The Drugs to Review for Optimised Prescribing (aka DROP) List has been one of our most popular tools for a number of years with commissioners and clinicians. The document was first released in 2011, built from an accumulation of the top items on local lists of low prioroty treatments and those whre there is a limited evidence base to support use. It has now evolved to incorporate medicines optimisation principles, self care and most recently the NICE do-not-do’s. The list is sorted by spend and items where there is a spend of greater than £500,000 in England and Wales.
The DROP-List: An IntroductionThe DROP-List has always sought to support Medicines Optimisation principles, which details that "treatments of limited clinical value are not used and medicines no longer required are stopped. The new DROP-List contains 30 items, which at the time of publication amounted to a total annual national spend of over £336 million. The cost avoidance included within the new document could amount to around £50 million per year.
For each area we will produce an independent bulletin along with implementation materials, however the main DROP-List bulletin contains:
- Recommendations around the rationale and delivery of the DROP-List items.
- The top 30 drugs identified as being of the lowest priority for prescribers, and the national annual spend on these items.
- Summary information on each of the items, along with rationale, where use may be appropriate, suggested alternatives and indicative associated savings.
We have incorporated the NICE do not do’s that can be prescribed and which can be easily measured through epact data, however as part of the work to identify these, we produced a list of all prescribabale do not do.s which has been published as an excel spreadsheet that can be filtered by BNF category. This spreadsheet will be updated quarterly.
To support the, each month we will publish the DROP-List Scorecard which offers detail on activity and cost avoidance across all of our subscribing CCGs/CSUs.
The DROP-List Items
Below is a list of the now 30 Drugs to Review for Optimised Prescribing items - along with links to where you can find the resources:
The DROP-List Bulletin v4.0 - July 2015The 2015/16 version of the DROP list and supporting documents can be found here. A slideset is also available for use locally.
The DROP-List and Self Care
Some of the items on the DROP-List are suitable for self care, we have been developing a separate self care webkit looking specifically at items suitable for self care and treating minor ailments therefore the self care items will eventually be removed from the DROP-List when we update the overarching document. You can visit the self care webkit by clicking the button below:
The DROP-List in DataThe PrescQIPP Drugs to Review for Optimised Prescribing is one of our most popular project areas. We have traditionally produced a snapshot for this area, however following the release of the NEW DROP-List, we have now updated the monitoring to a whole new level of utility - akin to our other scorecards.
DROP-List Webinar May 2015 - Covering DROP 2015 UpdateOn the 20th May 2015 we held the a webinar to introduce our 2015 update to the DROP-List - with Sajida Khatri - with a particular focus on the new inclusions such as NICE do-not-dos. You can now view this webinar below:
DROP-List Webinar April 2014 - Covering 2014 Optimisation of DROPOn the 9th April 2014 we held the all new DROP-List webinar - with Sajida Khatri - in advance of the new DROP List that was published in May 2014. You can now view this webinar below:
Self Care – AnalgesiaThis item on the DROP-List covers prescribing for analgesia items (excluding POM medicines), where these products are being prescribed for minor ailments such as acute mild pain, fever etc, they can be purchased over the counter as part of self care. The resources developed as part of the self care package are patient information resources that cover pain and fever.
Rubefacients (Excluding Topical NSAIDs)The rubefacients bulletin supports the PrescQIPP DROP list. It reviews the place in therapy of the rubefacients which also have a nice do not do attached to them. An audit and patient letter are available as supporting tools.
Travel Vaccines Not Prescribable on NHSThe travel vaccines bulletin and supporting resources will support CCGs wishing to review their prescribing policies on travel vaccines. It identifies those vaccines that should not be prescribed on the NHS for travel as well as offering advice on developing a local policy on travel vaccines.
Antihistamines (OTC and Prescription Only Medicine (POM))Hayfever can be managed as part of self care and several antihistamines and nasal sprays are available to purchase over the counter. The self care resources on hayfever are patient information resources.
LiothyronineThis DROP-List support bulletin looks at the place in therapy of liothyronine and combination products containing levothyroxine and liothyronine. In light of a limited evidence base supporting its use and the increased cost of these products, a review of therapy is recommended. Supporting tools include an audit, patient information letter and community pharmacist notification letter.
Lidocaine PlastersThis bulletin looks at lidocaine plasters and provides the rationale for not initiating lidocaine plasters in new patients, and for current patients to be considered for discontinuation of their prescription for lidocaine plasters.
Nasal Sprays (OTC)Nasal sprays for the symptomatic relief of hayfever and congestion can be purchased by the as part of self care.
Doxazosin MR (Cardura® XL)No good evidence of additional benefit over immediate release doxazosin.
Fentanyl Immediate Release FormulationsImmediate release fentanyl has a NICE do not do as a first line treatment for breakthrough pain. This bulletin will focus on fentanyl immediate-release formulations and provide the rationale for new patients to be commenced on immediate-release morphine, and for current patients to be considered for a switch to immediate-release morphine or have their therapy reviewed and stopped where appropriate.
Omega-3 Fatty Acids and Other Fish OilsThis bulletin focuses on omega-3 fatty acids and provides the rationale for therapy to be stopped or for patients to be switched to alternative agents and for new patients not to be started on omega-3 fatty acids.
