> New medicines / ACE

New medicines

Area Clinical Effectiveness Committee (ACE, formerly AMMC)

The Dudley Area Clinical Effectiveness Committee (ACE) meets every two months to discuss issues concerning prescribing across the health economy. This page of the website will keep local clinicians up to date with discussions around choice of drugs. If there are any issues you wish raised with the ACE please call 01384 321979 or email joanne.roberts47@nhs.net

Click here for a New Drug Application Form.

Click here for a brand optimisation/Line Extension application

Click here for the ACE Sub Committee Terms of Reference

Q. Which documents need to be approved by ACE?
A. Any document produced by or for the CCG by individuals or groups of clinicians which direct the clinical management of patients and is expected to be used in a primary care setting by primary care contractors and /or their employees.
Please read the 'Assurance Framework for managing clinical policies and guidelines' for further information:

Please see below for ACE decisions made from April 2011. Click on drug name to take you to relevent section of formulary. We aim to put decisions from ACE meetings onto this site within two weeks of each meeting.

Drug	Date of Application	Indication	Decision	Comments
Metolazone (Xaqua)		Xaqua is indicated for the treatment of • oedema related to kidney diseases, including the nephrotic syndrome and states of impaired renal function • oedema related to congestive heart failure		Amber recommended Formulations of metolazone are not interchangeable (refer to Metolazone memo- Feb 23)
Phenazone (Otigo)	February 2023	Management of acute otitis media	Approved	Limited to community pharmacy treatment only, until further update
Dexcom ONE	February 2023	Real-time Continuous Glucose Monitoring (rt-CGM)	Approved	Dexcom ONE is approved for use in the Black Country, as Amber Recommended in line with existing NHSE criteria, not NICE CG
Bempedoic Acid/Bempedoic acid with Ezetimibe	September 2021	Treating primary hypercholesterolaemia or mixed dyslipidaemia	Approved	Amber initiation (Secondary Care Lipid Clinic) for both Nustendi® and Nilemdo® Secondary Care to monitor treatment at 6 -12 months
Trurapi (insulin Aspart biosimilar brand line extension and risk assessment	September 2021	Diabetes Melitus	Approved	Trurapi biosimilar accepted for brand formulary prescribing. Trurapi is a biosimilar of the rapid-acting insulin analogue NovoRapid. Changes to be considered at individual patient review by secondary care or community specialist diabetes teams initially. Support for primary care team medicines optimisation will follow at later date.
N-Acetylcysteine (NACSYS) Effervescent Tablet 600 mg	November 2020	Mucolytic in respiratory disorders such as in bronchitis, emphysema and bronchiectasis.	Approved	Indicated in ADULTS only.Indicated in ADULTS only.
Semaglutide (Rybelsus®)	September 2020	Type 2 diabetes	Approved	For use under diabetes specialist led teams. 6 month review of patient outcomes to be brought back to ACE by diabetes consultant.
Brand Line Extension - Evolve HA® 0.2% Eye Drops	September 2020	Artificial tears	Approved	For new patients as first line choice and this will be a phased approach (for existing patients on Hylo-Forte 0.2% eye drops) for those not under active ophthalmology follow up.
Brand optimisation - Xaggitin (Methylphenidate MR)	July 2020	ADHD	Approved	• Xaggitin is considered bioequivalent to Concerta XL based. • Proposal for both new patients and changing existing generic and Concerta XL prescriptions
Brand optimisation - Oxypro PR (1st line); Oxeltra PR (2nd line)	July 2020	Pain	Approved	Approved for inclusion in the formulary- to be prescribed by brand, switching endorsed from generic/non-formulary brands. Oxycodone Hydrochloride M/R formulations are bioequivalent and brand prescribing is recommended to ensure safe practice
