Script saving scheme _Savings calculated from July 2010 Drug Tariff_

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					Script saving scheme (Savings calculated from July 2010 Drug Tariff)

Intervention target                            Recommendation to GP
Prescription item not required by              Mark as Not Dispensed and do not supply.
patient                                        Inform GP within two working days

Specials

 Hypromellose eye drops 0.25%                  That 0.3% be prescribed
                                                 Saving about £99 per item

 Paracetamol suspension 500mg/5ml              That 250mg/5ml be prescribed
                                                 Saving about £110 per item

 Metformin oral solution 500 mg/5ml            That metformin oral powder sachets (sugar free)
                                                 be prescribed, either 500mg or 1g per sachet as
                                                 appropriate
                                               Saving for 30 x 500mg doses = £88.92
                                               Saving for 30 x 1g doses = £177.83

 Amisulpride Liq special 25mg/5ml              That licensed amisulpride solution 100mg/ml be
                                                 prescribed (comes with dosing pipette)

 Midazolam Liq Special oromucosal              That Epistatus, 5ml be prescribed
  10mg/ml                                        Saving about £90


Strength optimisation                          That, for once daily dosage:
                                               1 x 20mg be prescribed rather than 2 x 10mg
Citalopram 2 x 10mg tablets                    Saving for 28days = £1.14
           2 x 20 mg tablets                   1 x 40mg be prescribed rather than 2 x 20mg
                                               Saving for 28 days = £1.28

Gabapentin change tablets to capsules –
only if prescribed for neuropathic pain
Gabapentin 600mg tablets                       Suggest 2 x 300mg gabapentin capsules
                                               Changing 100 gabapentin 600mg tabs to 2 x 100
                                               gabapentin 300 mg capsules saves £19.10

Gabapentin 800mg tablets                       Suggest 2 x 400 mg gabapentin capsules
                                               Changing 100 gabapentin 800mg tabs to 2 x 100
                                               gabapentin 400mg capsules saves £37.24



Pregabalin capsules only if prescribed for     Suggest to GP changes the prescription to:
neuropathic pain                               1 x 50mg )
2 x 25mg taken together                        1 x 100mg )
2 x 50mg taken together                        1 x 150mg )Saving per dose + £1.15
2 x 75mg taken together                        1 x 200mg )
2 x 100mg taken together                       1 x 300mg )
2 x 150mg taken together


Metformin 500mg MR x 2, taken together         Suggest GP changes the prescription to 1 x
                                               metformin 1g MR
                                               Saving per dose = 7p
Over use

GTN sprays – 4 or more dispensed in a year       GP: Advise of frequency of dispensing.
                                                 Patient : Recommend GP appointment as angina
                                                 not well controlled
Salbutamol for asthma patients – more
than 2 salbutamol MDIs dispensed per             GP: Advise of average number of salbutamol
month and no steroid inhaler prescribed          MDIs dispensed per month
Using 2 or more canisters of beta2 agonists      Patient: Recommend GP or asthma nurse
per month, or >10-12 puffs per day is a mark     appointment as asthma poorly controlled
of poorly controlled asthma that puts patients
at risk of fatal or near-fatal asthma (BTS
guidelines revised June 2009)


Steroid creams
If possible, check emollient use.
Amount of steroid cream used in 2 weeks          If patient using more than these amounts, inform
should not exceed:                               GP of:
30g       for face and neck                       quantity dispensed per 2 week period.
30g       for both hands                          Maximum recommended by BNF
30g       for scalp                               Emollient use
60g       for both arms                          Counsel patient on appropriate use
100g      for both legs
100g      for trunk
30g       for groins and genitalia

Blood glucose testing strips for patients
NOT on insulin
 if any strips are being prescribed for         Recommend to GP that BGTS are deleted from
  patients treated by either diet alone, or      repeats.
  metformin alone.                               Explain rationale to patient

Sip feeds
 How many is the patient actually using ?
 Check whether suitable flavours are being      If current prescription exceeds current usage,
  dispensed                                      advise GP of
                                                  actual usage and recommend a reduction in the
                                                    amount prescribed
                                                  preferred flavour if this is not currently prescribed
Others
                                                 Contact prescriber, agree change and that a new
Prednisolone gastro resistant tablets            Rx will be sent within 72 hrs. Dispense standard
Joint Formulary Committee has                    prednisolone if agreed.
recommended that standard prednisolone           Saving for 28 x 5mg tablets = £7.61
tablets should be prescribed rather than
gastro resistant
Ferrous sulphate tablets                         Contact prescriber, agree change to ferrous
Switch to ferrous fumarate 210mg is              fumarate 210mg and that a new Rx will be sent
recommended                                      within 72 hrs. Dispense ferrous fumarate
                                                 Saving for 28 ferrous fumarate 210mg = £1.06

Items returned unused in MDS boxes               Advise GP within 2 working days of the drug/s not
                                                 taken and percentage of doses returned

				
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