NRT FORMULARY Reimbursement Guide April 2018 Max £65 NRT per person per quit attempt ( max 4 quit attempts per year)

Product and Brand / Reimbursement
PRICE / Licensed Use / 2 Weeks Supplied As /

Reduction Process

/ Correlation Guide
24 hour patch
Niquitin CQclear patch or flesh coloured patch.
Supplied as 21 mg, 14mg or 7 mg
1 patch per 24 hours. / 21mg x 7 £9.94
14mg x 7 £9.94
7mg x 7 £9.94 / Use in children:
For ages 12 and over only (12-17 on medical advice only.)
Use in pregnancy: Licensed*
Use in breastfeeding: Licensed.
* Remove the patch before going to Bed / 2 x 7 pack. / 21mg for 6 weeks.
14 mg for 2 weeks.
7 mg for 2 weeks.
Then review. / If smoking more than 10 per day:
21mg for 6 weeks.
14 mg for 2 weeks.
7 mg for 2 weeks.
16 hour patch
Nicorette Invisi frosted clear patch.
Supplied as 25mg, 15mg or 10mg.
1 patch per day. / 25mg x 7 £11.13
15mg x 7 £11.06
10mg x 7 £10.99 / Use in children:
For ages 12 and over only.
Use in pregnancy: Licensed.
Use in breastfeeding: Licensed. / 2 x 7 pack. / 25mg for 8 weeks.
15mg for 2 weeks.
10 mg for 2 weeks. / If smoking more than 10 per day:
25mg for 8 weeks.
15 mg for 2 weeks.
10 mg for 2 weeks.

Inhalator 15mg

Nicorette

Supplied as pack of 20 or 36 tubes or starter pack with 4 tubes.
Maximum use 6 tubes per day. / 36 cartridges £25.56 / Use in children:
For ages 12 and over only.
Use in pregnancy: Licensed.
Use in breastfeeding: Licensed. / Up to
2 x 36 pack. / Advise using up to 6 tubes per day for 8 weeks; gradual reduction to 3- 6 tubes over following 2 weeks then reduce to 0 over next 2 weeks. / Inhale when urge to smoke occurs.

Lozenge 2mg & 4 mg

Niquitin CQ

Supplied as pack of 36 or 72.
Maximum: use 15 per day.
Mint or Original flavour / 2mg x 36 £5.76
4mg x 36 £5.76 / Use in children:
For ages 12 and over only.
Use in pregnancy: Licensed.
Use in breastfeeding: Licensed. / Up to
3 x 72 / Week’s 1- 6: 1 lozenge every 1 –2 hours. Use at least 9 per day.
Weeks 7 - 9:1 lozenge every 2 – 4 hours.
Weeks 10 - 12 1 lozenge every 4 – 8 hours. / 2mg For smokers who have their first cigarettes less than 30 minutes of waking.
4mg For smokers who have their first cigarettes within 30 minutes of waking.

Gum 2mg & 4mg

Nicorette

Supplied as pack of 15, 30 or 105.
Flavours: Original,fresh fruit, Icy white, fresh mint
Maximum: use 15 per day. / 2 mg x 105
£ 9.45
4mg x 105 £12.60 / Use in children:
For ages 12 and over.
Use in pregnancy: Licensed.
Use in breastfeeding: Licensed. / Up to
2 x 105 / For ages 18 and over, reduce dose gradually after 8 weeks. Clients must be ready to stop at 3 months. / If smoking lessthan 20 cigarettes per day: one 2mg piece of gum chewed slowly on urge to smoke.
If smoking morethan 20 cigarettes per day: one 4mg piece chewed slowly on urge to smoke
Mouth Spray 1mg
Nicorette
1 dose: 1-2 sprays
Maximum: use 2 doses per hour (4 sprays) over 16hrs in a 24nr period.
Supplied as 13.2ml spray. (150 sprays) / 13.2mg Single
£13.06
26.4mg Double
£20.59 / Use in children:
For ages 12 and over.
Use in pregnancy: Licensed.
Use in breastfeeding: Licensed. / Up to
4 sprays / Reduce the number of sprays used until stopped completely.

NICE public health guidance 10 recommends the consideration of offering a combination of nicotine patches and another form of NRT (such as Gum, Inhalator, Lozenge, Nasal or Mouth Spray) to people who show a high level of dependence on nicotine or who have found single forms of NRT inadequate in the past. PATIENTS CAN PURCHASE SECONDARY NRT TO SUPPORT THEIR QUIT ATTEMPT with guidance.

NICE guidance recommends that pregnant women, who use a patch, should use a 16hr patch / remove the patch before going to bed.

Please see Northamptonshire Stop Smoking Service Specification for medications, which will require GP referral. If there are any concerns about a patients general health or they are on a number of medications please refer to GP for prescription.

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