Dumfries & Galloway Health Board
Prescribing Support Team

PACS Tier 2 Policy

Posted: 9 Aug 18 Edited: 9 Aug 18
ADTC Forms


This policy outlines the NHS D&G management process for medicines requested via the Peer Approved Clinical System Tier 2 (PACS 2) which replaces the previous Individual Patient Treatment Request (IPTR) process. The exception is where the medicines is not approved due to a non submission. In these cases an IPTR form should be used).

SMC advice for a particular medicine and indication is made on the basis of an evaluation of the comparative clinical evidence and cost effectiveness compared with comparators used in Scottish practice at the time and is applicable to the population covered in the advice. The PACS 2 process is not intended to overturn the SMC advice, but provides an opportunity for senior clinicians, on a case-by-case basis for individual patients, to request use of a licensed medicine (other than ultra-orphan) that is not recommended by the SMC following their appraisal on clinical and cost-effectiveness, is being used out with SMC restrictions, or has been submitted but not yet evaluated by the SMC.