This page will bring together all the PrescQIPP specials resources and suggests good practice and how to optimise the use of licensed medicines, alternatives and reviews to be done to support the reduced use of specials. Each set resource makes recommendations, as well as supportive documentation where applicable and alternative resources from other providers.
B159: Specials Prescribing Optimisation Tool (SPOT) ListThe Specials Prescribing Optimisation Tool (SPOT) is based on the national specials prescribing data. This list includes specials that appear regularly in the top ten specials prescribed list, those where there has been a significant growth in prescribing and those that may not appear very often but when they do pose significant cost pressure due to their expense.
The SPOT resource (and supporting bulletins) provide information on specials versus licensed medication. Support tools include advice on hierarchy of risk, on alternatives, and areas for cost saving.
PrescQIPP Bulletins to Support the SPOT-List
The bulletins linked below are the more in depth reviews of items on the spot list designed to support implementation of change for specific treatments.
B108: MelatoninThe Melatonin SPOT list support document reviews the place in therapy for melatonin and recommends reviewing patients regularly to assess for continued need. A shared care template document is available so support appropriate prescribing.
B120: Vitamin DThe vitamin D resource provides information on licensed preparations, pathways for adults and children as well as guidance around licensed alternatives.
Other Vitamin D Resources
- Commentary on the medico-legal aspects of prescribing vitamin D
- UKMI documents:
- Q&A: Vitamin D supplements for vegetarians and vegans
- Q&A: Dose of vitamin D to treat deficiency
- Q&A: Calcium and vitamin D supplements for vegetarians and vegan
- Q&A: Dose of oral vitamin D during pregnancy
- Q&A: Vitamin D products for patients with peanut or soya allergy
- National Osteoporosis Society Guidance - Vitamin D and Bone Health: A Practical Clinical Guideline for Patient Management
- National Osteoporosis Society - Vitamin D and Bone Health: A Practical Clinical Guideline for Management in Children and Young People
This bulletin focuses on the use of glycopyrronium in hypersalivation (both off label and unlicenced special usage). It also covers use in other conditions in both adults and children.
Other Glycopyrronium Resources
- UKMI documents:
- Medicines Q&A: Management of hypersalivation (October 2015)
- Drug treatment options
- Hyoscine hydrobromide
- Alternatives to glycopyrronium and hyoscine
- Medicines Q&A: Management of hypersalivation (November 2015)
- Drug treatment options
- NICE Hypersalivation: oral glycopyrronium bromide
B123: OmeprazoleThe omeprazole resource provides recommendations on licensed alternatives where appropriate for patients on unlicensed preparations.
B133: Topical DiltiazemThe topical diltiazem resource discusses the evidence available and alternative treatments. A pathway to treat anal fissure is also available as a supporting tool.
B147: Buccal Midazolam
This bulletin reviews the place in therapy of unlicensed buccal midazolam and switching to a licences product where appropriate. Safety issues and savings are also discussed.
Video Specials Prescribing Optimisation Tool Webinar - February 2015 - Rakhi AggarwalIn this webinar Rakhi Aggarwal, PrescQIPP’s Pharmacist Project Manager for Specials introduces the SPOT List (Specials Prescribing Optimisation Tool) and providing an overview of plans for future delivery around Specials in 2015. Subscibers can now view this webinar below:
The Specials Tariff WatchThe quarterly Specials Tariff Watch is designed to help prescribers navigate the changes in Part VIIIB of the drug tariff to facilitate cost-effective prescribing. It also includes the top ten list of potential highest savings. The document is based on, and replaces, work by Anne Fowler of NHS Lancashire (with thanks!).
Royal Pharmaceutical Society Specials Guidance
In April 2016, the Royal Pharmaceutical Society produced professional guidance for prescribers of specials which is an update of a resource produced by the National Prescribing Centre in 2011.
Bulletin 48 - Liquid Formulation Requirements in Bariatric Surgery patients
The number of weight-loss bariatric procedures has been on the increase, especially since the publication of NICE guidelines on obesity in which bariatric surgery was recommended as a treatment option for some patients. Following bariatric surgery patients are restricted to a liquid diet and their medications are usually changed from solid dosage forms to unlicensed liquid formulations. This switch may not be necessary or may continue for longer than the clinical need and can have significant implications for the drug budget. This bulletin provides information for prescribers on the appropriate prescribing of liquid formulations for patients that have undergone bariatric surgery.
B168: British Association of Dermatologists Revised Guidelines
This bulletin reviews the prescribing of dermatology specials to try and ensure that any prescribing of dermatology specials is appropriate and in line with the British Association of dermatologists guidelines.
Other British Association of Dermatologists Resources
Other Products on the SPOT-List and Best Practice
The products below have appeared in the SPOT-List, however as there are useful supporting resources and information already available, we have signposted to these rather than produce new resources.
Magnesium Glycerophosphate/Magnesium Oxide Resources
Magnesium oral preparations appear in the top 20 SPOT list. UKMI have produced a useful resource recommending the preferred choice for the treatment and prevention of magnesium deficiency when clinically appropriate.
Midodrine tablets appear in the top 20 SPOT list. In March 2015 a licensed preparation of midodrine tablets became available as Bramox 2.5mg and 5mg tablets.
Sodium bicarbonate 1mmol/ml oral solution was granted a UK license in September 2014. It is licensed for the treatment of hyperacidity, dyspepsia and provide symptomatic relief heartburn and peptic ulceration for patients 12 years and above. Specialist Pharmacist Services have produced a document as the licensed product was subject to some labelling safety concerns and use of unlicensed preparations is currently known to continue. The table in the link below summarises details of currently known products.
NICE Evidence Summaries: Unlicensed/Off-Label MedicinesNHS has recently started producing evidence reviews for unlicensed or off-label medicines. It has already published two reviews. The first covers the off-label use of tranexamic acid for the treatment of significant haemorrhage following trauma, and the second reviews the use of unlicensed melatonin preparations for the treatment of sleep disorders in children and young adults with attention deficit hyperactivity disorder. There are plans to publish more reviews in the coming months and a list of those proposed can be found on the NICE website along with the published reviews at the following link:
NICE has produced a statement to describe what the evidence summaries on unlicensed or off-label medicines cover:
“Evidence summaries: unlicensed or off-label medicines' summarise the published evidence for selected unlicensed or off-label medicines that are considered to be of significance to the NHS, where there are no clinically appropriate licensed alternatives. The summaries provide information for clinicians and patients to inform their decision-making and support the construction and updating of local formularies.
The summaries support decision-making on the use of an unlicensed or off-label medicine for an individual patient, where there are good clinical reasons for its use, usually when there is no licensed medicine for the condition requiring treatment, or the licensed medicine is not appropriate for that individual.
The strengths and weaknesses of the relevant evidence are critically reviewed within this summary, but this summary is not NICE guidance.”