The Department of Health and Social Care (DHSC) and NHS England (NHSE) have announced a new approach to the supply of COVID-19 antivirals to patients living in the community.

Ministers have decided that this will follow the business as usual approach to medicines supply, with prescribers in general practices being asked to prescribe the medicines and prescriptions being dispensed in community pharmacies. However, pharmacy contractors will be able to order the antivirals free of charge from the Government’s stockpile, via Alliance Healthcare.

Background information

Currently, eligible patients can access COVID-19 antivirals via Covid Medicines Delivery Units.

NICE issued guidance at the end of March 2023 on the use of several COVID-19 antivirals, which includes some products being prescribed in primary care for eligible patients. The NHS has a requirement to implement this NICE recommendation within 90 days of its publication.

Read more about this in an alert from the Chief Medical Officer

Accessing supplies of COVID-19 antivirals

Earlier in the pandemic, the UK Government purchased large quantities of several COVID-19 antiviral products and these have been stockpiled for future use.

DHSC has signed an agreement with Alliance Healthcare to distribute two of these products to community pharmacies in England:

Molnupiravir 200mg capsules (Lagevrio 200mg capsules)
Nirmatrelvir 150mg tablets and Ritonavir 100mg tablets (Paxlovid 150mg/100mg tablets)

The products will be supplied free of charge to contractors.

Further information on ordering the products will be available from Alliance Healthcare in due course.

Reimbursement for dispensed products

The usual Drug Tariff fees will be paid in relation to the dispensing of prescriptions for these products.

As the stock has been supplied free of charge from the Government stockpile, contractors will not be reimbursed based on the manufacturer’s list price, which is typically the case for proprietary medicines. Contractors will receive a nominal reimbursement amount of £2.50, which DHSC has set to recognise the purchase margin contractors would ordinarily retain on products they had purchased to fulfil a prescription.

PSNC’s view

PSNC has been discussing the proposed approach to distribution of COVID-19 antivirals with NHS England and DHSC for many months. During these discussions, we have maintained a stance that the supply of these products should not be considered business as usual, as there will be additional elements of activity which contractors need to undertake in relation to dispensing these prescriptions.

Additionally, we believe work undertaken by contractors related to the COVID-19 pandemic should attract additional funding, over and above the baseline community pharmacy funding.

NHS England and DHSC have not been willing to accept the arguments put forward by PSNC and consequently the decision by Ministers to pursue the business as usual approach is an imposition of policy, rather than a negotiated agreement with PSNC.

Commenting on this decision by Ministers, Janet Morrison, PSNC CEO, said:

“Pharmacy contractors and their teams should be fairly funded by the NHS and Government for additional workload that results from the pandemic. We made the case for this to apply to the new arrangements for the distribution of C-19 antivirals, but Ministers were not willing to agree to our legitimate request.

“We previously warned Ministers that without additional funding, the roll-out of additional services and the PQS during Year 5 of the CPCF deal was neither feasible nor affordable. Community pharmacies are having to work harder and harder for less money and many are at breaking point.

“The same argument applies to additional workload falling on the sector: more money is needed to safely resource additional work.”

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