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Joint Formulary
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 Formulary Chapter 10: Musculoskeletal and joint diseases - Full Chapter
10.01.03  Expand sub section  Drugs which suppress the rheumatic disease process
10.01.03  Expand sub section  Gold
10.01.03  Expand sub section  Penicillamine
10.01.03  Expand sub section  Antimalarials
10.01.03  Expand sub section  Drugs affecting the immune response to top
10.01.03  Expand sub section  Cytokine modulators
Abatacept
(Rheumatology)
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Approved for:

  • Rheumatoid arthritis in line with the NCL RA pathway
  • Juvenile Idiopathic Arthritis (JIA; see NICE TAs)

Provider notes

  • NMUH:
    • This medicine has a positive NICE TA and is listed in the Trust Medicines Formulary when used in line with NICE recommendations and/or Local Trust Guidelines.
    • To be prescribed by Rheumatologists ONLY.
    • Check MHRA Drug Safety Updates.
    • See links below.
  • RFL:
    • Approved for Rheumatoid Arthritis and Juvenile Idiopathic Arthritis, in line with NICE guidance
  • RNOH:
    • Restricted to Rheumatology Consultants ONLY.
  • UCLH:
  • WH:
    • As per NICE TA and above
 
Link  NCL JFC: Rheumatoid arthritis DMARD and high-cost drug pathway
Link  NICE TA195: Adalimumab, etanercept, infliximab, rituximab and abatacept for the treatment of rheumatoid arthritis after the failure of a TNF inhibitor
Link  NICE TA375: Rheumatoid arthritis not previously treated with DMARDs or after conventional DMARDs only have failed
Link  NICE TA373: Abatacept, adalimumab, etanercept and tocilizumab for treating juvenile idiopathic arthritis
Adalimumab
(Rheumatology)
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NOTE: There is more than one monograph for this medicine, click here to search for formulary status and its use for other indications. 

Approved for:

  • Rheumatoid arthritis in line with the NCL RA pathway
  • Juvenile Idiopathic Arthritis (JIA; see NICE TA)
  • Ankylosing Spondylitis (see NICE TAs)
  • Psoriatic Arthritis (PsA; see NICE TAs)

Provider notes

  • NMUH: 
    • Check MHRA Drug Safety Updates
    • This medicine has a positive NICE TA and is listed in the Trust Medicines Formulary when used in line with NICE recommendations and/or Local Trust Guidelines.
    • Restricted to Consultant Rheumatologists
    • See links below
  • RFL:
    • Approved for use in Psoriatic Arthritis, Rheumatoid Arthritis, Ankylosing Spondylitis and non-radiographic axial spondyloarthritis
  • RNOH:
    • Restricted to Rheumatology Consultants Only
  • UCLH:
  • WH:
    • As per NICE TA and above
 
Link  NCL JFC: Psoriatic arthritis (PsA) high-cost drug pathway
Link  NCL JFC: Rheumatoid arthritis DMARD and high-cost drug pathway
Link  NICE TA195: Rheumatoid arthritis - after failure of a TNF inhibitor
Link  NICE TA199: Psoriatic arthritis
Link  NICE TA373: Abatacept, adalimumab, etanercept and tocilizumab for treating juvenile idiopathic arthritis
Link  NICE TA375: Rheumatoid arthritis not previously treated with DMARDs or after conventional DMARDs only have failed
Link  NICE TA383: TNF-alpha inhibitors for ankylosing spondylitis and non-radiographic axial spondyloarthritis
Anakinra
(Adult onset Stills disease)
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NOTE: There is more than one monograph for this medicine, click here to search for formulary status and its use for other indications. 

Approved for adult-onset Stills disease in line with NHSE commissioning policy (JFC October 2018)

Provider notes

  • NMUH:
    • Non-formulary
  • RFL:
    • Approved for AOSD in line with NHSE policy (see below)
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • Non-formulary
 
Link  NHSE 170056P: Anakinra/tocilizumab for the treatment of Adult-Onset Stillís Disease refractory to second-line therapy (adults)
Apremilast
(Rheumatology)
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NOTE: There is more than one monograph for this medicine, click here to search for formulary status and its use for other indications. 

