co-codaprin, Aspav?Single dose compound preps don’t support effective dose titration Prescribe drug individually BLACKCompound preps for ear wax removal*Offer little added benefit over simple e.g. olive oil, or sodium bicarbonate ear drops.BLACKCommercial eyelid cleansing preparationsGMMMG DNP list on basis that it is not a cost effective use of NHS resourcesBLACKCough medicines including codeine, pholcodine, simple linctuses. Preparations of dextromethorphanGMMMG DNP list – Poor Evidence base this list is not comprehensive but all cough remedies and demulcents are not funded.BLACKCovermark Classic? Foundation? or Covermark Finishing Powder?*See Camouflage ProductsBLACKCrestor preparations all strengthsBranded preparations are significantly more expensive than the generic equivalentsBLACKCyanocobalaminUse tablets only where a patient is unable to have B12Injections patient is vegan and has a proven dietary eficiency. GREYCymbalta preparations all strengthsBranded preparations are significantly more expensive than the generic equivalentsBLACKDabigatran (Pradaxa?)*See ApixabanGREYDapoxetine (Priligy?)*NTS recommendation does not support use. Click here to view statementBLACKDermacolor Camouflage Cream? or Fixing Powder?*See Camouflage ProductsBLACKDermatonics? *To be used in diabetic patients only on the advice of a specialist podiatrist to prevent loss of patency of the skin. GREYDermatrix?*See Silicone preparations to improve the appearance of scar tissue BLACKDextromethorphan in cough preparationsSee cough remediesBLACKDiamorphine linctusSee cough remediesBLACKDicycloverine (all preparations)GMMMG DNP list on basis that it is not a cost effective use of NHS resourcesBLACKDiclofenac as branded preparations (e.g.Voltarol?)*Branded preparations can be significantly more expensive than the generic equivalentsBLACKDiuretics with potassiumGMMMG DNP list- safety concernsBLACKDonepezil as branded preparations (e.g. Aricept?)*Branded preparations are significantly more expensive than the generic equivalentsBLACKDosulepin preparationsGMMMG DNP list –NICE states specifically not to use this drug due to safety concernsBLACKDoxazosin MR preparations*MR formulation offers no benefit over the standard release preparation due to the long half-life of the drug. 4mg MR ~2mg standard releaseBLACKDriclor application*Product for Cosmetic Purpose. Use only prior to referral for botulinum toxin therapy in line with EUR policy is appropriateGREYDropSafe? Safety Insulin pen needlesGMMMG DNP list BLACKDulaglutide*As per LiraglutideGREYDuraphat? ToothpasteGMMMG DNP list- safety concerns for GP prescribing. Dental practitioners may prescribe.BLACK (FP10)Edoxaban*As per ApixabanGREYEffexor ? all strengthsBranded preparations can be significantly more expensive and offer no added value over the generic. Generic prescribing is required.BLACKEflornithine (Vaniqa) ? cream*Cosmetic use is not permitted. All requests for approval require photographic evidence of severity (2 days without shaving)BLACKEicosapentaenoicacid preparations e.g.Omacor?/Maxepa?or Prestylon?)*Nationally identified as a low priority for fundingBLACK Eletriptan as branded preparations*Branded preparations can be significantly more expensive and offer no added value over the generic. Generic prescribing is required.BLACKErgotamine all preparationsGMMMG DNP list- safety concernsBLACKEscitalopram as branded preparations eg Cipralex?*Branded preparations can be significantly more expensive and offer no added value over the generic. Generic prescribing is required.BLACKEsomeprazole tablets – as a branded preparation e.g. Nexium?*Branded preparations are significantly more expensive and offer no added value over the generic. Generic prescribing is requiredBLACKEtoricoxib as branded preparations e.g. Arcoxia?)* Branded preparations can be significantly more expensive and offer no added value over the generic. Generic prescribing is required.BLACKEvoke e-cigarettesGMMMG DNP list – Poor Evidence baseBLACKExenatide*As per LiraglutideGREYExenatide MR*As per LiraglutideGREYFentanyl TabletsFor short term use on the advice of the Specialist Palliative Care ConsultantsGREYFentanyl nasal sprays and lozenges*NTS does not recommend routine use of these agents over more established therapies Click here to view the statementBLACKFerric Maltol (Feraccru?)*Only to be used for iron deficiency in line with NTS statement when initiated by a specialist only.GREYFidaxomicin (Dificlir?)