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Royal Berkshire NHS Foundation Trust
Berkshire Healthcare NHS Foundation Trust
Berkshire West Clinical Commissioning Group
 
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 Formulary Chapter 10: Musculoskeletal and joint diseases - Full Chapter
Notes:
This formulary is used by multiple organisations. There may be some instances where an item is on the formulary for one organisation but not the others. To help distinguish between each organisation, text will be colour coded, i.e. information relating to the Royal Berkshire NHS Foundation Trust will be in blue and Berkshire Healthcare NHS Foundation Trust will be in purple. Please ensure you read all information detailed under a drug.   
 Details...
10.01.03  Expand sub section  Drugs which suppress the rheumatic disease process
10.01.03  Expand sub section  Gold
10.01.03  Expand sub section  Penicillamine
10.01.03  Expand sub section  Antimalarials
10.01.03  Expand sub section  Drugs affecting the immune response to top
Abatacept (Orencia®)
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Formulary
Red
High Cost Medicine
note  Commissioning requirements for funding apply prior to use for both NHS england and CCG indications. Please contact pharmacy for details prior to prescribing this item.

Royal Berkshire NHS Foundation Trust >> Formulary Item injection / pre-filled syringe
Restricted Item ONLY in line with NICE TA - link below
 
Link  APC 161 Criteria for initiation continuation and discontinuation of high-cost (rechargeable) drug for the treatment of rheumatoid arthritis v1.3
Link  NICE TA 195 - Adalimumab, etanercept, infliximab, rituximab and abatacept for the treatment of rheumatoid arthritis after the failure of a TNF inhibitor
Link  NICE TA 373 - Abatacept, adalimumab, etanercept and tocilizumab for treating juvenile idiopathic arthritis
Link  NICE TA 375 - Adalimumab, etanercept, infliximab, certolizumab pegol, golimumab, tocilizumab and abatacept for rheumatoid arthritis not previously treated with DMARDs or after conventional DMARDs only have failed
   
Adalimumab (Humira®)
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Formulary
Red
High Cost Medicine
note  Commissioning requirements for funding apply prior to use for both NHS england and CCG indications. Please contact pharmacy for details prior to prescribing this item.

Royal Berkshire NHS Foundation Trust >> Formulary Item injection / pre-filled syringe
Restricted Item ONLY in line with NICE TA - link below


 
Link  APC 160 - Psoriatic Arthritis; Criteria for initiation, continuation and discontinuation of high-cost (rechargeable) drug
Link  APC 161 Criteria for initiation continuation and discontinuation of high-cost (rechargeable) drug for the treatment of rheumatoid arthritis v1.3
Link  NICE TA 195 - Adalimumab, etanercept, infliximab, rituximab and abatacept for the treatment of rheumatoid arthritis after the failure of a TNF inhibitor
Link  NICE TA 373 - Abatacept, adalimumab, etanercept and tocilizumab for treating juvenile idiopathic arthritis
Link  NICE TA 375 - Adalimumab, etanercept, infliximab, certolizumab pegol, golimumab, tocilizumab and abatacept for rheumatoid arthritis not previously treated with DMARDs or after conventional DMARDs only have failed
Link  NICE TA 383 - TNF-alpha inhibitors for ankylosing spondylitis and non-radiographic axial spondyloarthritis
   
Apremilast (Otezla®)
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Restricted Drug Restricted
Red
High Cost Medicine
note  Commissioning requirements for funding apply; NHS England Indication require IFR prior to use; CCG indications require prior approval prior to use. Please contact pharmacy for details prior to prescribing this item.

Royal Berkshire NHS Foundation Trust >> Formulary Item tablets
Restricted Item CURRENTLY FUNDING for Plaque Psoriasis ONLY in line with NICE TA - see Apremilast in section 13 below



 
Link  APC 160 - Psoriatic Arthritis; Criteria for initiation, continuation and discontinuation of high-cost (rechargeable) drug
Link  Apremilast - 13.05.03 Drugs affecting the immune response
   
Cytotoxic Drug Azathioprine
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Formulary
Amber
Amber for Gastroenterology Use - click here

Royal Berkshire NHS Foundation Trust >> Formulary Item tablets
 
Link  Shared Care Prescribing Guidance - AZATHIOPRINE for the treatment of inflammatory joint disease
   
Baricitinib (Olumiant®)
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Formulary
Red
note  Commissioning requirements for funding apply prior to use for both NHS England and CCG indications. Please contact pharmacy for details prior to prescribing this item.