Approved for:

  • Psoriatic Arthritis (PsA; see NICE TA)

Provider notes

  • NMUH:
    • This medicine has a positive NICE TA and is listed in the Trust Medicines Formulary when used in line with NICE recommendations and/or Local Trust Guidelines.
    • To be prescribed by Rheumatologists ONLY
    • See links below
    • Check MHRA Drug Safety Updates
  • RFL:
    • As per NICE guidance for PsA
  • RNOH:
    • Rheumatology Consultants ONLY
  • UCLH:
  • WH:
    • As per NICE TA and above
 
Link  NCL JFC: Psoriatic arthritis (PsA) high-cost drug pathway
Link  NICE TA433: Apremilast for treating active psoriatic arthritis
Baricitinib
(Rheumatology)
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Approved for:

  • Rheumatoid arthritis (see NICE TA)

Provider notes

  • NMUH:
    • This medicine has a positive NICE TA and is listed in the Trust Medicines Formulary when used in line with NICE recommendations and/or Local Trust Guidelines - TO AWAIT UPDATED NCL JFC PATHWAY PRIOR TO PRESCRIBING
    • See link below
  • RFL:
    • As per NICE guidance for the treatment of RA
  • RNOH:
    • Rheumatology Consultants Only
  • UCLH:
  • WH:
    • As per NICE TA and above
 
Link  NCL JFC: Rheumatoid arthritis DMARD and high-cost drug pathway
Link  NICE TA466: Baricitinib for moderate to severe rheumatoid arthritis
Certolizumab pegol
(Rheumatology)
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NOTE: There is more than one monograph for this medicine, click here to search for formulary status and its use for other indications. 

Approved for:

  • Rheumatoid arthritis in line with the NCL RA pathway
  • Ankylosing Spondylitis (see NICE TAs)
  • Psoriatic arthritis (PsA; see NICE TAs)

Provider notes

  • NMUH:
    • This medicine has a positive NICE Technology Appraisal and is listed in the Trust Medicines Formulary when used in line with NICE recommendations and/or Local Trust Guidelines (see links below).
    • Restricted to Consultant Rheumatologists
    • See MHRA Drug Safety Update.
    • See links below.
  • RFL:
    • Approved for Rheumatoid Arthritis, Psoriatic Arthritis, Ankylosing Spondylitis and non-radiographic axial spondyloarthritis in line with NICE guidance.
  • RNOH:
    • Restricted for Rheumatology Consultants ONLY.
    • See links below.
  • UCLH:
  • WH:
    • As per NICE TA and above
 
Link  NCL JFC: Psoriatic arthritis (PsA) high-cost drug pathway
Link  NCL JFC: Rheumatoid arthritis DMARD and high-cost drug pathway
Link  NICE TA375: Rheumatoid arthritis not previously treated with DMARDs or after conventional DMARDs only have failed
Link  NICE TA383: TNF-alpha inhibitors for ankylosing spondylitis and non-radiographic axial spondyloarthritis
Link  NICE TA415: Certolizumab pegol for treating rheumatoid arthritis after inadequate response to a TNF-alpha inhibitor
Link  NICE TA445 : Certolizumab pegol and secukinumab for treating active psoriatic arthritis after inadequate response to DMARD
Etanercept
(Rheumatology)
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NOTE: There is more than one monograph for this medicine, click here to search for formulary status and its use for other indications. 

JFC approved Benepali as the brand of choice.