*Use only on advice of microbiologist Use restricted to preserve the effectiveness of this drug against C Diff.GREYFinasteride 1mg tablets*Unlicensed product for the treatment of hair loss. This treatment is for cosmetic reasons and is not funded by BLACKFlexitol?, hand balm and skin balm products*Cosmetic products without an evidence base of added benefit over formulary options.BLACKFlexitol? heel balm*To be used in diabetic patients only on the advice of a specialist podiatrist to prevent loss of patency of the skin. GREYFluoride supplements (inc. tablets, mothwashes and toothpastes)These products should only be prescribed at CCG expense by a qualified Dental Practitioner who can assess the individuals fluoride status.GREYFlash glucose testing systems (Freestyle Libre?)Use is only permitted on the advice of and under the supervision of specialist services in line with the GMMMG FreeStyle Libre recommendation GREYFrovatriptan as branded preparations*Branded preparations can be significantly more expensive and offer no added value over the generic. Generic prescribing is required.BLACKFulvestrant (Faslodex?)GMMMG DNP list on basis that it is not a cost effective use of NHS resourcesBLACKGabapentin topical*GMMMG DNP list – Poor Evidence baseBLACKGamolenic acid (all preparations)GMMMG DNP list on basis that it is not a cost effective use of NHS resourcesBLACKGlibenclamide*For use on specialist advice only High risk of hypoglycaemiaGREYGliclazide MR tablets any strengthGMMMG DNP list on basis that it is not a cost effective use of NHS resourcesBLACKGluten free bread* Prescribable for individuals with confirmed gluten enteropathy with a maximum quantity of 8 loaves every 2 monthsGREYGluten free flour mixes*Prescribable for individuals with confirmed gluten enteropathy onlyGREYGluten Free foods other than bread or flour mixes*Blacklisted in line with National position paper pending changes to the national tariff ( expected December 2018)BLACKGlucosamine any saltGMMMG DNP list – Poor Evidence baseBLACKGlucosamine with ChrondroitinGMMMG DNP list – Poor Evidence baseBLACKGrass Pollen extract (Grazax?)NHS Stockport do not fund and NTS do not recommend. Click Here to view statement.BLACKHeel balms with high percentage urea 25%To be used in diabetic patients only on the advice of a specialist podiatrist to prevent loss of patency of the skin. GREYHepatitis B vaccination for travelGMMMG DNP list on basis that it is not a cost effective use of NHS resourcesBLACKHerbal medicines*Lack of evidence base to support prescribingBLACKHomeopathic preparations*Lack of evidence base to support prescribingBLACKIcaps? productsSee Multivitamin Preps for eye healthBLACKIndependence wound drainage bag with extra dressings eg Prosys VAP1 or VAP2STAMP considers that these products are not an appropriate use of NHS resources except in exceptional circumstances. Prior approval requiredBLACKIdoxuridine in dimethyl sulfoxide Herpid?GMMMG DNP list – Poor Evidence baseBLACKInosine Panobex*No proven antiviral activity.BLACKInositol (Hexopal?)GMMMG DNP list – Poor Evidence baseBLACKInsecticidal cream shampoo or cream rinse*Less effective than other formulations e.g. lotions which may be prescribedBLACKInsulin degludec*For use on specialist advice only NTS recommended use only in individuals with diabetes who, despite having all other medications optimised, fail to maintain glycaemic control overnight and in whom hypoglycaemia is a risk or in those with an unpredictable lifestyle e.g. shift workersGREYInsulin Degludec in combination with Liraglutide (IdegLira? & Xultophy?)*NTS does not recommend the use of this insulin in combination with Liraglutide (click here to view) BLACKInsulin pen needles <7mm length costing more than ?6 per 100 needlesGMMMG DNP list BLACKInsulin Pen needles above 7mm lengthGMMMG regardless of cost- Forum for Injection technique guidanceBLACKIrbesartan as branded preparations e.g. (Aprovel?)*Branded preparations are significantly more expensive than the generic equivalents.BLACKIron –all modified release preparationsGMMMG DNP list on basis that it is not a cost effective use of NHS resourcesBLACKIron with added vitamins (exc folic acid in pregnancy)*Offer little added benefit and greatly increased cost.BLACKJapanese Encephalitis vaccination for travelGMMMG DNP list on basis that it is not a cost effective use of NHS resourcesBLACKKaolin preps*Adsorbents are no longer recommended for acute diarrhoeaBLACKKelo cote?