Royal Berkshire NHS Foundation Trust >> Formulary Item tablet
Restricted Item ONLY in line with NICE TA - link below
Link  APC 161 Criteria for initiation continuation and discontinuation of high-cost (rechargeable) drug for the treatment of rheumatoid arthritis v1.3
Link  NICE TA466 - Baricitinib for moderate to severe rheumatoid arthritis
   
Belimumab (Benlysta®)
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Formulary
Red
High Cost Medicine
note  NHS England Commissioning requirements for funding apply prior to use. Please contact pharmacy for details prior to prescribing this item.

Royal Berkshire NHS Foundation Trust >> Formulary Item injection / pre-filled syringe
Restricted Item ONLY in line with NICE TA - link below
 
Link  NICE TA 397 - Belimumab for treating active autoantibody-positive systemic lupus erythematosus
   
Certolizumab Pegol (Cimzia®)
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Formulary
Red
High Cost Medicine

First line anti-TNF

note  Commissioning requirements for funding may apply. Please contact pharmacy for details prior to prescribing this item.
- NHS England indications require an IFR prior to use.
- CCG indication require funding application prior to use.

Royal Berkshire NHS Foundation Trust >> Formulary Item injection
- First line choice for Rheumatoid Arthritis in line with NICE TA 375 (replaces TA 186)
- For ankylosing spondyloarthritis as per NICE TA 383

 
Link  APC 160 - Psoriatic Arthritis; Criteria for initiation, continuation and discontinuation of high-cost (rechargeable) drug
Link  APC 161 Criteria for initiation continuation and discontinuation of high-cost (rechargeable) drug for the treatment of rheumatoid arthritis v1.3
Link  NICE TA 375 - Adalimumab, etanercept, infliximab, certolizumab pegol, golimumab, tocilizumab and abatacept for rheumatoid arthritis not previously treated with DMARDs or after conventional DMARDs only have failed
Link  NICE TA 383 - TNF-alpha inhibitors for ankylosing spondylitis and non-radiographic axial spondyloarthritis
Link  NICE TA 415 - Certolizumab pegol for treating rheumatoid arthritis after inadequate response to a TNF-alpha inhibitor
Link  NICE TA 445 - Certolizumab pegol and secukinumab for treating active psoriatic arthritis after inadequate response to DMARDs
   
Ciclosporin (Neoral®, Sandimmum®)
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Formulary
Amber
Amber for Dermatology Use - click here

Amber for Renal or Transplant Use - click here

Amber for Gastroenterology Use - click here

Royal Berkshire NHS Foundation Trust >> Formulary Item capsules / Solution (Sandimmum brand) / injection
 
Link  Shared Care Prescribing Guidance - CICLOSPORIN for the treatment of inflammatory joint disease
   
Etanercept (Enbrel®, Benepali®)
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Formulary
Red
High Cost Medicine
note  Commissioning requirements for funding apply prior to use for both NHS england and CCG indications. Please contact pharmacy for details prior to prescribing this item.

Royal Berkshire NHS Foundation Trust >> Formulary Item injection / pre-filled syringe
Restricted Item ONLY in line with NICE TA - link below
***New initiations should be started on the most cost effective brand***

 
Link  APC 125: Biosimilar etanercept (Benapali) for the treatment of inflammatory conditions
Link  APC 160 - Psoriatic Arthritis; Criteria for initiation, continuation and discontinuation of high-cost (rechargeable) drug
Link  APC 161 Criteria for initiation continuation and discontinuation of high-cost (rechargeable) drug for the treatment of rheumatoid arthritis v1.3
Link  NICE TA 195 - Adalimumab, etanercept, infliximab, rituximab and abatacept for the treatment of rheumatoid arthritis after the failure of a TNF inhibitor
Link  NICE TA 373 - Abatacept, adalimumab, etanercept and tocilizumab for treating juvenile idiopathic arthritis
Link  NICE TA 375 - Adalimumab, etanercept, infliximab, certolizumab pegol, golimumab, tocilizumab and abatacept for rheumatoid arthritis not previously treated with DMARDs or after conventional DMARDs only have failed
Link  NICE TA 383 - TNF-alpha inhibitors for ankylosing spondylitis and non-radiographic axial spondyloarthritis
   
Golimumab (Simponi®)
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Formulary
Red
High Cost Medicine
note  Commissioning requirements for funding apply prior to use for both NHS England and CCG indications. Please contact pharmacy for details prior to prescribing this item.

