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Medicines management tips for skin prescribing

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Medicines management tips for skin prescribing Prescribing tips Betnovate cream and ointment (30g and 100g) is currently about half the cost if prescribed as a brand ... – PowerPoint PPT presentation

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Title: Medicines management tips for skin prescribing


1
Medicines management tips for skin prescribing
2
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 ointment 30g 3.16
  • Betnovate cream/ointment 100g 4.05
  • Generic betamethasone valerate 0.1 cream 100g
    9.10 ointment 100g 10.53
  • NDCCG could save approximately 21,600 per year
    if switched to Betnovate.

3
Jan 14 Generic or brand Betnovate prescribing by
practice
4
Potential annual saving by practice
5
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

6
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7
Trend of bath additive prescribing
8
LPL 63.4 500mls 3.10
9
Prescribing sunscreen
  • Endorse ACBS
  • Not eligible if on medicines that sensitise skin
  • Abnormal cutaneous photosensitivity resulting
    from genetic disorders or photodermatoses

10
AK prescribing
  • Review diclofenac 3 / solaraze prescribing has
    it been picked in error?

11
Prescribing tips
Dont generic prescribe if there isnt 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 cant easily identify these on epact as they
    are likely to have been listed as unspec. on
    epact

12
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 lt52g cheaper diltiazem cream, gt52g
    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.derbyshiremedicinesma
    nagement.nhs.uk

13
www.derbyshiremedicinesmanagement.nhs.uk
14
Specials A-Z on website
Technicians can set up quick keys to the specials
A-Z or medicines management website
15
Urea and salicylic acid preparations
  • 10 salicylic acid in aqueous cream, 100g
    266.95
  • Unspec drug code cant 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.
  • Instead of 10 salicylic acid cream trial 10
    urea cream (Aquadrate or Hydromol intensive)
  • Instead of 25 salicylic acid cream consider 25
    urea cream (Flexitol Heel balm)
  • Prescribe as brand to prevent a special urea
    cream being dispensed

16
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17
Specials December 13
18
Acne National Spend Trend
19
Cost of acne products (Sept 13)
20
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 contra-indications).
    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.

21
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.

22
CRHFT how to send in prescribing issues
  • http//www.chesterfieldroyal.nhs.uk/gp/?_ts1
  • 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.
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