Approved for:

  • Rheumatoid arthritis in line with the NCL RA pathway
  • Juvenile Idiopathic Arthritis (JIA; see NICE TAs below)
  • Ankylosing spondylitis (see NICE TAs below)
  • Psoriatic Arthritis (PsA; see NICE TAs below)

Provider notes

  • NMUH:
    • This medicine has a positive NICE Technology Appraisal and is listed in the Trust Medicines Formulary when used in line with NICE recommendations and/or Local Trust Guidelines
    • Restricted to Consultant Rheumatologists
    • See MHRA Drug Safety Update
    • See links below
  • RFL:
    • Approved for use in Rheumatoid Arthritis, Psoriatic Arthritis, Ankylosing Spondylitis and non-radiographic axial spondyloarthritis in line with NICE guidance
  • RNOH:
    • Rheumatology Consultants ONLY
    • Please prescribe by brand name Benepali or Enbrel - patients requiring 50 mg should be prescribed Benepali and patients requiring 25 mg should be prescribed Enbrel
    • See links below
  • UCLH:
  • WH:
    • As per NICE TA and above
 
Link  NCL JFC: Psoriatic arthritis (PsA) high-cost drug pathway
Link  NCL JFC: Rheumatoid arthritis DMARD and high-cost drug pathway
Link  NICE TA195: Rheumatoid arthritis after the failure of a TNF inhibitor
Link  NICE TA199: Psoriatic arthritis
Link  NICE TA373: Abatacept, adalimumab, etanercept and tocilizumab for JIA
Link  NICE TA375: Rheumatoid arthritis not previously treated with DMARDs or after conventional DMARDs only have failed
Link  NICE TA383: TNF-alpha inhibitors for ankylosing spondylitis and non-radiographic axial spondyloarthritis
Golimumab
(Rheumatology)
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Approved for:

  • Rheumatoid arthritis in line with the NCL RA pathway
  • Ankylosing Spondylitis (see NICE TAs)
  • Psoriatic Arthritis (PsA; see NICE TAs)

Provider notes

  • NMUH:
    • This medicine has a positive NICE TA and is listed in the Trust Medicines Formulary when used in line with NICE recommendations and/or Local Trust Guidelines
    • Restricted to Consultant Rheumatologists
    • See links below
    • Check MHRA Drug Safety Updates
  • RFL:
    • Restricted to Rheumatology
    • Approved for use in Rheumatoid Arthritis, Psoriatic Arthritis, Ankylosing Spondylitis and non-radiographic axial spondyloarthritis in line with NICE guidance
  • RNOH:
    • Rheumatology Consultants ONLY.
  • UCLH:
  • WH
    • As per NICE TA and above
 
Link  NCL JFC: Psoriatic arthritis (PsA) high-cost drug pathway
Link  NCL JFC: Rheumatoid arthritis DMARD and high-cost drug pathway
Link  NICE TA220: psoriatic arthritis
Link  NICE TA225: Golimumab for the treatment of rheumatoid arthritis after the failure of previous disease-modifying anti-rheumatic drugs
Link  NICE TA497: Golimumab for treating non-radiographic axial spondyloarthritis
Link  NICE TA375: Rheumatoid arthritis not previously treated with DMARDs or after conventional DMARDs only have failed
Link  NICE TA383: TNF-alpha inhibitors for ankylosing spondylitis and non-radiographic axial spondyloarthritis
Infliximab
(Rheumatology)
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NOTE: There is more than one monograph for this medicine, click here to search for formulary status and its use for other indications. 

Remsima is the brand of choice

Approved for:

  • Rheumatoid arthritis in line with the NCL RA pathway
  • Ankylosing Spondylitis (see NICE TAs)
  • Psoriatic Arthritis (PsA; see NICE TAs)

Provider notes

  • NMUH:
    • This medicine has a positive NICE TA and is listed in the Trust Medicines Formulary when used in line with NICE recommendations and/or Local Trust Guidelines.
    • Restricted to Consultant Rheumatologists
    • See links below.
    • Check MHRA Drug Safety Updates.
  • RFL:
    • Approved for use in Rheumatoid Arthritis, Psoriatic Arthritis, Ankylosing Spondylitis and non-radiographic axial spondyloarthritis in line with NICE guidance
    • Approved for sarcoid (seek pharmacy advice)
    • Approved for Bechets disease (see pharmacy advice)
  • RNOH:
    • Restricted for Rheumatology Consultants ONLY.
  • UCLH:
  • WH:
    • As per NICE TA and above
 
