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Immune system
Immune system / Immune system disorders and transplantation
  antithymocyte immunoglobulin (rabbit) Off Formulary NICE TA481
  avacopan Restricted NICE TA825
Avacopan

Treatment in accordance with NICE guidelines and criteria.

This is commissioned by NHSE for active granulomatosis and a Blueteq form must be completed before prescribing. Please contact the Pharmacy High-Cost Drugs team if any assistance is required.

  azathioprine Restricted
AZATHIOPRINE

For oncological treatment, or for immunological therapy by those experienced.

For use in Gastroenterology, azathioprine is SC in the Black Country formulary, i.e. for prescribing in primary care under a shared care agreement.

  basiliximab Off Formulary NICE TA481
  belimumab Off Formulary NICE TA752
Belimumab

This is commssioned by NHSE for the indications below and a Blueteq form must be completed before prescribing. Please contact the Pharmacy High-Cost Drugs team if any assistance is required.

Any other use is non-formulary and the non-formulary request process should be followed. 

Active autoantibody-positive systemic lupus erythematous

  canakinumab Off Formulary
Canakinumab

This is commssioned by NHSE for the indications below and a Blueteq form must be completed before prescribing. Please contact the Pharmacy High-Cost Drugs team if any assistance is required.

Any other use is non-formulary and the non-formulary request process should be followed. 

Periodic fevers and autoinflammatory diseases

  chloroquine Off Formulary
Chloroquine

For malaria this is Black in the Black Country IMOC formulary for prophylaxis, but can be supplied on a private prescription. For all other uses it is Green.

  ciclosporin Restricted NICE TA369
  Solution for infusion
Sandimmun (Novartis Pharmaceuticals UK Ltd) Off Formulary
  hydroxychloroquine sulfate On Formulary
  mycophenolate mofetil Restricted NICE TA481
NICE TA481
  Gastro-resistant tablet
Mycophenolate mofetil (Non-proprietary) Off Formulary
  rituximab Restricted NICE TA308
NICE TA195
NICE TA243
NICE TA137
NICE TA193
NICE TA226
NICE TA174
NICE TA359
NICE TA561
RITUXIMAB

This is commissioned by NHSE

1. for the treatment of ANCA-associated vasculitis in adults, or

2. for refractory Systemic Lupus Erythematosus (SLE) in Adults and children, or 

3. for adult and post-pubescent patients for the prevention of Delayed Haemolytic Transfusion Reactions and Hyperhaemolysis in patients with haemoglobinopathies, or 

4. for the treatment of immunobullous disease in adults and children with pemphigoid (as 4th line treatment), or 

5. for the treatment of immunobullous disease in adults and children with pemphigus (as 3rd line treatment), or

6. in combination with venetoclax for the treatment of previously treated chronic lymphatic leukaemia

and a Blueteq form must be completed before prescribing. Please contact the Pharmacy High-Cost Drugs team if any assistance is required.

All other indications are ICB commissioned and a Blueteq form is required before prescribing, if available.


 

  sirolimus Off Formulary NICE TA481
  tacrolimus Restricted NICE TA82
NICE TA481
NICE TA481
  voclosporin Restricted NICE TA882
Voclosporin

This is commissioned by NHSE and a Blueteq form must be completed before prescribing. Please contact the Pharmacy High-Cost Drugs team if any assistance is required.

Immune system / Multiple sclerosis
  dimethyl fumarate Nice-approved drug
DIMETHYL FUMARATE

This is commssioned by NHSE for the indications below and a Blueteq form must be completed before prescribing. Please contact the Pharmacy High-Cost Drugs team if any assistance is required.

Any other use is non-formulary and the non-formulary request process should be followed. 

Multiple Sclerosis relapsing–remitting in adults and children

Skilarence® NICE TA475
Tecfidera® NICE TA320
  fingolimod Nice-approved drug NICE TA254
FINGOLIMOD

This is commssioned by NHSE for the indications below and a Blueteq form must be completed before prescribing. Please contact the Pharmacy High-Cost Drugs team if any assistance is required.

Treatment of highly active relapsing remitting multiple sclerosis after 1st line treatment in children

Treatment of rapidly evolving severe (RES) relapsing-remitting multiple sclerosis after natalizumab treatment in children

Treatment of rapidly evolving severe (RES) relapsing-remitting multiple sclerosis after natalizumab treatmen

  glatiramer acetate Off Formulary NICE TA527
  natalizumab Nice-approved drug NICE TA127
Immune system / Autoimmune hepatitis
  budesonide Restricted NICE TA708
  Modified-release tablet
Cortiment (Ferring Pharmaceuticals Ltd) Off Formulary
  Gastro-resistant capsule
Budenofalk (Dr. Falk Pharma UK Ltd) Off Formulary
  Gastro-resistant granules
Budenofalk (Dr. Falk Pharma UK Ltd) Off Formulary
  penicillamine Restricted