FOI2026/2096

Reference	FOI2026/2096
Description	ICB formulary and funding process for ICB commissioned, hospital only high cost medicines
Date Requested	13/10/2026
Date Replied	03/11/2026
Category	Prescribing

I am requesting recorded information held by NHS Greater Manchester Integrated Care Board under section 1 of the Freedom of Information Act 2000. This request covers the ICB’s own processes, including those of any Area Prescribing Committee or joint formulary group that the ICB hosts, chairs or is a voting member of. I am not asking for the internal policies or records of NHS trusts or other organisations.

Definitions

“In scope medicine” means a medicine that meets all four of these conditions:

(i) it has a positive NICE Technology Appraisal (TA) recommendation;

(ii) it is commissioned by the Integrated Care Board (ICB), not by NHS England specialised commissioning;

(iii) it is excluded from the NHS Payment Scheme as a high cost drug and funded on a pass through basis;

(iv) it is designated hospital or specialist only (for example RAG rated red), so prescribing does not transfer to primary care.

“ICB committee” means any Area Prescribing Committee (APC), integrated medicines optimisation committee, joint formulary committee, high cost drugs group, place based prescribing group or equivalent that the ICB hosts, chairs or is a voting member of, and that reviews, approves or funds formulary additions.

“Place” means each place based partnership within the ICB area.

Where I ask for documents, a copy of or link to the current version is enough.

Part A: Committee structure across the ICB

A1. A list of each ICB committee, with the places and NHS trusts it covers, and whether its decisions apply across the whole ICB or are advisory to individual places or trusts.

A2. Whether a single joint formulary and a single RAG (traffic light) list apply across the whole ICB area. If more than one applies, please list each one and the area or trusts it covers.

A3. The current terms of reference for each ICB committee named in A1, including membership by role, quorum, meeting frequency and how its recommendations are ratified by the ICB.

A4. Whether any subgroup (for example a high cost drugs, guidelines or other therapeutic specialty subgroups) reviews in scope medicines before they go to the ICB committee.

Part B: ICB process for in scope medicines

B1. Any ICB policy, standard operating procedure or flowchart that sets out the steps from publication of a NICE TA to an in scope medicine being funded and available to prescribe at providers in the ICB area.

B2. Whether in scope medicines are added to the formulary by

(a) automatic adoption when NICE publishes,

(b) an abbreviated or reduced application, or

B3. The application form or template for each route, and the list of evidence or supporting information requested as standard. Examples include clinical sponsor, place in the treatment pathway, budget impact assessment and the population it is based on, expected patient numbers, service impact, prior approval form and homecare arrangements.

B4. Whether the ICB’s process for in scope medicines differs from its process for

(a) NHS England commissioned medicines,

(b) medicines without a NICE TA, and

(c) medicines for which commissioning responsibility is due to transfer from NHS England to ICBs. If it does, please provide the document that describes the difference.

Part C: Funding and prior approval

C1. How the ICB funds in scope medicines that are excluded from the NHS Payment Scheme (for example pass through invoicing against provider contracts, a high cost drugs budget or a block arrangement), and the document that sets this out.

C2. Whether the ICB requires prior approval or timebound retrospective approval (Blueteq or equivalent) before an eligible patient is treated with an in scope medicine, at what point in B1 the prior approval form is created, and which ICB team creates and administers it.

C3. Whether the ICB requires a contract variation, business case or funding approval separate from formulary approval before a provider can be reimbursed for an in scope medicine, and which ICB committee or officer approves it.

Part D: Points of contact with outside bodies (ICB records only)

D1. Using the ICB’s own documents, at which steps in B1 the ICB requires a submission from, notifies, or needs input from an NHS trust, NHS England, a regional medicines optimisation committee or any other body, and the name of that body. I am only asking what the ICB’s records show about the ICB’s role, not for the other body’s policies.

Part E: Timelines

E1. The ICB’s target timescale for each step in B1, and how the ICB makes sure it meets the statutory requirement to make NICE TA medicines available within 90 days, or within any shorter period NICE specifies.

E2. The ICB’s most recent report on compliance with NICE TA implementation timescales covering the last 12 months, such as a NICE TA tracker or formulary compliance report.

Part F: Meeting schedules

F1. For each ICB committee and subgroup named in A1 and A4, the meeting dates between the date of this request and 30 April 2027, with the deadline for submitting papers or applications for each meeting.

Part G: Contacts

G1. The job title and generic team email address for

(a) formulary applications,

(b) NICE TA implementation and

I believe this request can be answered from existing ICB documents and within the appropriate limit. If you estimate that answering in full would exceed the section 12 cost limit, please do not refuse the whole request. Instead, please answer the following parts in this order of priority, until the limit is reached:

B1, B2 and B3 (process, adoption route and standard evidence)

C1 and C2 (funding route and prior approval)

A1 and A2 (committees and formularies across the ICB)

E1 (target timescales)

F1 (meeting dates and submission deadlines)

C3 and D1 (separate funding approval and points of contact with outside bodies)

B4, A3, A4, E2 and G1

Part A: Committee structure across the ICB

A1. A list of each ICB committee, with the places and NHS trusts it covers, and whether its decisions apply across the whole ICB or are advisory to individual places or trusts.