*See Silicone preparations to improve the appearance of scar tissue BLACKKeromask Finishing Powder? /Masking Cream?*See Camouflage ProductsBLACKKetoconazole oral productsGMMMG DNP list- safety concernsBLACKLacriserts ocular lubricantSTAMP considers that there is a only a narrow, defined place for use of the drug or preparation where all other treatment options have been tried and failed.GREYLactase e.g.Colief?GMMMG DNP list – Poor Evidence baseBLACKLanolin cream (Lansinoh HPA)GMMMG DNP list on basis that it is not a cost effective use of NHS resourcesBLACKLatisse? eye drops (bimatoprost 0.03%)*Cosmetic use, product is licensed to thicken eye lashes. This restriction does not apply to 0.3% drops for treatment of Glaucoma.BLACKLesinurad preparationsNICE does not recommend. Negative NICE TABLACKLetrozole as a branded preparation (Femara?)*Branded preparations are significantly more expensive than the generic equivalentsBLACKLevocetirizineGMMMG DNP list on basis that it is not a cost effective use of NHS resourcesBLACKLidocaine (Versatis? or Ralvo?) GMMMG DNP list – Poor Evidence baseBLACKLinaclotide*For use with in line with NICE CG61 only where ?optimal or maximum tolerated doses of previous laxatives from different classes have not helped and?they have had constipation for at least 12 months. Specialist follow up must be in place for 1st three months. GREYLiothyronineGMMMG DNP list – Poor Evidence baseFor use within secondary care only for hypothyroid crisis and post thyroid surgery (short term)GREYLiothyronine extracts including Armour thyroid preparationsNational Guidance not to prescribe in hypothyroidism due to safety concernsBLACKLiraglutide*Only to be used for people with type 2 diabetes within the NICE guideline see sections 1.6.28 1.6.29 GREYLixisenatide*As per LiraglutideGREYLoperamide as a branded preparation (Imodium?)*Branded preparations are significantly more expensive than the generic equivalents.BLACKLosartan as branded preparations*Branded preparations are significantly more expensive than the generic equivalents.BLACKLubiprostone*For use with in line with NICE TA 318 onlyGREYLyrica? brand of pregabalin (this brand only)Branded preparation is significantly more expensive than the generic equivalents.BLACKMacule? EH preparationsSee Multivitamin Preps for eye healthBLACKMacushields preparationsSee Multivitamin Preps for eye healthBLACKMelatonin All unlicensed preparations*Use licensed Circadin? MR 2mg tablets as per GREY list and current shared care protocols. Unlicensed preps do not have shared care and GP carries the full responsibilityBLACKMeningitis ACWY vaccination for travelGMMMG DNP list on basis that it is not a cost effective use of NHS resourcesBLACKMepiform?*See Silicone preparations to improve the appearance of scar tissue BLACKMeprobamate all preparationsGMMMG DNP list- safety concernsBLACKMethenamine Hippurate*For prescribing only by hospital consultants with the agreement of their microbiology department. Not for prescribing in primary care.GREYMethocarbamol* all preparationsNo evidence base to support its useBLACKMigraleve? all presentations*More effective agents are available. If necessary prescribe pain relief and anti-emetic where attacks are frequent. Available OTCBLACKMinoxidil Lotions*Products are marketed for a cosmetic condition, hair lossBLACKMometasone nasal sprays –as branded preparations (e.g.Nasonex ?)*Branded preparations are significantly more expensive than the generic equivalents.BLACKMonoamine oxidase inhibitors*For use only on specialist Psychiatric recommendation onlyGREYMontelukast- as branded preparations*Branded preparations can be significantly more expensive and offer no added value over the generic. Generic prescribing is required.BLACKMoxisylyte (Opilon?)GMMMG DNP list – Poor Evidence baseBLACKMultivitamin & mineral preps marketed for eye health or for AMD includingGMMMG DNP list – Poor Evidence base and safety concernsBLACKMylife Clickfine & Clickfine AutoProtect insulin pen needles*See insulin pen needlesBLACKNalmefene*For use within the NICE TA within the agreed local pathway GREYNaltrexone / Bupropion (Mysimba?)NTS Statement not recommended Click here to view the statement also not recommended by NICE TA494BLACKNaproxen + Esomeprazole (Vimovo?)GMMMG DNP list on basis that it is not a cost effective use of NHS resourcesBLACKNaratriptan as branded preparations (e.g. Naramig)*Branded preparations can be significantly more expensive & offer no added value over the generic. BLACKNedocromil Sodium inhaled preps*Lack of evidence baseBLACKNefopam (Accupan?)