NHSGGC Adult Medicines Formulary

www.ggcmedicines.org.uk

NHS Greater Glasgow and Clyde aim to promote high-quality, cost-effective prescribing in all areas of care. This Therapeutics Handbook is one such tool for prescribers to help ensure that they are consistently giving patients evidence-based treatment.

Good prescribing dictates that the choice of therapy should be made on the basis of sound clinical evidence of efficacy, safety and also takes into consideration patient acceptability and cost effectiveness. The Greater Glasgow and Clyde Adult Medicines Formulary takes the above into account when considering a medicine for inclusion and therefore prescribing from the Formulary is consistent with good clinical practice.

All licensed medicines referred to in this Handbook are included in the NHSGGC Adult Medicines Formulary.

Structure of the Formulary

The NHSGGC Formulary contains two main sections, the Preferred List and the Total Formulary.

The Preferred List is composed of approximately 350 medicines which represent the first-line agents for many classes of medicine and cover many common conditions and diseases. It is primarily aimed at the generalist prescriber, and those specialists prescribing outwith their specialty. For that reason, various therapeutic areas are not suitable for inclusion in the Preferred List, for example oncology medicines.

The Total Formulary comprises all other formulary medicines and generally contains specialist medicines and second and third-line agents from classes included in the Preferred List.

Non-Formulary prescribing and processes

The need for prescription of medicines from outwith the Formulary (non-Formulary prescribing) is recognised, but it is expected that:

Formal treatment guidelines / protocols will exclude non-Formulary medicines.
Non-Formulary status will apply to new medicines until accepted for use by the Scottish Medicines Consortium (SMC) and the Area Drug and Therapeutics Committee (ADTC). Further information regarding the SMC, including all previous decisions, can be found on their website: www.scottishmedicines.org.uk.
Non-Formulary prescribing may be necessary and approved for individual patients in accordance with local processes including the Peer Approved Clinical System Tier 2 (PACS 2) and Individual Patient Treatment Request (IPTR) processes.
An overview of the main routes of access to medicines which are not recommended for use by the SMC or awaiting evaluation follows and the GGC Medicines website also has a useful flowchart to help ascertain which process to follow.

Peer Approved Clinical System Tier 1 (PACS UO)

This is currently the process used by clinicians to access medicines for ultra-orphan conditions which have been evaluated under the ultra-orphan framework before April 2019 and are subsequently not recommended for use in NHSScotland or are validated as being ultra-orphan in Scotland, but have not been assessed by SMC.

Peer Approved Clinical System Tier 2 (PACS 2)

PACS 2 is intended to be used for requests for licensed medicines and indications where:

The SMC has evaluated the medicine and indication and issued 'Not Recommended' advice, or;
The request relates to the use of a medicine outwith the SMC restrictions, or;
The medicine and indication have been submitted to the SMC, but the SMC are yet to issue advice.

Individual Patient Treatment Requests (IPTR)

The IPTR process will likely be replaced but currently it is still a valid route of requesting access to medicines in the following specific circumstances:

Where the SMC have issued 'Not Recommended' advice because the manufacturing company has not made a submission to SMC for this medicine or indication, or;
Where a company have yet to make a submission to SMC for this medicine and indication
Where the intended use of the medicine is outwith the SMC restrictions where these are based solely on the company requesting a selective positioning or sub-population.

Where to find Formulary information

The Greater Glasgow and Clyde ADTC has a website containing useful Formulary information at: www.ggcmedicines.org.uk. Click in the blue 'GGC Formulary' menu button to expand into therapeutic chapter view or use the pink search box to check whether specific medicines are included in the Formulary. If using the GGC Medicines App there is a link to the Formulary from the home screen. Alternatively, the Medicines Policy and Guidance Team (see Appendix 6 for contact details), based within Medicines Information in Glasgow Royal Infirmary, are happy to answer any specific queries where the information is not readily available.

Guideline reviewed: May 2023

Page last updated: June 2023