Link  NCL JFC: Psoriatic arthritis (PsA) high-cost drug pathway
Link  NCL JFC: Rheumatoid arthritis DMARD and high-cost drug pathway
Link  NICE TA195: Rheumatoid arthritis (after failure of a TNF inhibitor)
Link  NICE TA199: Psoriatic arthritis
Link  NICE TA375: Rheumatoid arthritis not previously treated with DMARDs or after conventional DMARDs only have failed
Link  NICE TA383: TNF-alpha inhibitors for ankylosing spondylitis and non-radiographic axial spondyloarthritis
Ixekizumab injection
(Rheumatology)
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NOTE: There is more than one monograph for this medicine, click here to search for formulary status and its use for other indications. 

See NICE TA for eligibility criteria

Provider notes

  • NMUH:
    • Non-formulary
  • RFL:
    • As per NICE guidance for the treatment of Psoriatic Arthritis
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • Non-formulary
 
Link  NCL JFC: Psoriatic arthritis (PsA) high-cost drug pathway
Link  NICE TA537: Ixekizumab for treating active psoriatic arthritis after inadequate response to DMARDs
Rituximab
(Rheumatology, Vasculitis)
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NOTE: There is more than one monograph for this medicine, click here to search for formulary status and its use for other indications. 

Truxima brand is first choice (JFC March 2017).

Approved for:

  • Rheumatoid Arthritis; in line with the NCL RA pathway, including as monotherapy when methotrexate is C/I or not tolerated (July 2013)
  • ANCA associated vasculitis; in line with NHS England Commissioning Policy (May 2015)
  • Myositis (dermatomyositis and polymyositis); in line with NHS England Commissioning policy (September 2016)

Provider notes

  • NMUH:
    • This medicine has a positive NICE Technology Appraisal and is listed in the Trust Medicines Formulary when used in line with NICE recommendations and/or Local Trust Guidelines
    • See links below
    • See MHRA Drug Safety Update
  • RFL:
    • Approved for use in rheumatoid arthritis, inflammatory myopathies, vasculitis and SLE
    • Seek advice from pharmacy prior to initiating treatment
    • See links below
  • RNOH:
    • Restricted to Rheumatology Consultants ONLY
    • See links below
  • UCLH:
  • WH:
    • As per NICE TA and above
 
Link  NCL JFC: Rheumatoid arthritis DMARD and high-cost drug pathway
Link  NHSE 16036/P: Rituximab for the treatment of dermatomyositis and polymyositis (adults)
Link  NICE TA195: Rheumatoid arthritis - after failure of a TNF inhibitor
Link  NICE TA308: Rituximab in combination with glucocorticoids for treating anti-neutrophil cytoplasmic antibody-associated vasculitis
Link  NHSE A13/P/a: Rituximab for the treatment of ANCA-associated vasculitis in adults
Sarilumab
(Rheumatology)
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See links below

Provider notes

  • NMUH:
    • This medicine has a positive NICE TA and is listed in the Trust Medicines Formulary when used in line with NICE recommendations and/or Local Trust Guidelines - TO AWAIT UPDATED NCL JFC PATHWAY PRIOR TO PRESCRIBING
    • See links below
  • RFL:
    • As per NICE guidance
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • As per NICE TA and NCL JFC pathway
 
Link  NCL JFC: Rheumatoid arthritis DMARD and high-cost drug pathway
Link  NICE TA485: Sarilumab for moderate to severe rheumatoid arthritis
Secukinumab
(Rheumatology)
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NOTE: There is more than one monograph for this medicine, click here to search for formulary status and its use for other indications. 