*Only to be used in those patients with moderate to severe chronic liver disease who require analgesia stronger than paracetamol in whom NSAIDS and moderate strength opiates are contraindicatedGREYNew-Gel +?*See Silicone preparations to improve the appearance of scar tissue BLACKOccuvite? PreservisionSee Multivitamin Preps for eye healthBLACKOcuvite? luteinSee Multivitamin Preps for eye healthBLACKOlmesartan as branded preps (e.g. Olmetec?)*Branded preparations are significantly more expensive than the generic equivalents.BLACKOlodaterol (Striverdi Respimat?)For use in COPD only, where all other LABA’s are not tolerated or where patient requires a respimat deviceGREYOmega 3 preparationsSee Eicosapentanoic acidBLACKOmeprazole- as a branded preparation e.g. Losec?*Branded preparations are significantly more expensive and offer no added value over the generic. Generic prescribing is required by policy.BLACKOndansetron*For use in chronic emesis on Specialist recommendation where all other treatment options have failedGREYOral Atropine*Poor benefit to risk ratio for use as an anti spasmodic BLACKOrlistat preparations*To be used only On the advice of Specialist Weight Management Service where BMI >40 or >35 with risk factors Or where BMI is 30-40 (or 28-35 with risk factors) after assessment by the Healthy Stockport Weight management service and all other measures have failed to reduce BMI. For all patients and initial 5% of body weight must be lost in first 12 weeks and weight must reduce each month thereafter to continue. GREYOscillating positive expiratory pressure devices* e.g. FlutterFor use only by the COPD Specialist TeamGREYOxycodone with Naloxone* (Targinact?)GMMMG DNP list on basis that it is not a cost effective use of NHS resources and has a poor evidence base Only to be used in those patients with moderate to severe chronic liver disease who require analgesia stronger than paracetamol in whom NSAIDS and moderate strength opiates are contraindicated?BLACKParacetamol / isometheptene mucate* (Midrid?)*These products are not appropriate to use from a safety or efficacy point of view, over existing treatments. Can be purchased OTCBLACKParacetamol/ tramadol tablets (Tramacet?)GMMMG DNP list on basis that it is not a cost effective use of NHS resourcesBLACKPentosan Oral*NICE does not recommend this product. Evidence summary August 2015BLACKPentoxifylline (Trental?)GMMMG DNP list – Poor Evidence baseBLACKPerampanel*Only on specialist advice for patients with highly refractory epilepsy who are unable to tolerate at least two other more established adjunctive therapies. GREYPerindopril arginine*GMMMG DNP list on basis that it is not a cost effective use of NHS resourcesBLACKPholcodine linctus, all strengthsSee cough remediesBLACKPiroxicam ( oral preps)Use on Specialist recommendation only due to safety concernsGREYPollinex and Pollinex QuatroGMMMG DNP list – efficacy not proven and safety concernsBLACKPotaba? (potassium Aminobenzoate)*Of doubtful therapeutic value. BLACKPotassium hydroxide (Molludab? ) solution 5%GMMMG DNP list on basis that it is not a cost effective use of NHS resourcesBLACKPrazosin- unlicensed indicationsGMMMG DNP list –Only for licensed indications due to poor evidence base outside the current licenseBLACKPrednisolone EC tabletsGMMMG DNP list – Poor evidence baseBLACKPrednisolone MR tablets (Lodotra?)GMMMG DNP list – Poor Evidence baseBLACKPregabalin as branded Lyrica?*Brand is significantly more expensive and offers no added value over the generic or low cost brands. Generic prescribing is advised.BLACKPreservision lutein?See Multivitamin Preps for eye healthBLACKPrilocaine/ lidocaine (Tempe?) spray*NTS recommendation does not support use. Click here to view recommendationBLACKProTime 3 cuvettes?*Approval must be given for every patient prescribed these strips to ensure safe and effective support is in place. Use will be approved where self monitoring is part of a structured system with support from a designated anti-coagulant monitoring service.GREYRanitidine 75mg tabletsOther more cost effective alternatives availableBLACKRabies vaccination for travelGMMMG DNP list on basis that it is not a cost effective use of NHS resourcesBLACKRESPeRate?GMMMG EUR group supported NICE recommendation not to routinely provide relaxation treatmentsBLACKRetapumulin (Altargo?)*Poor cost effectiveness evidenceBLACKRifaximin 550mg (Targaxan?)