Royal Berkshire NHS Foundation Trust >> Formulary Item injection / pre-filled syringe
Restricted Item ONLY in line with NICE TA - link below

 
Link  APC 160 - Psoriatic Arthritis; Criteria for initiation, continuation and discontinuation of high-cost (rechargeable) drug
Link  APC 161 Criteria for initiation continuation and discontinuation of high-cost (rechargeable) drug for the treatment of rheumatoid arthritis v1.3
Link  NICE TA 220 - Golimumab for the treatment of psoriatic arthritis
Link  NICE TA 375 - Adalimumab, etanercept, infliximab, certolizumab pegol, golimumab, tocilizumab and abatacept for rheumatoid arthritis not previously treated with DMARDs or after conventional DMARDs only have failed
Link  NICE TA 383 - TNF-alpha inhibitors for ankylosing spondylitis and non-radiographic axial spondyloarthritis
Link  NICE TA 497: Golimumab for treating non-radiographic axial spondyloarthritis
   
Infliximab (Remicade®, Remsima®, Inflectra®)
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Formulary
Red
High Cost Medicine
note  Commissioning requirements for funding apply prior to use for both NHS England and CCG indications. Please contact pharmacy for details prior to prescribing this item.

Royal Berkshire NHS Foundation Trust >> Formulary Item injection / pre-filled syringe
Restricted Item ONLY in line with NICE TA - link below
***New initiations should be started on the most cost effective brand***

 
Link  APC 099: Biosimilar infliximab
Link  APC 160 - Psoriatic Arthritis; Criteria for initiation, continuation and discontinuation of high-cost (rechargeable) drug
Link  APC 161 Criteria for initiation continuation and discontinuation of high-cost (rechargeable) drug for the treatment of rheumatoid arthritis v1.3
Link  NICE TA 195 - Adalimumab, etanercept, infliximab, rituximab and abatacept for the treatment of rheumatoid arthritis after the failure of a TNF inhibitor
Link  NICE TA 375 - Adalimumab, etanercept, infliximab, certolizumab pegol, golimumab, tocilizumab and abatacept for rheumatoid arthritis not previously treated with DMARDs or after conventional DMARDs only have failed
Link  NICE TA 383 - TNF-alpha inhibitors for ankylosing spondylitis and non-radiographic axial spondyloarthritis
   
Leflunomide
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Formulary
Amber
Royal Berkshire NHS Foundation Trust >> Formulary Item tablets
 
Link  Shared Care Prescribing Guidance - LEFLUNOMIDE for the treatment of inflammatory joint disease
Link  MHRA advice regarding risk of hepatotoxicity, haemotoxicity, infections, and birth defects
   
Cytotoxic Drug Methotrexate
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Formulary
Amber
Amber for Gastroenterology Use - click here

Amber for Dermatology Use - click here

Royal Berkshire NHS Foundation Trust >> Formulary Item tablets (2.5mg) / oral solution

Must specify formulation, dose (number of tablets where appropriate), strength & frequency

 
Link  Rheumatology Department DMARD Monitoring Guidelines for Methotrexate v2
Link  UKMI QA: Methotrexate and alcohol guidance
   
Methotrexate (Metoject®)
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Formulary
Amber
Royal Berkshire NHS Foundation Trust >> Formulary Item pre-filled pen

Must specify dose, form, strength & frequency



 
Link  Rheumatology Department DMARD Monitoring Guidelines for Methotrexate v2
   
Mycophenalate Mofetil
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Formulary
Amber
Red Transplant clinic use
click here

Amber for Renal Use
click here

Amber for Rheumatology Use


Royal Berkshire NHS Foundation Trust >> Formulary Item tablets/ capsules / oral suspension / IV infusion
 
Link  Shared Care Prescribing Guidance - MYCOPHENOLATE MOFETIL for the treatment of inflammatory joint disease
   
Rituximab (rheumatology) (MabThera® / Truxima®)
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Formulary
Red
High Cost Medicine
note  Commissioning requirements for funding apply prior to use for both NHS England and CCG indications. Please contact pharmacy for details prior to prescribing this item.

Royal Berkshire NHS Foundation Trust >> Formulary Item injection / pre-filled syringe
Restricted Item ONLY in line with NICE TA - link below
***New initiations should be started on the most cost effective brand***

 
Link  APC 161 Criteria for initiation continuation and discontinuation of high-cost (rechargeable) drug for the treatment of rheumatoid arthritis v1.3
Link  NICE TA195: Rheumatoid arthritis - drugs for treatment after failure of a TNF inhibitor
   
Secukinumab (Cosentyx ®)
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Formulary
Red
High Cost Medicine
note  Commissioning requirements for funding may apply. Please contact pharmacy for details prior to prescribing this item.