Fixapost (Latanoprost/Timolol) PF single dose units	June 2020	Reduction of intraocular pressure (IOP) in patients with open angle glaucoma and ocular hypertension who are insufficiently responsive to topical beta-blockers or prostaglandin analogues	Approved	Ophthalmology recommendation or initiation only if intolerance to preserved version
Slenyto (Melatonin 1mg, 5mg tablets slow release)	November 2019	Insomnia in children with autism-spectrum disorders (ASD) and/or Smith-Magenis Syndrome (SMS)	Approved	Treatment as per shared care agreement
Octasa (Mesalazine MR) – Brand line Optimisation	June 2020		Approved	Previously approved on formulary for new patients. Now approved for patients to be switched from generic Mesalazine/Asacol brand to Octasa
VisuXL	July 2019	Severe dry eyes	Approved	Prescribed by consultant ophthalmologist only
	May 2019			PKG Commissioning statement: At the Prescribing and Medicines Management Sub Committee [PSC] approved to fund 50 reports during the course of this financial year. ACE noted the approval for 50 reports by the CCG PSC
Flutiform K-haler	May 2019	Asthma	Approved	Option for adolescents using the Easibreathe device
Aerochamber Flo-VU	May 2019		Approved	Preferred formulary choice, replacing all other spacer devices noting that only one would need to be prescribed per year
Verkazia	May 2019	Severe vernal keratoconjunctivitis	Approved	For children from 4 years of age and adolescents where ciclosporin A 0.1% is required
Mexiletine	April 2019	Arrhythmia	Hospital use ONLY	Mexiletine is no longer prescribed in primary care. Mexiletine should be prescribed and dispensed by the hospital
Brand optimisation - Metoject (methotrexate s/c)	January 2019	All licensed indications	Approved	Brand Optimisation
Desunin 800 international units tablets (colecalciferol [vitamin D3])	November 2018	Vitamin D deficiency	Approved	Click here for Vitamin D deficiency guidance
Acidex	November 2018	indigestion	Approved	Replaces Gaviscon Advance.
Sukkarto MR (Metformin MR tabs)	November 2018	Diabetes	Approved	Preferred brand of Metformin MR
Relvar	November 2018	Asthma	Approved	Relvar for inclusion in the adult asthma guidelines.
Butec patches	November 2018	Pain	Approved	Existing patients prescribed buprenorphine patch to be switched to Butec brand.
Stexterol 25,000 units	November 2018	Vitamin D deficiency	Approved	Optional treatment dose for vitamin D deficiency where Invita D3 liquid is not an option
Semaglutide	November 2018	Type 2 diabetes	Approved	Replacing exenatide twice daily injection
Thorens liquid	May 2018	Vitamin D deficiency	Approved	Approved for formulary listing
Invita D3 solution	May 2018	Vitamin D deficiency	Removal	Removed from formulary
Quinine sulphate	May 2018	Nocturnal leg cramps	Approved	Approved for formulary listing
Quinine Bisulphate	May 2018	Nocturnal leg cramps	Removal	Removed from formulary
HydroTac dressings	March 2018	Wound care dressings	Approved	Approved for formulary listing
Lyofoam & Biatain dressings	March 2018	Wound care dressings	Removal	Removed from formulary
Sialanar (glycopyrronium) oral solution	March 2018	Symptomatic treatment of severe sialorrhoea (chronic pathological drooling) in children and adolescents aged 3 years and older with chronic neurological disorders.	Approved	Preferred brand of glycopyrronium oral solution
ProCal	March 2018	Disease-related malnutrition or other ACBS indication	Removal	Removed from formulary
Calogen-Extra	March 2018	Disease-related malnutrition or other ACBS indication	Approved	To remain on the formulary for use in secondary care and for those patients prescribed smaller daily volumes in primary care
Altrashot	March 2018	Disease-related malnutrition or other ACBS indication	Approved	Approved for formulary listing
