Part 12

DRUGS TO BE PRESCRIBED IN CERTAIN CIRCUMSTANCES UNDER THE NHS SCHEDULE 2
DRUGS, MEDICINES AND OTHER SUBSTANCES TO BE ORDERED BY CONTRACTORS
IN THE PROVISION OF PRIMARY MEDICAL SERVICES UNDER A GENERAL MEDICAL
SERVICES CONTRACT ONLY IN CERTAIN CIRCUMSTANCES
Drug, medicine or other
substance
Clobazam
Treatment of infections and inflammation of the oropharynx Treatment of Seborrhoeic Dermatitis and Pityriasis Versicolor Tadalafil (Cialis) Thymoxamine Hydrochloride (Erecnos) Vardenafil (Levitra) Sildenafil (Viagra); or (b) a man who is a national of an EEA State who is entitled to treatment by virtue of Article 7(2) of Council Regulation 1612/68(a) as extended by the EEA Agreement or by virtue of any other enforceable DRUGS TO BE PRESCRIBED IN CERTAIN CIRCUMSTANCES UNDER THE NHS Community right who has erecticle dysfunction and was on 14th September 1998 receiving a course of treatment under a national health insurance scheme of an EEA State for this condition with any of the drugs listed in sub-paragraph (a); or (c) a man who is not a national of an EEA state but who is the member of the family of such a national who has an enforceable Community right to be treated no less favourably than the national in the provision of medical treatment and has erectile dysfunction and was being treated for that condition on 14th September 1998 with any of the drugs listed in sub-paragraph (a); or (d) a man who is suffering from any of the following - multiple sclerosis Parkinson's disease Poliomyelitis prostate cancer severe pelvic injury single gene neurological disease spina bifida spinal cord injury; or treatment for renal failure by dialysis; or radical pelvic surgery renal failure treated by transplant. assessed by the relevant consultant and/or advised by the relevant consultant as suffering severe distress as a result of erectile dysfunction DRUGS TO BE PRESCRIBED IN CERTAIN CIRCUMSTANCES UNDER THE NHS Drug, medicine or other
substance
(a) clinical priority group patients Treatment of influenza accordance with a community based virological surveillance scheme that influenza A or influenza B is circulating in the locality in which the patient resides or is present or was present at the time that the virus was circulating; within 48 hours of the onset of symptoms. influenza during an outbreak of influenza. accordance with a community based virological surveillance scheme that influenza A or influenza B is circulating in the locality in which the patient resides; an influenza-like illness through being in close contact with someone with whom the patient lives who is or has been suffering from an influenza-like illness; protected by vaccination against influenza because the patient- vaccinated because vaccination is contraindicated; vaccinated since the previous influenza season; DRUGS TO BE PRESCRIBED IN CERTAIN CIRCUMSTANCES UNDER THE NHS but the vaccine is not well matched to the strain of influenza circulating in the locality in which the patient resides or is or has been present; care establishment and another resident or member of staff of the establishment has an influenza-like illness; and prophylaxis within 48 hours of exposure to an influenza-like illness. influenza during an outbreak of influenza. (a) clinical priority group patients and at-risk patients where- influenza B is circulating in the locality in which the within 48 hours of the onset of symptoms. (a) clinical priority group patients Prophylaxis of influenza and at-risk patients where- accordance with a community based virological surveillance scheme that influenza A or influenza B is circulating in the locality in which the patient resides; an influenza-like illness through being in close DRUGS TO BE PRESCRIBED IN CERTAIN CIRCUMSTANCES UNDER THE NHS contact with someone with whom the patient lives who is or has been suffering from an influenza-like illness; protected by vaccination against influenza because the patient- vaccinated because vaccination is contraindicated; vaccinated since the previous influenza season; but the vaccine is not well matched to the strain of influenza circulating in the locality in which the patient resides or is or has been present; care establishment and another resident or member of staff of the establishment has an influenza-like illness; and prophylaxis within 48 hours of exposure to an influenza-like illness. In this Schedule - 'clinical priority group' means • People aged over six months who are at risk-patients. • All pregnant women; • Those who have been or who are in close contact with people with compromised immune systems e.g. people in regular close contact with patients on treatment for cancer • Frontline health and social care workers. "at-risk" means a patient who falls into the 'clinical risk category' listed in the table below. DRUGS TO BE PRESCRIBED IN CERTAIN CIRCUMSTANCES UNDER THE NHS Clinical Risk Category
Examples (but decisions should be based on clinical judgement)
