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Joint Formulary Newsletter

Bedfordshire and Luton Joint Formulary Newsletter

December 2020, Number 5


The Bedfordshire and Luton Joint Formulary (a combined medicines formulary for use by BCCG, LCCG, Bedford Hospital and the Luton and Dunstable University Hospital) is now ‘live’. It can be accessed here

Unless otherwise stated decisions made apply to all organisations in the Joint Formulary Group.

RED RED - Hospital Only - to be prescribed by a specialist and supplied from secondary care ONLY throughout treatment
AMBER Amber medicines are considered suitable for GP prescribing following specialist initiation
GREEN These medicines are appropriate for initiation in both primary and secondary care. Prescribing is appropriate within licensed or local recommendations
SCG Shared Care - These medicines require specialist initiation and stabilisation. Ongoing division of responsibility for drug and disease monitoring between specialist and GP by a Shared Care Guideline (SCG). If no SCG in place, status reverts to RED.
BLACK A decision has been made by either or both the local or national NHS not to routinely commission this preparation for its licensed indications. DO NOT PRESCRIBE
The following ADDITIONS to the Joint Formulary were agreed at the JPC Committee Meeting
  • Semaglutide Oral Tablets (Rybelsus®) (Amber – SCG)

The addition of Semaglutide oral tablets to the Formulary was approved under the following circumstances:-

    • in line with current NICE and JPC recommendations on the place in therapy for GLP1 agonists
    • Second line choice after consideration of the s/c GLP1 agonist preparations noting that patient selection is key, given potential interactions.
    • Initiation (under any circumstances) only by the Specialist Service (as defined in the SCG) as patient selection is key. (This differs from Injectable GLP1 agonist criteria where GPs may initiate under certain circumstances)
    • Passed to GPs for prescribing when patient stable. This would be after 3-6 months depending on co-morbidities/concurrent medication.
  • The proposal to add oral semaglutide prompted a review of GLP1 Agonists and the following update was agreed:-
    • Subcutaneous preparations of Liraglutide, Semaglutide and Dulaglutide are now joint first line choices with oral semaglutide as an option if the subcutaneous preparations were unsuitable.
    • Removal of once weekly exenatide except for existing patients.
  • Lyumjev Insulin (Lilly) (Amber)
    • This is a new analogue insulin formulation of insulin lispro. It is formulated to be faster acting.
    • The JPC supported use in line with current JPC recommendations for Fiasp® but in adult patients only.
  • Diazoxide for intractable hypoglycaemia in adults (red)
    • Approved for addition to the Joint Formulary but hospital prescribing only.
    • GP Prescribing is NOT recommended.
  • Subcutaneous Infliximab (red)
    • The Committee agreed to support the introduction of s/c infliximab as a temporary addition to the Formulary until 31st March 2021 to assist the Trust in reducing pressure on hospital attendance during the Covid 19 pandemic (Winter period). This decision will be reviewed at the 17th March 2021 JPC meeting.
  • Fobumix® (green)
    • Fobumix® Easyhaler contains budesonide and formoterol of which the combination is already approved as Symbicort® and Duoresp® devices.
    • The JPC agreed to approve the addition of Fobumix® to the Joint Medicines Formulary and the minor amendments to the COPD and Asthma guidelines that would be required as a result of this Formulary addition.
  • Softacort® (Hydrocortisone Sodium Phosphate 0.335%) Eye Drops (amber)
    • The JPC supported the addition of Softacort® to the Joint Formulary.
Hospital Drug and Therapeutic Committee Updates
  • Orajel extra strength Dental gel added to formulary.
  • Bismuth (Pepto Bismol) – addition to the Formulary for pylori treatment. PHE Guidance which we refer to in the Community Antimicrobial Guidelines already agreed by JPC in February 2020.
CCG Prescribing Committees

No meeting since last JPC

Wound Care Formulary Group (Ratified by the JPC)

No update from the Wound Care Group

Decisions Made By Joint Formulary Group (Ratified by the JPC)
  1. WaveSense Jazz and Gluco RX Nexus removed from list of approved BGTS
  2. Insulin Degludec entry created for 200 unit strength
  3. Kerracontact Ag not available, Aquacel ag is equivalent. Note on formulary
  4. Bromocriptine – no longer recommended for lactation suppression removed from this section
  5. Co-Phenylcaine spray added to formulary (red hospital only).
  6. Dorzolamide eye drops added to formulary (amber).
  7. Oxybutynin, mirabegron and tolterodine traffic light status amended to green with link to pathway added.
  8. Ayendi nasal spray is discontinued – moved to non-formulary with a note to state no longer available..
  9. Tinzaparin traffic light removed note added to state usually hospital only with a link to document explaining circumstances in which primary care prescribing is permitted.


NICE Updates

Joint Formulary updates following publication of NICE Technology Appraisal Guidance

 CCG Commissioned

  • Naldemedine for treating opioid-induced constipation technology appraisal guidance [TA651] Published date: 30 September 2020
    • Added to joint formulary (amber)
  • Galcanezumab for preventing migraine Technology appraisal guidance [TA659] Published date: 18 November 2020
    • Added to Joint Formulary (red)

NHSE Commissioned- New drugs added

  • Polatuzumab vedotin with rituximab and bendamustine for treating relapsed or refractory diffuse large B-cell lymphoma.Technology appraisal guidance [TA649] Published date: 23 September 2020
    • added Joint Formulary
  • Osimertinib for treating EGFR T790M mutation-positive advanced non-small-cell lung cancer Technology appraisal guidance [TA653] Published date: 14 October 2020
    • added Joint Formulary
  • Osimertinib for untreated EGFR mutation-positive non-small-cell lung cancer Technology appraisal guidance [TA654] Published date: 14 October 2020
    • added Joint Formulary
  • Volanesorsen for treating familial chylomicronaemia syndrome, Highly specialised technologies guidance [HST13] Published date: 21 October 2020,
    • To be created and added to the Formulary if the Bedfordshire Hospitals Foundation Trust is a designated centre for prescribing and administering this medication.
  • Nivolumab for advanced squamous non-small-cell lung cancer after chemotherapy, Technology appraisal guidance [TA655] Published date: 21 October 2020.
    • added Joint Formulary
  • Siponimod for treating secondary progressive multiple sclerosis, Technology appraisal guidance [TA656] Published date: 18 November 2020
    • added Joint Formulary
  • Carfilzomib for previously treated multiple myeloma, Technology appraisal guidance [TA657] Published date: 18 November 2020
    • added Joint Formulary
  •  Isatuximab with pomalidomide and dexamethasone for treating relapsed and refractory multiple myeloma Technology appraisal guidance [TA658] Published date: 18 November 2020
    • Recommended via Cancer Drugs Fund – JPC Action – Create Isatuximab on NetFormulary and add link to Isatuximab and pomalidomide drug entries.
  • Darolutamide with androgen deprivation therapy for treating hormone-relapsed non-metastatic prostate cancer Technology appraisal guidance [TA660] Published date: 25 November 2020
    • Recommended – JPC Action – Created and link added to Joint Formulary
  •  Pembrolizumab for untreated metastatic or unresectable recurrent head and neck squamous cell carcinoma Technology appraisal guidance [TA661] Published date: 25 November 2020
    • Recommended – JPC Action – Link added to Joint Formulary



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