Transcript Medicine Management Tips

Medicines
management tips for
skin prescribing
Prescribing tips
Prescribing by brand – sometimes it is cheaper!
•
Betnovate cream and ointment (30g and 100g) is currently about half the cost
if prescribed as a brand rather than generically.
Betnovate cream/ointment 30 g = £1.43
Generic betamethasone valerate 0.1% cream 30g = £2.73
Betnovate cream/ointment 100g = £4.05
Generic betamethasone valerate 0.1% cream 100g = £9.10
£10.53
•
ointment 30g = £3.16
ointment 100g =
NDCCG could save approximately £21,600…… per year if switched to
Betnovate.
Jan 14 Generic or brand Betnovate
prescribing by practice
Potential annual saving by practice
Prescribing tips
Consider switches or cheaper products for new patients
• Aqueous cream 500g = £4.95 switch to ZeroAQS 500g = £3.29
(SLS free, can be used as cream, soap substitute and bath
additive)
• Diprobase 500g = £6.32 consider switch to Oilatum Junior
Cream 500ml = £4.99
Prices – March Mims / Drug Tariff
Trend of bath additive prescribing
LPL 63.4 500mls = £3.10
Prescribing sunscreen



Endorse ACBS
Not eligible if on
medicines that
sensitise skin
Abnormal cutaneous
photosensitivity
resulting from genet
disorders or
photodermatoses
AK prescribing
BNF Name
Total
Quantity Quant x
items
Total
Items
Total Act
Cost
Diclofenac Sod_Gel 3%
22
50
1,100
£778.33
Diclofenac Sod_Gel 3%
2
100
200
£141.49
Picato_Gel 150mcg/g
1
0
0
£20.12
Picato_Gel 500mcg/g
1
1
1
£60.04
20
50
1,000
£707.57
Solaraze_Gel 3%
46
2,301 £1,707.54
• Review diclofenac 3% /
solaraze prescribing –
has it been picked in
error?
Prescribing tips
Don’t generic prescribe if there isn’t a listed generic in
the drug tariff
•
When a product is not listed in the drug tariff e.g. specials and some generic names for
branded products, pharmacies and dispensing practices can endorse the invoice price of
products they have obtained for prescriptions, and can potentially claim out of pocket
expenses as well
•
•
Movelat cream / gel £7.19 for 125g
Mucopolysaccharide polysulphate/salicylic cream and gel – claims have been submitted
for £65.00/125gm
•
We can’t easily identify these on epact – as they are likely to have been listed as unspec.
on epact
Prescribing tips
Specials – costs vary substantially unless they are in
the specials drug tariff
Specials drug tariff products are still expensive, but cost will be the same whichever pharmacy
or dispensing practice dispenses the product:
• Coal tar solution 5% in betamethasone valerate 0.025% ointment 100g (and less) =
£173.67 (£0.13 per g above 100g)
• Diltiazem 2% cream 30g (and less) = £81.49 (£2.16 per g above 30g)
• Diltiazem 2% ointment 30g (and less) = £125.89 (£0.06 per g above 30g)
Scripts <52g cheaper diltiazem cream, >=52g cheaper diltiazem ointment
•
Glyceryl trinitrate 0.2% ointment 30g (and less) = £36.44 (£1.21 per g above 30g)
Look at specials A-Z on www.derbyshiremedicinesmanagement.nhs.uk
www.derbyshiremedicinesmanagement.nhs.uk
Specials A-Z on website
Technicians can set up quick keys to the specials A-Z or
medicines management website
Drug
Diltiazem Hcl
Cream/Gel/Ointment 2%
Drug
Glyceryl Trinitrate Ointment
Drug
Coal Tar Paste
Coal tar soln 5% Betameth
Val. 0.25% Oint
Step 1: Use a licensed medicine in
a suitable formulation (incl change to Step 2: Use a licensed medicine in
different drug in same therapeutic
an unlicensed manner *
class)
For anal fissures consider switching to
licensed Glyceryl trinitrate ointment 0.4%
(Rectogesic)
Step 1: Use a licensed medicine in
a suitable formulation (incl change to Step 2: Use a licensed medicine in
different drug in same therapeutic
an unlicensed manner *
class)
For anal fissures consider LICENSED
glyceryl trinitrate ointment 0.4%
(Rectogesic)
Step 1: Use a licensed medicine in a
suitable formulation (incl change to Step 2: Use a licensed medicine in
different drug in same therapeutic
an unlicensed manner *
class)
Consider switching to LICENSED,
commercially available coal tar
preperation if appropriate e.g CarboDome (coal tar 10%). Cocois scalp
ointment (Coal Tar 12%, Salicylic acid
2%, precipitated sulphur 4%), Psoriderm
cream (coal tar 6%, Lecithin 0.4%)
Consider Alphsol HC (coal tar 5%,
hydrocortisone 0.5%, allantoin 2%)
Step 3: LAST RESORT: Use an
unlicensed special
2% CREAM & OINTMENT included in
Part VIIIB of Drug Tariff from 2012
Step 3: LAST RESORT: Use an
unlicensed special
Unlikely to need: licensed products
available
Step 3: LAST RESORT: Use an
unlicensed special
Included in Part VIIIB of Drug tariff from
November 2012
Urea and salicylic acid preparations
10% salicylic acid in aqueous cream, 100g = £266.95
Unspec drug code – can’t tell what was prescribed for many items
Unlicensed, shorter expiry – BNF recommends 2 weeks exp
Time to order
Consider trial of urea containing product instead e.g.
