Spreadsheet: 42c5b178-f852-4f70-b14d-6e0be706d8a8
Sheet: HCDDLP

Annex 7b - High Cost Drugs, Devices and Listed Procedures
 |  |  |  |  |  |  |  |  | Key:
 |  |  |  |  |  |  |  |  | Added/Altered in 2014-15
High cost drugs
Cytokine Modulators |  | Torsion Dystonias and other involuntary movements |  | Immunomodulating drugs |  | Drugs used in Neutropenia |  | Hypertension and heart failure
Vasodilator antihypertensive drugs/Pulmanory Arterial Hypertension |  |  |  | Myelodysplastic Syndrome |  | Parenteral Nutrition |  | Lipid-regulating drugs
Fibrinolytic drugs |  | Antibacterial Drugs |  | Antineoplastic drugs |  | Gout and cytotoxic-induced hyperuricaemia |  | Pulmonary Fibrosis
Blood-related products |  | Antifungals |  | Protein kinase inhibitors |  | [NAME] |  | Retinal disorders
Allergen Immunotherapy |  | AIDS/HIV antiretrovirals |  | Corticosteroids and other immunosuppressants |  | Enzymes |  | Renal dialysis/nephrology outpatient drugs
Allergic Emergencies |  | Cytomegalovirus infection |  | Drugs affecting the Immune response |  | [NAME] |  | Hormone antagonists
[NAME] surfactants |  | Viral Hepatitis (B&C) & Respiratory Syncytial Virus |  | [NAME] |  | Subfoveal choroidal neovascularisation
Mucolytics |  |  |  | Paroxysmal nocturnal haemoglobinuria |  | Skin Conditions
Hypnotics and anxiolytics |  | Growth Hormone & Growth Hormone Receptor Antagonist |  | Platelet Disorder Drugs |  | intravenous/subcutaneous human normal immunoglobulins
Non-opioid analgesics |  |  |  | Drugs used in hypoplastic, haemolytic, and renal anaemias |  | Bone morphogenetic protein
Neurodegenerative Conditions |  | Drugs affecting bone metabolism |  | Drugs used in Metabolic disorders |  | Poisoning
Notes
See worksheet 'Mapping of HCDs' for the high cost drug by BNF category and see worksheet 'Detailed HCDs'  for the detailed high cost drug list
The lists will not be updated in-year and as such any new drug that is added to a category or sub-category in the BNF in year (shown in worksheet 'Mapping of HCDs') will be captured by the National Tariff rules around High cost drugs, devices and listed procedures
Devices:
Device |  |  |  |  | Comments/Notes
3 dimensional mapping and linear ablation catheters used for complex cardiac ablation procedures
Aneurysm coils |  |  |  |  | Separated aneurysm coils and flow diverters for intracranial aneurysms
Bespoke orthopaedic prostheses |  |  |  |  | Bespoke prostheses designed and manufactured for individual patients plus modular limb salvage replacements for femur or shoulder (non CE marked)
Biological mesh, including synthetic equivalents |  |  |  |  | Synthetic equivalents included
Bone Anchored Hearing Aids
Bone Growth Stimulators
Carotid, iliac and renal stents |  |  |  |  | Includes embolic protection devices
Circular external fixator frame
Consumables associated with per oral single operator cholangioscope
Consumables for robotic surgery
Deep brain, vagal, sacral, spinal cord and occipital nerve stimulators
Devices used in connection with pulmonary artery banding
Drug-eluting peripheral angioplasty balloon
Endovascular stent graft |  |  |  |  | Includes aortic stent grafts
Flow diverters for intracranial aneurysms
ICD (Implantable Cardioverter-Defibrillator)
ICD with CRT (Cardiac Resynchronisation Therapy) capability
Insulin pumps and pump consumables
Intracranial stents
Intrathecal drug delivery pumps
Pacemaker extraction sheaths
Maxillofacial bespoke prostheses
Occluder, Vascular, Appendage and Septal devices
Percutaneous valve repair and replacement devices for mitral and pulmonary valve only
Peripheral vascular stents |  |  |  |  | Includes peripheral vascular drug eluting stents
Radiofrequency, cryotherapy and microwave ablation probes and catheters |  |  |  |  | Except where used for complex Gastrointestinal Tract Endoscopy procedures
Procedures
Procedure |  | When to exclude |  | Local Grouper processing |  | SUS PbR processing
Head and Neck Reconstructive Surgery~ |  | Pre-Processing at episode level |  | Do not run through grouper |  | Episodes need to be processed using '=' exclusion
Intracranial Telemetry% |  | Pre-Processing at episode level |  | Spells containing an episode with OPCS Code A111 or A112 |  | Episodes need to be processed using '=' exclusion
Pelvic Reconstructions |  | Pre-Processing at episode level |  | ICD10 primary diagnosis of: S324 or S328 And OPCS code of Z75*, Z841 or Z842 And either 1. OPCS code of W195, W196, W198, W208, W209, W213, W214, W232, W236, [NAME], W248, W654, W655 or W677 OR  2. OPCS code of (W211, W212, W215, W218 or W219) and W281 |  | Episodes need to be processed using '=' exclusion
PETCT (outpatient and direct access only) |  | Post-Processing |  | HRG RA42Z is excluded |  | The unbundled HRG will not have a mandatory tariff set
Soft Tissue Sarcoma |  | Pre-Processing at episode level |  | ICD10 (any position) diagnosis of: C40, C41, C47, C48 or C49 And OPCS primary procedure code is not missing and is not a chapter X code |  | Episodes need to be processed using '=' exclusion
~Surgery for the excision of and reconstruction for, upper aerodigestive tract, skull base, salivary and thyroid gland malignancies and non-malignancies
% including any subsequent cortical mapping and epilepsy surgery