Anoro Ellipta	January 2018	COPD	Approved	Approved in line with the updated COPD guidelines
Incruse Ellipta	January 2018	COPD	Approved	Approved in line with the updated COPD guidelines
Trelegy Ellipta	January 2018	COPD	Approved	Approved in line with the updated COPD guidelines
Trimbow	January 2018	COPD	Approved	Approved in line with the updated COPD guidelines
Spiolto Respimat	January 2018	COPD	Approved	Approved in line with the updated COPD guidelines
Dymista	January 2018	Allergic Rhinitis	Approved	Restricted use, third line
FreeStyle Libre® Glucose Monitoring System	January 2018	Diabetes	Approved	As per conditions in the commissioning statement
Brand optimisation - Foodlink Complete (and with fibre)	November 2017	Oral nutritional supplement	Approved	New product application and brand optimisation form Approved
Vesomni	November 2017	Urinary storage symptoms and voiding symptoms associated with BPH	Non-formulary	Vesomni is no longer formulary, however whilst the guidance is being updated, the current guidance remains active except for the section on Versomni
Brand optimisation - Pipexus prolonged-release tablets	September 2017	Parkinson's disease	Approved	This product is a cost effective option compared to generic pramipexole prolonged release tablets
Brand optimisation - Ipinnia XL	September 2017	Parkinson's disease	Approved	This product is a cost effective option compared to generic pramipexole prolonged release tablets. Requip and Repinex to be removed
Brand optimisation - Stanek	September 2017	Parkinson's disease	Approved	Approved for inclusion in the formulary as the preferred brand of levodopa/carbidopa and entacapone
Brand optimisation - Axalid and Alzain	July 2017	Neuropathic pain	Approved	Approved for inclusion in the formulary- to be prescribed by brand in place of Lyrica for neuropathic pain
Brand optimisation - Vencarm	July 2017	Anxiety, depressions and panic disorder, with or without agoraphobia	Approved	Cost effective option for prescribing for Venlafaxine modified release
Brand optimisation - Meatal Dilators	July 2017		Approved	Prescribed following the recommendation of Continence Team
Brivaracetam	July 2017	Epilepsy	Approved	Use as 2nd line treatment as per SMC guidance for treatment failure. Only licensed in Adults. Specialist review for a period of 1 year. Specialist initiation and stabilisation. Approval to formulary focus epilepsy without secondary generalisation for second adjunctive therapy
Opicapone	July 2017	Parkinson Disease	Approved	Once daily, before or after levodopa combinations. Specialist initiation
Safinamide	July 2017	Parkinson Disease	Approved	Specialist initiation
Brand optimisation - Spiriva Respimat	July 2017	COPD	Approved	Cost effective option in primary care in place Spiriva Handihaler
Brand optimisation - Sodium hyaluronate Eye drops - Optive Fusion	May 2017	Dry eye	Approved	Approved for inclusion in the formulary- to be prescribed by brand. Optive and Optive plus removed.
Brand optimisation - Macrogol sachets - Cosmocol	May 2017	Constipation	Approved	Approved for inclusion in the formulary- to be prescribed by brand. Movicol and Laxido remove from formulary
Brand optimisation - Co-Codamol 30/500 mg tablets and capsuls - Zapain	May 2017	Pain	Approved	Approved for inclusion in the formulary- to be prescribed by brand
Thealoz Duo	May 2017	severe dry eye	Approved	Thealoz Duo replaces carmellose Optive in severe dry eye on the previous pathway. This replaces Sodium hyaluronidate 0.2%, clinitas 0.4% as a more cost effective option
Trivalent influenza vaccine	February 2017	Influenza prophylaxis	Approved	Approved for inclusion in the formulary as the preferred choice of vaccine over quadrivalent vaccine
Marol (Tramadol) Prolonged Release tablets 100mg, 150mg, 200mg	February 2017	Treatment of moderate to severe pain	Approved
