NHS targets suncream prescriptions for cuts
Suncream, cold remedies and gluten-free food may no longer be available on the NHS in England under a crackdown on "low value" medicines.
NHS England announced a review after local health bosses identified £400m of spending they believe has little or no clinical value.
It also includes some types of pain relief and travel vaccines.
The proposals could see an outright ban or tighter restrictions on some products being prescribed by GPs.
An initial list of 10 products has been drawn up by NHS Clinical Commissioners, which represents local health managers who are in charge of budgets.
A number of them are available over-the-counter at a lower price than the cost to the NHS of prescribing them or include drugs for which there are more effective or cheaper alternatives.
Evidence submitted to NHS England - and seen by the BBC - argues that the prescribing of gluten-free products dates back to the 1960s when there was not the choice there is now in supermarkets and shops.
Cutting back on prescriptions for the 10 products could save the NHS over £100m a year.
While patients can be charged for prescriptions, the wide range of exemptions mean only one in 10 items handed out are paid for by individuals.
'Low value' medicines on the list and their annual cost to the NHS:
£30.93m on Liothyronine to treat underactive thyroid
£21.88m on gluten-free foods
£17.58m on Lidocaine plasters for treating nerve-related pain
£10.51m on Tadalafil, an alternative to Viagra
£10.13m on Fentanyl, a drug to treat pain in terminally ill patients
£8.32m on the painkiller Co-proxamol
£9.47m on travel vaccines
£7.12m on Doxazosin MR, a drug for high blood pressure
£6.43m on rubs and ointments
£5.65m on omega 3 and fish oils
Source: NHS Clinical Commissioners
NHS Clinical Commissioners has also highlighted other products which it wants reviewed once the initial batch of 10 have.
This includes suncream, cough and cold remedies and indigestion and heartburn medicines, which could bring the saving to £400m a year.
That is out of a total bill of over £16bn on medicines once those dispensed by both hospitals and GPs are taken into account.
NHS Clinical Commissioners chief executive Julie Wood said "difficult choices" had to be made given the unprecedented financial and demand challenges facing the NHS.
She said it was important to reduce spending on prescription items that have "little or no clinical value".
But Coeliac UK chief executive Sarah Sleet said she the move was "disappointing", adding not all shops and stores stocked gluten-free products.
"Research shows that budget and convenience stores, which are relied upon by the most vulnerable such as the elderly, those with disabilities and on low incomes, have virtually no provision."
She said not adhering to the diet could lead to serious complications, including osteoporosis.
Gill Nuttall, from skin cancer charity, Melanoma UK, also took issue with the move.
"I speak to melanoma patients every day who are receiving life prolonging treatments in melanoma, some of whom suffer some terrible side effects, including extreme reactions to the sun.
"Sun screen has a very high clinical value to those patients."
She said NHS England should think "very carefully" before restricting suncream prescriptions.
NHS England confirmed the review would begin in April, but did not put any timescale on how quickly a decision would be made.
The news comes ahead of a major announcement by NHS England later this week on the future of the health service.
On Friday Chief executive Simon Stevens will give an update of his five-year strategy which was launched in autumn 2014 and is now half-way through.
