RMOC work programme

Title Submitted Action Committee Committee meeting Further details Expected guidance
Biosimilar to biosimilar switching 28/12/2018 RMOC work programme topic South

Update published - March 2019


Following adalimumab biosimilar implementation, the RMOC considered the action to be taken if a patient does not tolerate the transition to a biosimilar. A position will be included in the next national adalimumab briefing note, but with a lack of evidence to support such switching, this is primarily a clinical decision.

Biosimilar insulin guidance 28/12/2018 RMOC work programme topic South

Update published - March 2019


Biosimilar insulins has been prioritised as the next topic for the RMOC BVB group to look at. It was thought that the NHS can achieve better value for money from insulins by increasing the uptake of biosimilars. This may increase the entry of new biosimilar insulin products into the NHS. The Commissioning Support Unit are providing support for this project and will report to the next South RMOC meeting in May

Melatonin for treatment of insomnia in children with neurodevelopmental disorders and neurogenetic diseases: new medicines review 28/12/2018 RMOC work programme topic North
The product was identified through SPS horizon scanning mechanisms and has been agreed for review through the RMOC system. It has recently been approved by EU licensing authorities. See www.sps.nhs.uk/medicines/melatonin/ for more details.
Hydrocortisone granules in capsules for opening (Alkindi) 28/12/2018 RMOC work programme topic London 06/03/2019

More information coming soon

Levodopa (inhaled) – adjunctive to oral levodopa for “off episodes” in the management of Parkinson’s disease: new medicines review 28/12/2018 RMOC work programme topic North
The product was identified through SPS horizon scanning mechanisms and has been agreed for review through the RMOC system. It is currently undergoing review by the EU licensing authorities. See www.sps.nhs.uk/medicines/levodopa/ .
for more details
rivaroxaban 2.5mg for PAD/CAD 20/12/2018 RMOC work programme topic North 07/03/2019

More information coming soon

Doxylamine/pyridoxine (Xonvea) oral for treatment of nausea and vomiting of pregnancy: new medicines review 18/12/2018 RMOC work programme topic North
This product is a fixed-dose combination modified-release tablet containing a histamine H1 receptor antagonist (doxylamine 10mg) and vitamin B6 (pyridoxine 10mg). Its anticipated use is for nausea and vomiting in pregnancy (NVP) in women who do not respond to conservative management. The product was identified through SPS horizon scanning mechanisms and has subsequently been identified as requiring review through the RMOCs.
Sequential use of biologics 17/09/2018 RMOC work programme topic South

Update published - March 2019


The RMOC has been asked to provide evidence for sequential biologic therapy. This issue concerns the number of cycles of biologicals used before use is limited. This is a difficult area with a limited evidence base. Limited sequential use of biologics has been covered to varying degrees in NICE guidance although no definitive answer reached due mainly to the lack of evidence. The RMOC will explore the evidence base in this area.

Sodium docusate 10/09/2018 RMOC work programme topic North 07/03/2019

More information coming soon

Melatonin for sleep disorders in children and adults with neurodevelopmental disorders 29/08/2018 RMOC work programme topic South
RMOC determination of shared care suitability for new and existing medicines 21/08/2018 RMOC work programme topic North

More information coming soon

National revision of standardised & quality assured shared care templates through RMOC shared care programme of work 21/08/2018 RMOC work programme topic North

More information coming soon

GLP1 choice in those with CVD 15/08/2018 RMOC work programme topic Midlands and East 05/12/2018

Update published - January 2019


A position statement is expected on this topic. The committee noted that clinical trials assessing the impact of several GLP-1 mimetics on cardiovascular outcome have been published in recent years and there is some evidence from clinical trials of potential differences between agents within this class of medicines. Whilst the RMOC is mindful of current NICE guidance and note that NICE will update their guidance in due course there is currently a paucity of robust cost-effectiveness data and a lack of a suitable cost effectiveness model.

National shared care guidelines for immunosupressants from Tertiary Referral Centres 02/08/2018 RMOC work programme topic North

More information coming soon

Carbetocin for use in NHS ambulance services 05/07/2018 RMOC work programme topic London
Proposal to establish and oversee a national ‘do once’ system for organisational medicines governance 04/07/2018 RMOC work programme topic South

Update published - November 2018


The RMOC system is to endorse and give oversight to a national "do once" system for patient group directions.

PIL explaining Prescribing responsibilities between primary & secondary/tertiary care 22/06/2018 RMOC work programme topic North

More information coming soon

Multi Compartment Compliance Aids 14/06/2018 RMOC work programme topic London

Update published - December 2018


A project developing a 'gold standard' approach to multicompartment compliance aids is planned. A scoping document is being prepared.

Primary care monitoring of drugs that fall under specialised comissioning 07/06/2018 RMOC work programme topic North

More information coming soon

Melatonin for sleep disorders in children 29/05/2018 RMOC work programme topic South
Drug decision making for tertiary and super specialist centres 29/05/2018 RMOC work programme topic North

More information coming soon

Prior Approval BlueTeq Standardisation 16/05/2018 RMOC work programme topic South

Update published - March 2019


The RMOC considered a proposal for standardised BlueTeq templates to be adopted by CCGs to provide greater clarity and reduced variation in the system. This arose since prescribers in acute trusts have different templates to complete for different CCGs which add complexity and potentially inequity to the system. On behalf of the RMOC, SPS had surveyed APCs/CCGs within the South England region to identify the degree of uptake of BlueTeq. The survey confirmed wide variation on the use of BlueTeq between CCGs, and the medicines it is used for. It was agreed that producing national standard templates would be a major undertaking and therefore the RMOC would work on producing a set of principles to follow regarding use of BlueTeq.

Patient Information to explain prescribing responsibilities 14/05/2018 RMOC work programme topic North

More information coming soon

Biosimilar switching programmes – ‘nocebo vs. meaningful differences between products’ 14/05/2018 RMOC work programme topic South

More information coming soon

Cost Comparator Tool to Optimise Best Value Biologic 03/05/2018 RMOC work programme topic South

Update published - March 2019


The RMOC considered the cost comparator tool, which is used in a number of Trusts in Bristol. The tool supports selecting the best value biological at the point of a clinician selecting a therapy. It does not replace clinical judgement or patient preference, but supports optimising the patients’ therapy. The RMOC supported further exploration of how the tool could be used more widely in the NHS.

Stopping medication 23/04/2018 RMOC work programme topic London

Update published - December 2018


Deprescribing guidance will be developed. A scoping document is being prepared.

Prescribing of insulin in frail and elderly who are being managed at home 17/04/2018 RMOC work programme topic Midlands and East

More information coming soon

Learning Disabilities Mortality Review (LeDeR) 10/04/2018 RMOC work programme topic North

More information coming soon

Evidence for the use of heparinised saline for maintaining patency of intravascular catheters 03/04/2018 RMOC work programme topic London 04/07/2018

Guidance published - February 2019


31/01/2019
Sodium Oxybate 14/03/2018 RMOC work programme topic Midlands and East 05/12/2018

Update published - January 2019


NHS England has a commissioning policy for sodium oxybate for narcolepsy in children however there is no similar policy for adults. The committee was previously asked to consider the continuation of sodium oxybate in adolescent patients on their transition into adulthood who benefitted from its use for narcolepsy with cataplexy. Additional information was discussed at the most recent meeting and the RMOC recognised that variation in prescribing and access to the drug is in part due to variations in the way specialist sleep services are commissioned and provided. Further discussions with NHS England specialised commissioning are warranted before guidance is issued.