Prednisolone soluble tablets	October 2016	Prednisolone soluble tablets reintroduced on childrens wards, liquid preferred over crushing tablets as per previous ACE decision in primary care	Approved
Thickeners formulary application	October 2016	Approved for Resource Thicken Up Clear to be used in Primary Care and Nutilis Clear in hospital	Approved
Zlatal (Methotrexate)	October 2016	Zlatal is indicated for the treatment of -active rheumatoid arthritis in adult patients, -polyarthritic forms of severe, active juvenile idiopathic arthritis, when the response to nonsteroidal anti- inflammatory drugs (NSAIDs) has been inadequate, -severe recalcitrant disabling psoriasis, which is not adequately responsive to other forms of therapy such as phototherapy, PUVA, and retinoids, and severe psoriatic arthritis in adult patients.	Approved	Note: Device is a Prefilled syringe and different to Metoject
Binosto (Alendronate)	October 2016	Treatment of postmenopausal osteoporosis. Binosto 70 mg reduces the risk of vertebral and hip fractures.	Approved	Proposed switch from liquid to effervescent tablets which will be written generically
Vitamin B Co strong	October 2016	To be removed from DWMHT formulary ACE decision – Non formulary	Non-formulary
Brand optimisation - buprenorphine transdermal patches - Butec	September 2016	Pain	Rejected	Primary Care pain guidelines state Butrans is not appropriate, therefore unable to review and support BuTrans at this moment.
Brand optimisation Cilique	September 2016	Hormonal contraception	Approved	Approved for inclusion in the formulary for new patients, practices to consider whether to switch patients
Brand optimisation Levest/ Rigivedon	September 2016	Hormonal contraception	Approved	Approved for inclusion in the formulary for new patients, practices to consider whether to switch patients
Brand optimisation Yacella/Lucette	September 2016	Hormonal contraception	Approved	Approved for inclusion in the formulary for new patients, practices to consider whether to switch patients
Brand optimisation- Symbicort 200/6 MDI	September 2016	Asthma and COPD	Approved	Approved for inclusion in the formulary for new patients, practices to consider whether to switch patients
Contiform Only and Pelvic Toner - after review by specialist physiotherapist (Dudley Continence Service) UgoFix Gentle Clip for Catheters Bladder Infusion Kit Prosys All silicone Catheter	September 2016	Continence services	Approved
Entresto (Sacubitril / valsartan)	June 2016	Adult patients for treatment of symptomatic chronic heart failure with reduced ejection fraction	Approved	See Dudley Health Economy guidance on implementation - click here
Abasaglar	May 2016	Treatment of diabetes mellitus in adults, adolescents and children aged 2 years and above.	Approved	Approved for inclusion in the formulary
Guanfacine	May 2016	ADHD	Approved	To be included in the formulary in line with the proposed ESCA for initiation by DWMHT CAMHS consultants
Fostair 200/6 pMDI inhaler	March 2016	Asthma in adults	Approved	Only to be used in adults with asthma
Fostair 200/6 Nexthaler DPI	March 2016	Asthma in adults	Approved	Only to be used in adults with asthma
Fostair 100/6 Nexthaler DPI	March 2016	COPD in adults	Approved	Additional use in adults with COPD
Microgynon 30 / Maexini tablets	March 2016	Contraception	Approved	Maexini approved for inclusion in the formulary for CASH, Microgynon 30 to remain as formulary choice in primary care
Desogestrel / Feonolla / Cerelle tablets	March 2016	Contraception	Approved	Feonolla approved for inclusion in the formulary for CASH, Cerelle to remain as formulary choice for primary care
Lisdexamfetamine dimesylate 30 mg	Feb 2014	Attention deficit hyperactivity disorder refractory to methylphenidate (initiated by a specialist)	Approved	Shared care guidelines available