Royal Berkshire NHS Foundation Trust >> Formulary Item
Restricted Item ONLY in line with NICE TA - link below
Secukinumab is recommended as a first line option for treating ankylosing spondylitis in adults whose disease has responded inadequately to conventional treatments (such as
NSAIDs) or patients in whom an anti-TNF may not be suitable.(Please note that patients requiring secukinumab in AS after failure of anti-TNFs are not covered by the APC policy)

 
Link  APC 133: Secukinumab for the treatment of AS
Link  APC 160 - Psoriatic Arthritis; Criteria for initiation, continuation and discontinuation of high-cost (rechargeable) drug
Link  NICE TA 350 - Secukinumab for treating moderate to severe plaque psoriasis
Link  NICE TA 407 - Secukinumab for active ankylosing spondylitis after treatment with non-steroidal anti-inflammatory drugs or TNF-alpha inhibitors
Link  NICE TA 445 -Certolizumab pegol and secukinumab for treating active psoriatic arthritis after inadequate response to DMARDs
   
Tocilizumab (RoActemra®)
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Formulary
Red
High Cost Medicine
note  Commissioning requirements for funding apply prior to use for both NHS England and CCG indications. Prior approval is required prior to use. Please contact pharmacy for details prior to prescribing this item.

Royal Berkshire NHS Foundation Trust >> Formulary Item injection / pre-filled syringe
Restricted Item ONLY in line with NICE TA - link below

 
Link  APC 161 Criteria for initiation continuation and discontinuation of high-cost (rechargeable) drug for the treatment of rheumatoid arthritis v1.3
Link  Commissioning statement for Tocilizumb for GCA
Link  NICE TA 238 - Tocilizumab for the treatment of systemic juvenile idiopathic arthritis
Link  NICE TA 373 - Abatacept, adalimumab, etanercept and tocilizumab for treating juvenile idiopathic arthritis
Link  NICE TA 375 - Adalimumab, etanercept, infliximab, certolizumab pegol, golimumab, tocilizumab and abatacept for rheumatoid arthritis not previously treated with DMARDs or after conventional DMARDs only have failed
Link  NICE TA 518: Tocilizumab for treating giant cell arteritis
   
Ustekinumab (Stelara®)
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Formulary
Red
High Cost Medicine
note  Commissioning requirements for funding apply prior to use for both NHS England and CCG indications. Please contact pharmacy for details prior to prescribing this item.

Royal Berkshire NHS Foundation Trust >> Formulary Item injection / pre-filled syringe
Restricted Item ONLY in line with NICE TA - link below

 
Link  APC 160 - Psoriatic Arthritis; Criteria for initiation, continuation and discontinuation of high-cost (rechargeable) drug
Link  NICE TA 340 - Ustekinumab for treating active psoriatic arthritis
   
10.01.03  Expand sub section  Sulfasalazine
 ....
 Non Formulary Items
Anakinra  (Kineret®)

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Non Formulary
Red
Royal Berkshire NHS Foundation Trust>> NON - Formulary Item - contact pharmacy for advice
 
Methotrexate  (Ebetrex®)

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Non Formulary
Green
Royal Berkshire NHS Foundation Trust >> NON - Formulary Item - contact pharmacy for advice
 
  
Key
note Notes
Section Title Section Title (top level)
Section Title Section Title (sub level)
First Choice Item First Choice item
Non Formulary Item Non Formulary section
Restricted Drug
Restricted Drug
Unlicensed Drug
Unlicensed
Track Changes
Display tracking information
click to search medicines.org.uk
Link to adult BNF
click to search medicines.org.uk
Link to children's BNF
click to search medicines.org.uk
Link to SPCs
SMC
Scottish Medicines Consortium
Cytotoxic Drug
Cytotoxic Drug
CD
Controlled Drug
High Cost Medicine
High Cost Medicine
Cancer Drugs Fund
Cancer Drugs Fund
NHSE
NHS England
Homecare
Homecare
CCG
CCG

Traffic Light Status Information

Status Description

Amber

Medicines that should be initiated or recommended by a specialist for continuation in primary care. The specialist must notify the primary care provider that the prescribing responsibility has been transferred. Where applicable, shared care protocols will be agreed and must be adhered to. The shared care protocol must have been agreed by the relevant secondary care trust Drugs and Therapeutics Committee(s)(DTC) and approved by Berkshire West APC.   

Brown

Drugs that have been reviewed and not recommended for prescribing. These drugs are not considered a cost-effective use of scarce NHS resources. There may be individual patient-specific or clinical reasons why a drug deemed low priority may be suitable for a particular patient. This is for the GP to consider, weighing up the reasons against his/her allocated CCG budget. Where the decision is made to prescribe a low priority drug, detailed documentation must be included in the patients' notes for audit purposes. *Please note that low priority drug requests are unsuitable for the Case Review Committee and therefore should not be sent to this committee.   

Green

Medicines suitable for routine use and can be prescribed within primary care within their licensed indication in accordance with the BNF or other recognised national formulary. Primary care prescribers take full responsibility for prescribing  

Red

Medicines which should be prescribed by specialists only  

netFormulary