Approved for:

  • Ankylosing Spondylitis (see NICE TA)
  • Psoriatic arthritis (PsA; see NICE TA)

Provider notes

  • NMUH:
    • This medicine has a positive NICE Technology Appraisal and is listed in the Trust Medicines Formulary when used in line with NICE recommendations and/or Local Trust Guidelines
    • Restricted to Consultant Rheumatologists 
    • See links below
  • RFL:
    • Approved for use in the treatment of Ankylosing Spondylitis and Psoriatic Arthritis in line with NICE guidance
  • RNOH:
    • Rheumatology Consultants ONLY
  • UCLH:
  • WH:
    • As per NICE TA and above
 
Link  
Link  NCL JFC: Psoriatic arthritis (PsA) high-cost drug pathway
Link  NICE TA407: Secukinumab for active ankylosing spondylitis after treatment with non-steroidal anti-inflammatory drugs or TNF-alpha inhibitors
Link  NICE TA445: Certolizumab pegol and secukinumab for treating active psoriatic arthritis after inadequate response to DMARDs
Tocilizumab
(Rheumatology, Vasculitis)
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NOTE: There is more than one monograph for this medicine, click here to search for formulary status and its use for other indications. 

Approved for:

  • Rheumatoid arthritis in line with the NCL RA pathway (including without methotrexate [July 2013])
  • Juvenile Idiopathic Arthritis (JIA; see NICE TA)
  • Giant Cell Arteritis (see NICE TA)
  • Takayasu Arteritis - for RFL ONLY (JFC June 2017)
  • Adult-onset Stills disease in line with NHSE commissioning policy 170056P (JFC October 2018)

Provider notes

  • NMUH:
    • This medicine has a positive NICE Technology Appraisal and is listed in the Trust Medicines Formulary when used in line with NICE recommendations and/or Local Trust Guidelines
    • Restricted to Consultant Rheumatologists
    • See MHRA Drug Safety Update
    • See links below
  • RFL:
    • Approved for Rheumatoid arthritis, Adult Onset Stills Disease (AOSD), Juvenile Idiopathic Arthritis, Giant Cell Arteritis and Takayasu Arteritis
  • RNOH:
    • Rheumatology Consultants ONLY
  • UCLH:
  • WH:
    • As per NICE TA and above
 
Link  NCL JFC: Rheumatoid arthritis DMARD and high-cost drug pathway
Link  NHSE 170056P: Anakinra/tocilizumab for the treatment of Adult-Onset Stillís Disease refractory to second-line therapy (adults)
Link  NICE TA238: Tocilizumab for the treatment of systemic juvenile idiopathic arthritis
Link  NICE TA247: Tocilizumab for the treatment of rheumatoid arthritis
Link  NICE TA373: Abatacept, adalimumab, etanercept and tocilizumab for treating juvenile idiopathic arthritis
Link  NICE TA375: Rheumatoid arthritis not previously treated with DMARDs or after conventional DMARDs only have failed
Link  NICE TA518: Tocilizumab for treating giant cell arteritis
Link  NHSE 16056/P: Tocilizumab for Takayasu arteritis (adults)
Tofacitinib tabs
(Rheumatology)
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Formulary
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NOTE: There is more than one monograph for this medicine, click here to search for formulary status and its use for other indications. 

Approved for:

  • Rheumatoid arthritis (see NICE TA)
  • Psoriatic Arthritis (PsA; see NICE TA)

Provider notes

  • NMUH:
    • This medicine has a positive NICE TA and is listed in the Trust Medicines Formulary when used in line with NICE recommendations and/or Local Trust Guidelines - TO AWAIT UPDATED NCL JFC PATHWAY PRIOR TO PRESCRIBING
    • See links below
  • RFL:
    • Approved for the use of Rheumatoid Arthritis and Psoriatic Arthritis in line with NICE guidance
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • As per NICE TA and above
 
Link  NCL JFC: Psoriatic arthritis (PsA) high-cost drug pathway
Link  NICE TA480: Tofacitinib for moderate to severe rheumatoid arthritis
Link  NICE TA543: Tofacitinib for treating active psoriatic arthritis after inadequate response to DMARDs
Link  Tofacitinib - MHRA Drug Safety Update
Ustekinumab
(Rheumatology)
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GP - Red
High Cost Medicine
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NOTE: There is more than one monograph for this medicine, click here to search for formulary status and its use for other indications. 