1. Instead of 10% salicylic acid cream trial 10% urea cream
(Aquadrate or Hydromol intensive)
2. Instead of 25% salicylic acid cream consider 25% urea cream
(Flexitol Heel balm)
Prescribe as brand to prevent a “special” urea cream being
dispensed
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Specials December 13
Period
Name
Dec-13
Dec-13
Dec-13
Dec-13
Total
Items
BNF Name
Unspec Drug Code_(Discount
Not Deducted)
1
Unspec Drug Code_
1
Unspec Drug Code_(Discount
Not Deducted)
1
Unspec Drug Code_(Discount
Not Deducted)
1
Total Act
Quantity Cost
100
£205.14
100
£223.80
100
£208.77
100
£208.78
Medication Ordered
Unguentum M Cream -Cholestyramine 5% W/W in
Unguentum M
Hydrocortisone 1% cream 50% with 3% Sulpha, 3% salicyclic
acid to 100% with AqCr
Betamethasone valerate 0.1% ointment - 25% in coal tar
paste
Betamethasone valerate 0.1% ointment - 25% in coal tar
paste
Acne National Spend Trend
Cost of acne products (Sept 13)
Acne pathway
Mild comedonal acne - start with topical retinoid e.g. adapalene (Differin) cream or gel is the
formulary choice.
Mild inflammatory acne (papular/pustular) - use both a topical anti-inflammatory agent
(benzoyl peroxide) e.g. Quinoderm cream / Acnecide 5% gel and an antibacterial one e.g.
clindamycin (Dalacin T topical solution or lotion). If there are comedones add a topical
retinoid as well. Consider using combination products e.g. Duac Once Daily gel (clindamycin &
benzoyl peroxide) or Epiduo gel (adapalene & benzoyl peroxide 2.5%) although these tend to
be more expensive.
Moderate acne - combine systemic & topical treatment
Quinoderm / Acnecide cream in the morning
Topical adapalene at night e.g. Differin cream or gel
Oral antibiotics
Moderately severe acne in women- consider adding co-cyprindiol 2000/35 (if no contraindications). Once sustained improvement (3 months) consider changing to an oestrogenic
COC e.g. Gedarel 30/150 to prevent rebound.
Acne in pregnancy – Benzoyl peroxide, topical and oral erythromycin are all considered safe if
treatment considered appropriate.
Severe acne- as for moderate acne but consider early referral for oral isotretinoin if large
nodulocystic lesions, scarring or no rapid response to treatment.
CRHFT how to send in prescribing issues
•CRHFT direct reporting function on their website that
practices can use to report any CRHFT issue related to
medicines e.g. discharge concerns, inappropriate
prescribing requests, any other prescribing related issue.
•Martin Shepherd will then find an answer to the issue
and report this back to whoever submits the issue
(please note urgent clinical queries will still need to
made via phone calls to the relevant person at the
hospital).
•Martin will also collate information on issues raised and
take those to the bimonthly drug and therapeutics
committee at CRHFT, and also to the prescribing sub
group.
CRHFT how to send in prescribing issues
http://www.chesterfieldroyal.nhs.uk/gp/?_ts=1
username = gpuser
password = mozart
Then click on “prescribing concern” in the left hand list
and then click on the blue words, in the text on the
right hand side – email form template – this will open
up an automatic email which the GP or practice
member can complete and send direct to Martin
Shepherd at CRHFT.