*Rifaximin 550mg (Targaxan?) Restricted for use in hepatic encephalopathy For use within NICE TA for hepatic encephalopathy only.GREYRivaroxaban (Xarelto?)*See ApixabanGREYRizatriptan as branded preparations*Branded preparations can be significantly more expensive and offer no added value over the generic. Generic prescribing is required.BLACKRoflumilast (Daxas?)*For use in COPD under the care of a specialist as an add on to triple therapy within the criteria of NICE TA 461GREYRowachol*No evidence base to support its useBLACKRowatinex*Unproven benefit in the expulsion of CalculiBLACKRubefacients TopicalPoor evidence base“Topical rubefacient products may contain nicotinate and salicylate compounds, essential oils, capsicum and camphor. However, topical NSAID preps or Capsaicin preps are NOT rubefacients.”BLACKRutosides* (Paroven?)*Not regarded as effective for crampBLACKRybarvin ?Inhalant*Available by import, but UK product discontinued Not advised in any guideline and is not cost effective. Patients may purchase this if they so wish.BLACKSacubitril/ Valsartan (Entresto?)*Four use in certain categories of heart failure with reduced ejection fraction following initiation by a specialist as per NICE TA 388GREYSalbutamol 2mg and 4mg standard release tablets*There is no instance where these products are appropriate to use from a safety or efficacy point of view, over existing treatments BLACKScar Fix?*See Silicone preparations to improve the appearance of scar tissue BLACKSertraline as branded preparation (eg Lustral?)*Branded preparations can be significantly more expensive and offer no added value over the generic. Generic prescribing is required.BLACKSildenafil as a branded preparation e.g. Viagra?*Branded preparations are significantly more expensive and offer no added value over the generic. Generic prescribing is required but only within CCG policyBLACKSilDerm SpraySee Silicone preparations to improve the appearance of scar tissue BLACKSilgel? app preparations*See Silicone preparations to improve the appearance of scar tissue BLACKSilicone preparations to improve the appearance of scar tissue e.g keloid dressings, sprays and gels*NHS Stockport does not routinely commission cosmetic treatment. No such preparations to be prescribed without prior approval. Not all products may be contained in this list.BLACKSilk Garments e.g. Dermasilk? , Skinnies? and Dreamskin?*GMMMG DNP list – Poor Evidence baseBLACKSimple linctus , all preparationsSee cough remediesBLACKSimvastatin with ezetimibe (Inegy?)GMMMG DNP list on basis that it is not a cost effective use of NHS resourcesBLACKSlow release potassium preparations (Slow K?)*MR preparations offer little benefit over other formulations. Use an effervescent preparation.BLACKSodium Oxybate Xyrem?*Only for use in line with GMMMG position available at ? 100% natural iron supplement. Spatone? liquid iron supplement with vitamin C*GMMMG DNP list – Poor evidence base. Use 10 drops Nifrex? or1 ml Sytron? or supplement. 0.5ml of Fersamal? or Galfer? syrup as an alternativeBLACKStarflower oil*GMMMG DNP list due to lack of data on safety or efficacy over current licensed treatments.BLACKStoma appliances deodorants?GMMMG DNP list – Should not be required if pouch is correctly fitted. No odour should be apparent except when bag is emptied or changed.BLACKSufentanil sublingual tablet systemGMMMG DNP list – Poor Evidence baseBLACKSumatriptan as branded preparations (e.g. Imigran?)*Branded preparations can be significantly more expensive and offer no added value over the generic. Generic prescribing is required.BLACKSunscreens listed under ACBS rules*LA Roche-Posay Anthelios XL SPF 50+ Sunsense Ultra (Ego) SPF 50+Uvistat Lipscreen SPF 50Uvistat Suncream SPF 30Uvistat Suncream SPF 50Nationally these are only permitted for protection from UV radiation in abnormal cutaneous photosensitivity resulting from genetic disorders or photodermatoses, including those resulting from radiotherapy and chronic or recurrent herpes simplex labialis.GREYSunscreens not listed above*Not permitted under ACBS rulesBLACKSynovial fluid injections including Hyaluronan and sodium hyaluronate for osteoarthritis of the knee.There is limited evidence of effectiveness and NICE CG59 Osteoarthritis R32 recommendation states “Intra-articular hyaluronan injections are not recommended for the treatment of osteoarthritis. BLACKTadalafil 2.5mg and 5mg tablets*GMMMG DNP list on basis that it is not a cost effective use of NHS resourcesBLACKTadalafil 10mg and 20mg tablets*Use is only permitted to a maximum of 4 treatments per month in line with NHS Stockport CCG policy on the treatment of erectile dysfunctionGREY Tadalafil as brand Cialis? ( all preparations) ( New)GMMMG DNP list on basis that branded preparations are significantly more expensive than generic preparationsBLACKTamsulosin/ Dutasteride (Combidart?)