Quetiapine XL (Biquelle XL) - Brand of choice	Feb 2017	Schizophrenia	Approved
Duaklir Genuair (Aclidinium / Formoterol	March 2015	COPD	Approved
Repinex XL (Ropinirole XL)	January 2015	Brand optimisation of ropinirole modified release for Parkinson’s Disease	Approved	As directed by specialist initiation or review
Fluticasone/formoterol (Flutiform®)	November 2014	Asthma	Approved	For patients over 12 years
Alogliptin 6.25 mg, 12.5 mg, 25 mg tablets	November 2014	Type 2 diabetes as dual therapy in combination with either metformin, pioglitazone, a sulfonylurea, or insulin (when treatment with these drugs alone fails to achieve adequate glycaemic control), or as triple therapy in combination with metformin and either pioglitazone or insulin	Approved
Beclometasone/Formoterol (Fostair®) inhaler 100/6	July 2014	COPD	Approved	Now licensed for COPD
Fluticasone/Vilanterol (Relvar Ellipta®) inhaler 92/22	September 2014	COPD	Approved but see comments	For Respiratory Consultant Initiation ONLY at present
Prasterone	September 2014	Treatment of adrenal insufficiency	Approved	The committee agreed that this be added to the formulary for use by specialists only. It was acknowledged that since the affected cohort was a small number of patients, the patient pathway would involve an annual consultant appointment in addition to three specialist nurse outpatient appointments each year; prescriptions for Prasterone would be issued by the specialist at each of these appointments. There would be no prescribing of Prasterone in primary care.
Magnesium –L aspartate (Magnaspartate®) sachets	September 2014		Approved	Use of Magnaspartate ® classified as a food for special medical purposes to replace the unlicensed magnesium glycerophosphate tablets would reduce costs in both sectors.
Fesoterodine fumarate modified-releate tablets 4 mg, 8 mg	September 2014	Urinary frequency, urinary urgency, urge incontinence	Approved	To be used 2nd line if unsuccessful with tolterodine in line with local guidelines
Bimatoprost (Lumigan 0.03%) Single-dose eye drops	Dec 2013	Glaucoma and ocular hypertension	Approved	For patients requiring preservative free eye drops
Fluticasone furoate (Avamys nasal spray)	October 2012	Nasal allergy	Approved	Third line choice
Dovobet Gel	April 2012	Psoriasis	Approved
Fentanyl (Fenico brand patches)	April 2012	Analgesia	Not approved	Not approved due to problems with adherence
Fultium D3	April 2012	Vitamin D deficiency	Approved	Click here for Vitamin D deficiency guidance
Linagliptin	April 2012	Diabetes	Approved
Adrenaline (EpiPen)	February 2012	Allergic emergencies	Approved	EpiPen preferred brand
Dabigatran	December 2011	Anticoagulant	Approved	Secondary care for first 6 months
Ranolazine	October 2011	Angina	Approved
Saxagliptin	October 2011	Diabetes	Approved	For patients where renal function is a concern
Testosterone 2% Gel	October 2011	Male Hypogonadism	Approved
Cannabis Extract (Sativex)	April 2011	Moderate to severe spasticity to multiple sclerosis	Not Approved	Lack of Evidence of efficacy
Duloxetine	April 2011	Diabetic neuropathy	Approved
Leuprorelin acetate (Prostap 3 / Prostap SR)	April 2011	Prostate cancer	Approved
Methoxy Polyethylene Glycolepoetin Beta (Mircera)	April 2011	Symptomatic anaemia associated with chronic kidney disease	Approved	Supported by an ESCA
Bimatoprost 0.01% (Lumigan)	December 2010	Glaucoma	Not Approved	Minimal patients. 0.03% already on formulary
Cabergoline	April 2010	Parkinson's Disease	Removed
Pergolide	February 2010	Parkinson's Disease	Removed
Targinact	February 2010	Severe pain	Not approved	Not approved due to lack of evidence over products already on formulary

Approved for inclusion in the formulary- to be prescribed by brand. Optive and Optive plus removed.

Removed from formulary