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Referral Criteria

Criteria for Referring Applications to the Lancashire and South Cumbria Medicines Management Group

Introduction

Following agreement of the LSCMMG terms of reference and medicines application process, consideration has been given to how medicines might be identified as appropriate for referral to the LSCMMG process. As a result, the following criteria have been agreed.

Application criteria

Applications will only be accepted from LSCMMG member organisations. For a medicine application to be considered through the LSCMMG process, both the following criteria must first be met:

  • Commissioning responsibility will lie with CCGs rather than the NCB; AND
  • The medicine is not subject to NICE guidance for the proposed indication due to be issued within 6 months of the application.

IN ADDITION, at least one of the following criteria should be met:

  • The medicine is or will be a PbR tariff excluded product.
  • The annual cost per patient, inclusive of associated service costs, will exceed £5,000.
  • Use of the medicine could create a significant cost pressure in the primary care prescribing budget.
  • Use of the medicine could release significant cost savings in the prescribing budget.
  • The product is a genuinely novel treatment, i.e. first in class, or a significant new indication for an existing medicine.
  • There are existing variations in use of the medicine across Lancashire and South Cumbria, which are undesirable on clinical, therapeutic or equitable access grounds.
  • There is a need for local interpretation or clarification of existing NICE guidance.
  • In the case of a medicine which has previously been considered by LSCMMG, substantial new clinical evidence should be available and be detailed in the application.

N.B. The following categories of product will not usually be considered through the LSCMMG:

  • Combination products of medicines already available for the same general indication.
  • A product which is an isomer or metabolite of an existing medicine for the same general indication.
  • A medicine which is a “me too” product, or a new delivery system or formulation of an existing medicine for the same general indication.

LSCMMG member organisations may request that prescribable items which do not fulfil these criteria be reviewed via the LSCMMG processes. All such requests will be considered by LSCMMG and added to its work plan if agreed by the Group.