*For use only where patient cannot tolerate finasteride with tasmulosin but responds to dutasteride with tamsulosinGREYTapentadol M/R tabletsRestricted to those requiring treatment of severe chronic pain which can be adequately managed only with opioid therapies. Other alternatives should be tried firstGREYTestosterone Patches for hypoactive sexual desire (Intrinsa?)*Marketing licence in the UK was withdrawn. Listed to prevent supply of imported productsBLACKTherabiteGMMMG list – Poor evidence base for the deviceBLACKTick-borne encephalitis vaccination for travelGMMMG DNP list on basis that it is not a cost effective use of NHS resourcesBLACKToothpastes-Prescription onlyOnly dentists should prescribe prescription only toothpastes. Dental Rx onlyTopical Antifungal Preps Amorolfine (Loceryl?) Salicylic acid compound paint (Phytex?) Tiocanazole cutaneous solution (Trosyl?)*(Change- criteria reworded)NHS Stockport does not fund cosmetic therapy. Treatment of fungal nail infections should only be offered where: 1. the patient is immunocompromised; or 2. the patient has peripheral vascular disease; or 3. the patient is diabetic; or 4. the nail is painful; or 5. the patient is due to undergo surgery on that limb;And there has been confirmation of infection by laboratory testing.A course of appropriate oral treatment is far more effective for patients meeting the above criteria. These preparations should only be used where oral therapy is not clinically appropriate.GREYTopical antihistaminesMay cause hypersensitivity BLACKTopical RubefacientsGMMMG DNP list – Poor Evidence base “Topical rubefacient products may contain nicotinate and salicylate compounds, essential oils, capsicum and camphor. However, topical NSAID preps or Capsaicin preps are NOT rubefacients.”BLACKTopiramate capsules*Capsules are not good value for the NHS please use tablets instead for new patients and change existing prescriptions to tablets where clinically appropriateBLACK for new initiationsTrandolapril/ Verapamil (Tarka?)GMMMG DNP list on basis that it is not a cost effective use of NHS resourcesBLACKTrimipramineGMMMG DNP list on basis that it is not a cost effective use of NHS resourcesBLACKTriptans as branded preparations (e.g. Imigran?, Maxalt?, Naramig? and Zomig?)*Branded preparations are significantly more expensive than the generic equivalents.BLACKUlipristal acetate 5mg (Esmya?) * (Please note 30mg tablets for emergency hormonal contraception are not affected.)Surgeon responsible for arranging the surgery should prescribe the full course only for use in secondary care within a commissioned pathway as per NTS recommendation. Click here to view statement.BLACKVeil Cover Cream? & Finishing Powder*See Camouflage ProductsBLACKVichy Dermablend Foundation?*See Camouflage ProductsBLACKVisionace? preparationsSee Multivitamin Preps for eye healthBLACKVitalux-plus ?See Multivitamin Preps for eye healthBLACKVitamin B Compound & Vitamin B Compound Strong TabletsGMMMG DNP list – Poor Evidence base Should only be used on the advice of a dietician or in secondary care to prevent "re-feeding syndromeGREYVitamins minerals and antioxidants GMMMG DNP list – Poor Evidence base when for supplementation without a clear clinical indication/ deficiencyBLACKViteyes? original plus luteinSee Multivitamin Preps for eye healthBLACKYohimbineNTS deemed inappropriate due to lack of robust evidence of efficacy/safety.BLACKYellow Fever vaccination for travelGMMMG DNP list on basis that it is not a cost effective use of NHS resourcesBLACKZolmitriptan as branded preparations (e.g. Zomig?)*Branded preparations can be significantly more expensive and offer no added value over the generic. Generic prescribing is required.BLACKItems marked * are local commissioning decisions, all others are also on the GMMMG Do Not Prescribe or GREY lists and not subject to change unless the GMMMG position changesReviewed February 2017Amended April, May,June, October and December 17, January, April, May August October and November 2018Next review full list February 2019 ................
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