Formulary Update (April 2016)
To view the ADTC decisions on new medicines from the meeting on April 18th 2016 click here
(opens as a separate PDF)
In Scotland, a newly licensed medicine is routinely available for use in an NHS board only after it has been
- accepted for use in the NHSScotland by the Scottish Medicines Consortium (SMC), and/or
- accepted for use by the NHS board’s Area Drug and Therapeutics Committee (ADTC).
How does the NHS board decide which new medicines to make available for patients?
Each NHS board has an ADTC. The ADTC is responsible for advising the NHS board on all aspects of the use of medicines. ADTCs take account of national and, where applicable, local guidance when deciding which medicines should be routinely available.
What national guidance does the ADTC consider?
- SMC advises on the use of newly licensed medicines in NHSScotland. In the table, national guidance usually refers to SMC advice. Links to SMC advice for individual medicines are included in the table.
- In some cases, other agencies may also provide guidance on how medicines should be used. For example Healthcare Improvement Scotland provides advice on some health technology assessments, including National Institute for Health and Care Excellence Multiple Technology Appraisals (NICE MTAs).
What local guidance does the ADTC consider?
- Sometimes SMC accepts more than one medicine for treating a specific medical condition. Clinical experts in each NHS board provide advice to their ADTCs on which medicines can be routinely used. Sometimes clinical experts decide that established medicines are a better choice than new medicines.
- Medicines routinely available for use within an NHS board are usually included in the 'local formulary'. The formulary is a list of medicines for use in the NHS board that has been agreed by ADTC in consultation with local clinical experts. The formulary encourages prescribers to become familiar with a limited list of medicines which can be used to treat the majority of medical conditions.
What if a particular medicine is not routinely available in my NHS board?
- This is usually because the medicine has not been accepted by SMC for use in NHSScotland.
- There may also be differences in which medicines are preferred in NHS boards. If SMC accepts a number of medicines for which there are other medicines already available to treat a specific medical condition, the NHS board's decision may depend on clinical experts, preferences and experiences with the medicine in their local population and on local prescribing guidance. If a decision is made for a medicine not to be routinely prescribed, there are usually alternative medicines available on the formulary.
- If a medicine is not routinely available and there are no suitable formulary alternatives, a doctor can make a request to prescribe the medicine if they believe it will benefit an individual patient. All NHS boards have procedures in place to consider individual requests when a doctor considers that a medicine not included on the formulary would be the best treatment option for an individual patient.
The link to the table at the top of this post lists NHS Greater Glasgow and Clyde's decisions on new medicines.
If you need more information on medicines decisions in your NHS board area, please email hcis.adtc-collaborative@nhs.net