New Line Request Terms and Conditions

The New Line Request form is to be used for applications for new medicinal products, new formulations and extensions to previously agreed uses for medicinal and other relevant, pharmaceutical products to be prescribed by NHS services. Applications must include evidence-based information outlining the efficacy, therapeutic advantage, safety, financial impact of the new product and the cost relative to the products already used. Supporting documents should be from randomised controlled studies, NICE and from professional, peer reviewed journals. Requests must be made by an appropriate clinician or other senior professional, for example a trust pharmaceutical advisor, dentist or optician.

• Please complete all compulsory sections. Sufficient information will ensure efficient consideration of your request. Incomplete forms will not be processed.
• The form should be submitted electronically via the APC website. The relevant details are clearly outlined on the APC website for either the online version of the form or the Word version.
• The application should be supported by the relevant Associate Medical Director (secondary care), GP Prescribing Lead or Clinical Governance Lead (primary care) before submission.
• An application for a drug that has been rejected within the last twelve months will normally be refused unless supported by new evidence or new licensed indications.
• The manufacturer (pharmaceutical company) may provide information supporting the application, but the application must originate from an appropriate applicant.
• Where possible electronic versions of any references and other supporting documents should be electronically submitted along with this New Line Request.
• Hospital consultants may find it helpful to discuss their request and obtain support from their business manager and/or other consultants working in their specialty prior to submitting a request.
• If necessary, provide details in the appropriate section.
• If you have any problems or require further information, please telephone 07936 308862.
• Do not submit patient identifiable details with this New Line Request.

APC Meetings are held on a monthly basis. Decisions regarding the addition of a new product to the Formulary will take place when feedback from the trusts involved (North Lincolnshire CCG, North East Lincolnshire CCG and Northern Lincolnshire and Goole Foundation Trust) has been received. If the feedback is not received at least two weeks prior to the next APC meeting, the decision will be made at the subsequent meeting. Feedback from your application will be given within 14 weeks of receipt of a fully completed New Line Request.

The Formulary includes medicines and related pharmaceutical products that are approved for use by North Lincolnshire CCG, North East Lincolnshire CCG and Northern Lincolnshire and Goole Foundation Trust. Minor Ailments Help.

Please submit via the APC website (click here for a form). For support completing the New Line Request form, email Andy Karvot to arrange a 15 minute session at a convenient location.