Approved for:

  • Psoriatic Arthritis (PsA; see NICE TA)

Provider notes

  • NMUH:
    • This medicine has a positive NICE TA and is listed in the Trust Medicines Formulary when used in line with NICE recommendations and/or Local Trust Guidelines
    • Restricted to Consultant Rheumatologists 
    • See links below
    • Check MHRA Drug Safety Updates
  • RFL:
    • Psoriatic Arthritis in line with NICE guidance
  • RNOH:
    • Rheumatology consultants ONLY
    • See links below
  • UCLH:
  • WH:
    • As per NICE TA and above
    • Also see dermatology monograph

 

 
Link  NCL JFC: Psoriatic arthritis (PsA) high-cost drug pathway
Link  NICE TA340: Ustekinumab for treating active psoriatic arthritis
10.01.03  Expand sub section  Sulfasalazine
 ....
 Non Formulary Items
Anakinra
(Rheumatoid arthritis)

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Non Formulary
GP - Red
High Cost Medicine

NOTE: There is more than one monograph for this medicine, click here to search for formulary status and its use for other indications. 

Provider notes

  • NMUH:
    • Non-formulary
  • RFL:
    • Non-formulary
  • RNOH:
    • Non-formulary
  • UCLH:
  • WH:
    • Non-formulary
  
Key
note Notes
Section Title Section Title (top level)
Section Title Section Title (sub level)
First Choice Item First Choice item
Non Formulary Item Non Formulary section
Restricted Drug
Restricted Drug
Unlicensed Drug
Unlicensed
Track Changes
Display tracking information
click to search medicines.org.uk
Link to adult BNF
click to search medicines.org.uk
Link to children's BNF
click to search medicines.org.uk
Link to SPCs
Homecare
Homecare

Traffic Light Status Information

Status Description

GP - 1st

Medicines suitable for first-line use within primary care.

Can be initiated within primary care within their licensed indication, in accordance with nationally recognised formularies, for example the BNF, BNF for Children, Medicines for Children or Palliative Care Formulary. Primary care prescribers take full responsibility for prescribing.†

  

GP - 2nd

Medicines suitable for second-line use within primary care.

Can be initiated within primary care within their licensed indication, in accordance with nationally recognised formularies, for example the BNF, BNF for Children, Medicines for Children or Palliative Care Formulary. Primary care prescribers take full responsibility for prescribing.†

  

GP - Amber

Medicines that should be initiated by a specialist. Prescribing can be transferred to primary care once the patient has been stabilised. †

Shared care: For drugs with regular, ongoing need for monitoring and/or assessment of efficacy or toxicity. Prior agreement must be obtained by the specialist from the primary care provider before prescribing responsibility is transferred. The shared care protocol must have been agreed by the relevant secondary care trust Drugs and Therapeutics Committee(s) (DTC) and approved by the North Central London JFC.

Fact sheet: For drugs with some concerns surrounding safety or efficacy but do not require regular monitoring and/or monitoring of effectiveness/toxicity.

  

GP - Red

Medicines which should normally be prescribed by specialists only (hospital only).

For patients already receiving prescriptions in primary care - continue. No new patients to receive prescriptions in primary care.

See link for the complete NCL Red List https://www.ncl-mon.nhs.uk/wp-content/uploads/2017/08/ncl_red_list.pdf

  

GP - Grey

Medicines on hospital formularies which have not been reviewed for suitability in primary care.  

Black

Medicines not recommended for routine use in primary or secondary care.

Medicines, which the North Central London JFC has actively reviewed and does not recommend for use at present due to limited clinical and/or cost effective data.

  

netFormulary