Haemorrhoids TreatmentsThere are several preparations available over the counter to treat haemorrhoids. The self care resources provide patient information.
Dental Products Prescribed on FP10The Prescribing dental products on FP10 bulletin has been developed to encourage dentists to prescribe and not refer to GPs for a prescription(which can take up valuable appointment time), to ensure private patients have private prescriptions and also that patients are sign posted to self-care and purchase directly where prescriptions are not required. A poster is also available which can be displayed in GP surgeries highlighting key messages for patients.
Co-proxamol (Paracetamol/Dextropropoxyphene) and Tramacet® (Paracetamol/Tramadol)This bulletin focuses on co-proxamol and provides the rationale for patients to be switched to alternative analgesics and for new patients not to be started on co-proxamol. Information on co-proxamol’s market withdrawal, adverse effects, alternative treatment options in support of the switch and potential switch savings are provided.
This bulletin focuses on Tramacet® (paracetamol 325mg/tramadol 37.5mg) and provides the rationale for new patients to be initiated on paracetamol or paracetamol with codeine. Current patients should be considered for a switch to paracetamol alone or paracetamol with codeine. Information on the adverse effects of Tramacet®, options for dose conversion in support of the switch and potential switch savings are provided.
Oxycodone/Naloxone (Targinact®)This bulletin and resources provide further information on the evidence base for for using oxycodone/naloxone prolonged release tablets, the rationale to stop treatment and also suggests alternative treatment options. Support materials are also available for organisations to adapt and use to implement changes.
Antifungal Nail PaintThis bulletin focuses on topical antifungal nail treatment, i.e. amorolfine 5% nail lacquer (Loceryl®, Curanail®, Omicur®), tioconazole 28% cutaneous solution (Trosyl®) and salicylic acid, tannic acid and boric acid paint (Phytex®) which are low priority treatments. Self-care may be appropriate for the majority of asymptomatic patients with fungal infection of the nails. If treatment is deemed necessary, a systemic antifungal is more effective than topical therapy.
Vitamins and MineralsThe vitamins and minerals DROP-List bulletin reviews the place in therapy for the multivitamin and mineral supplements and also the vitamin B complex products. They are not recommended for prescribing as general pick me ups and prescribing should be reviewed and discontinued where appropriate. Audit template and patient letter templates are also available to adapt locally.
DosulepinThese resources review the place in therapy of dosulepin which is listed as a NICE 'do not do'. The drug has a very small margin of safety between the maximum therapeutic dose and potentially fatal doses. An audit is available to support review of current prescribing.
Eflornithine Cream (Vaniqua®) for HirsutismThis bulletin focuses on eflornithine cream which is a low priority treatment considered as a cosmetic treatment for hirsutism in women. It provides the rationale for self-funded hair removal methods as the primary treatment option for women with hirsutism. It is no.19 on the PrescQIPP DROP-List and is the second PrescQIPP publication to contain a data pack and the new style briefing alongside the bulletin and implementation tools.
Perindopril Arginine (Coversyl® Arginine) and Branded Coversyl®This bulletin, focuses on different perindopril formulations (salts) which are not directly equivalent. It provides the rationale for new patients to be commenced on generic perindopril erbumine, also known as tert-butylamine. Current patients can be considered for a switch from Coversyl® Arginine (perindopril arginine) to perindopril erbumine. Options for dose conversion in support of the switch, potential switch savings and information on perindopril adverse effects are also provided.
Lutein and Antioxidant VitaminsThe lutein and antioxidant vitamins bulletin discusses the lack of evidence available to support lutein and antioxidant vitamins as a treatment for the prevention of age related macular degeneration and provides tools to support review of current prescribing and links to patient information from the Macular Society.
Cough and Cold RemediesCoughs and colds are self limiting illnesses that can be managed with self care. These resources provide patient information.
AmiodaroneReview patients on amiodarone to ensure treatment is being appropriately monitored and that it is discontinued in indications where use is short-term only.
Minocycline for AcneThis bulletin focuses on minocycline for the treatment of acne vulgaris and provides the rationale for new patients to be commenced on an alternative antibiotic and for current patients to be considered for stopping therapy or a switch to an alternative antibiotic. It provides information on the serious adverse effects of minocycline, alternative treatment options and potential savings.
Aliskiren (Rasilez®)NICE state there is insufficient evidence of the effectiveness of aliskiren to determine its suitability for use in resistant hypertension.
Complementary Therapies, Herbal Supplements and HomeopathyThere is a limited evidence base and a lack of robust randomised controlled trials directly comparing complimentatry therapies with standard treatments. Some complimentary therapies are also associated with severe adverse effects, may significantly interact with other medicines and can delay accurate diagnosis of underlying pathology.
GlucosamineThis bulletin has been archived and is available to subscribers only.
Infantile ColicThe infantile colic DROP list bulletin covers the treatment of colic and the place in therapy for lactase, simeticone and gripe water products. Supporting materials include patient information leaflet and an audit.
ProbioticsThis bulletin focuses on reviewing prescribing of probiotics (including VSL#3®) and discontinuing therapy, particularly if ACBS prescribing criteria is not met for VSL#3®. An audit and a patient letter are available for organisations considering reviewing this therapy area.