The committee structure for NHS Greater Manchester (GM) Integrated Commissiong Board (ICB) includes the following groups and committees in relation to in-scope medicines:

Clinical Reference Group (CRG) operates in an advisory capacity.
High Cost Drugs Subgroup (HCDSG) reports to the Clinical Reference Group and operates in an advisory capacity.
Greater Manchester Medicines Management Group (GMMMG), represents the wider Greater Manchester Integrated Care System (ICS) and operates in an advisory capacity.
Clinical Effectiveness and Governance Committee (CEGC) operates in an advisory capacity.
Strategic Commissioning Committee (SCC) is a formally constituted committee with delegated decision-making authority.

A2. Whether a single joint formulary and a single RAG (traffic light) list apply across the whole ICB area. If more than one applies, please list each one and the area or trusts it covers

A single joint formulary and single RAG (traffic light) list applies across the whole Greater Manchester ICS area.

Link to Greater Manchester Formulary can be found here

Link to Greater Manchester RAG status can be found here

A3. The current terms of reference for each ICB committee named in A1, including membership by role, quorum, meeting frequency and how its recommendations are ratified by the ICB.

The ICB only has two formal Committees with delegated authority for making decisions. These committees are the Strategic Commissioning Committee and People and Resources Committee. All papers, dates of meetings and terms of references for these meetings (and associated subgroups) can be found on the public facing website: Meetings/Events | Greater Manchester Integrated Care Partnership

Clinical Effectiveness and Governance Committee Terms of reference have been published in historical Strategic Commissioning Committee Papers which can be found on public facing website: Meetings/Events | Greater Manchester Integrated Care Partnership

Clinical Reference Group (CRG) and Greater Manchester Medicines Management Group (GMMMG) terms of reference can be found on public facing website

A4. Whether any subgroup (for example a high cost drugs, guidelines or other therapeutic specialty subgroups) reviews in scope medicines before they go to the ICB committee.

The High cost drug subgroup (HCDSG) reviews CRG outputs including tariff excluded ICB-commissioned high cost drug TAs. Any recommendations are fed back to Clinical Reference Group and Greater Manchester Medicines Management Group.

Part B: ICB process for in scope medicines

NHS Greater Manchester formally take all NICE TAs through the medicines governance process however there is no illustration to represent. Form 1 – new medicine request form is available for new medicine requests.

B2. Whether in scope medicines are added to the formulary by

(a) automatic adoption when NICE publishes,

(b) an abbreviated or reduced application, or

None of the above

NHS Greater Manchester formally take all NICE TAs through the medicines governance process as above however there is no form or template available for each route.

B4. Whether the ICB’s process for in scope medicines differs from its process for

(a) NHS England commissioned medicines,

(b) medicines without a NICE TA, and

(c) medicines for which commissioning responsibility is due to transfer from NHS England to ICBs. If it does, please provide the document that describes the difference.

NHS Greater Manchester ICB do not have an in scope, medicines document describing the difference in process for the above.

Part C: Funding and prior approval

NHS Greater Manchester ICB follow national guidance as outlined in the National Payment Scheme

NHS Greater Manchester ICB utilise Blueteq for prior approval. Medicines Optimisation team oversees Blueteq. Forms are agreed by High Cost Drugs Subgroup and implemented by ICB’s Medicines Optimisation team.

Part D: Points of contact with outside bodies (ICB records only)

The Freedom of Information Act allows Public Authorities to decline to answer FOI requests when we estimate it would cost us more than £450 (equivalent to 18 hours, calculated at £25 per hour) to identify, locate, extract, and then provide the information that has been asked for.

Due to the volume and complexity of the data involved, it would require a disproportionate amount of time and resources to locate extract and collate the data, and therefore, on this occasion it is with regret NHS GM are not able to process this section of your request further.

On this basis, section 12(1) has been applied, because this would exceed the appropriate limit prescribed in the act.

In accordance with our duty under Section 16 of the Freedom of Information Act 2000 to provide reasonable advice and assistance, if you are able to narrow the scope of your request, we may be able to respond to it within the appropriate cost limit.

Part E: Timelines

E1 The ICB’s target timescale for each step in B1, and how the ICB makes sure it meets the statutory requirement to make NICE TA medicines available within 90 days, or within any shorter period NICE specifies.

NHS Greater Manchester formally take all NICE TAs through the medicines governance process as above. Medicines governance and pathway arrangements form part of the implementation process for NICE technology appraisals. The process includes assessment of patient numbers, service capacity, financial impact, system risks; with input from clinicians, providers and other relevant teams across Greater Manchester through consultation. These stages take time but are needed to ensure that prescribing arrangements are clinically safe, practical to deliver and clear across care settings. Therefore target timescale is not available.

E2. The ICB’s most recent report on compliance with NICE TA implementation timescales covering the last 12 months, such as a NICE TA tracker or formulary compliance report.

The report is not available

Part F: Meeting schedules

F1 For each ICB committee and subgroup named in A1 and A4, the meeting dates between the date of this request and 30 April 2027, with the deadline for submitting papers or applications for each meeting.

Clinical Reference group minutes and deadlines for submitting papers can be found on public facing website.

Greater Manchester Medicine Management Group minutes and deadlines for submitting papers can be found on public facing website.

Deadlines for all papers are one week prior to the meeting date.

On this basis, section 12(1) has been applied, because this would exceed the appropriate limit prescribed in the act.

Part G: Contacts

G1. The job title and generic team email address for

(a) formulary applications,

(b) NICE TA implementation and

The generic team email address for the above would be: nuth.enquiries.gmmmg@nhs.net

FOI2026/2096

Request

Response