• Chronic obstructive pulmonary disease (COPD) including chronic bronchitis and emphysema; bronchiectasis, cystic fibrosis, interstitial lung fibrosis, pneumoconiosis and bronchopulmonary dysplasia (BPD) • Asthma that requires continuous or repeated use of inhaled or systemic steroids or with previous exacerbations requiring hospital admission • Children who have previously been admitted to hospital for lower respiratory tract disease • Congenital heart disease • Hypertension with cardiac complications • Chronic heart failure • Individuals requiring regular medication and/or follow-up for ischaemic heart disease • Chronic renal failure • Nephrotic syndrome • Renal transplantation. • Cirrhosis • Biliary Atresia • Chronic hepatitis • Cerebrovascular disease, principally stroke and transient ischaemic attacks (TIAs) • Multiple sclerosis and related conditions • Hereditary and degenerative disease of the central nervous system • Type 1 diabetes • Type 2 diabetes (including treatment by insulin, oral hypoglycaemic drugs or diet alone) • Patients undergoing chemotherapy leading to immunosuppression • Asplenia or splenic dysfunction • HIV infection • Individuals treated with or likely to be treated with systemic steroids for more than a month at a dose equivalent to prednisolone at 20mgs or more per day (any age) or for children under 20 kgs a dose of 1mg or more per kg per day. • Some immunocompromised patients may have a suboptimal immunological response to the vaccine "child" means any person under the age of 16; "EEA Agreement" means the Agreement on the European Economic Area signed at Oporto on 2nd May 1992 (a) as adjusted by the Protocol signed at Brussels on 17th March 1993 (b); "EEA State" means a state which is a contracting party to the EEA Agreement or Switzerland; "residential care establishment" means a place where persons reside on a long term basis in (a) Cm 2073 and O.J. No. L1, 3.1.1994 p.3 (b) Cm 2183 and O.J. No. L1, 3.1.1994 p.3 DRUGS TO BE PRESCRIBED IN CERTAIN CIRCUMSTANCES UNDER THE NHS CRITERIA NOTIFIED UNDER THE TRANSPARENCY DIRECTIVE
Criteria notified to the European Commission under Article 7 of the Council Directive
relating to the transparency of measures relating to the pricing of medicinal products
for human use and their inclusion in the scope of the national health insurance
schemes (89/105/EEC)
The following six criteria have been separately notified by the UK Government to the European
Commission since 1989 to comply with Article 7 of the Transparency Directive.
First, under the Selected List Scheme, medicinal products in seventeen therapeutic categories which
are excluded from prescription on the grounds that, on expert advice, they had no clinical or therapeutic
advantage over other, cheaper drugs in the following categories: -
Mild to moderate painkillers
Indigestion remedies
Laxatives
Cold and cough remedies
Vitamins
Tonics
Benzodiazepine sedatives and tranquillisers
Anti-diarrhoeal drugs
Drugs for allergic disorders
Hypnotics and anxiolytics
Appetite Suppressants
Drugs for vaginal and vulva conditions
Contraceptives
Drugs used in anaemias
Topical anti-rheumatics
Drugs acting on the ear and nose
Drugs acting on the skin
Second, products may be considered as `borderline substances', which are not truly medicinal products
with clinical or therapeutic value, and are excluded from NHS prescription on that ground.
Third, as well as being freely on sale over the counter to the general public the cost to the NHS if the
product (s) were to be supplied on prescription could not be justified at any price likely to be economic to
the manufacturer and that supply of the product is not considered a priority for the use of the limited
resources available to the NHS.
Fourth, the products which nevertheless may meet a legitimate clinical or therapeutic need when
properly prescribed, are subject to misuse by drug misusers, and such misuse, or the manner in which
the product may be administered by drug misusers, gives rise to the risk of physical or mental morbidity
and alternative products may be available to meet all legitimate clinical or therapeutic needs.
Fifth, a medicinal product or category of medicinal products may be excluded entirely from supply on
NHS prescription. It may alternatively be excluded except in specified circumstances, or except in
relation to specified conditions or categories of conditions, or specified categories of patients. A
medicinal product or category of them may be so excluded where the forecast aggregate cost to the
NHS of allowing the product (or category of products) to be supplied on NHS prescription, or to be
supplied more widely than the permitted exceptions, could not be justified having regard to the relevant
circumstances including in particular: the First Minister's duties pursuant to the NHS (Scotland) Act 1978
and the priorities for the expenditure of NHS resources.
Sixth, products, which comprise an injection device prefilled with a drug may be excluded from supply
on NHS prescription if the same drug is available and can be used more economically in a container
which may be used in conjunction with a refillable injection device.
DRUGS TO BE PRESCRIBED IN CERTAIN CIRCUMSTANCES UNDER THE NHS

Source: http://www.isdscotland.org/Health-Topics/Prescribing-and-Medicines/Scottish-Drug-Tariff/Web_Part_12_Feb12.pdf