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Pre-exposure prophylaxis, or ‘PrEP’, for HIV has been shown to be highly effective in several real-world studies.
Results from the ‘PrEP Impact Trial’ — one of the world’s largest PrEP studies, including data from 24,000 participants recruited between October 2017 and July 2020 — were published in The Lancet in 2023, revealing that the use of PrEP among participants reduced the chances of developing HIV by 86%.
In 2019, Vaughan Gething, then Welsh minister for health and social services, reported that not one of the more-than 1,000 people who received PrEP via sexual health services had developed HIV while they were taking the drugs.
PrEP has been routinely available in the UK since 2017, and the most recent figures available, covering provision up until the end of 2024, show that 13,886 people have been prescribed HIV PrEP in Scotland during that time, with 111,123 people in England given the drugs during 2024 alone. The most recent Welsh data show that 2,319 people were prescribed PrEP in 2024, a 4.1% increase on 2023 and the highest ever figure on record.
But these data only cover prescriptions provided via sexual health services, which account for the vast majority of UK supply, raising concerns over inequitable access to PrEP.
An opinion article written for The Pharmaceutical Journal by specialists in sexual health, public health and pharmacy, published in October 2025, suggested that this exclusion was most common in trans women, people living outside urban areas, and people of black and black Caribbean heritage, particularly females.
Sexual health advocates, pharmacy groups and HIV charity the Terrence Higgins Trust have long argued that providing PrEP through community pharmacies could improve access among some of these hard-to-reach groups.
In January 2026, the Terrence Higgins Trust published a report on policy options for widening access to PrEP via pharmacies, setting out several benefits that this could provide in terms of access.
The report said this expansion could provide a route to PrEP for people who are unaware of their risk of acquiring HIV, do not not know about PrEP, or who are unlikely to present at a sexual health clinic. It also said it would reduce stigma that some people felt when visiting sexual health clinics, offer more convenient locations and opening times, and provide a shorter waiting time between deciding to start PrEP and receiving the medication.
Slow progress
However, proposals to offer PrEP access via primary care — specifically community pharmacy — have been around for several years, with little progress made.
In England, a ‘PrEP access and equity task and finish group’ — established by the Department of Health and Social Care (DHSC) in October 2022 to identify ways of improving access to PrEP, as part of the HIV action plan — recommended the establishment of a series of national pilots for PrEP provision in settings outside specialist sexual health clinics, including pharmacies.
Subsequently, a pilot service in the south west of England ran from October 2024 until spring 2025, the results of which were published in September 2025. The researchers, from the University of Bristol, made several recommendations in a policy briefing published with the pilot results.
They recommended that: community pharmacies should be embedded in national HIV prevention strategies, with inclusion in sexual health training and commissioning guidance; the government should develop a national pharmacist PrEP training programme to build confidence and capability; and it should invest in pharmacy infrastructure, staffing and on-site screening capacity to support effective service delivery.
The University of Bristol policy briefing also called for an expansion to UK pharmacy PrEP pilots “to assess scalability, cost-effectiveness, and equity impact”.
However, following the completion of the Bristol services, there are no known plans for further pilots in England.
In Wales, Jeremy Miles, cabinet secretary for health and social care, said in November 2024 that “a model providing more convenient access to PrEP in the community will be piloted”, with a spokesperson for the Welsh government later confirming that this would include pharmacies and that it was expected to begin in autumn 2025.
Further evidence is required to understand whether primary care pathways would reach patients who are not currently using sexual health services
Spokesperson for the Scottish government
However, in January 2026, the Welsh government told The Pharmaceutical Journal that the scheme had been delayed owing to “operational issues”.
“We are continuing to work with health boards and pharmacy contractors to establish a pilot to make PrEP available through community pharmacies in Wales,” the spokesperson said.
In Scotland, Public Health Scotland’s HIV update, published in September 2025, said that health boards have been scoping methods that could see the drugs provided via pharmacies and GP surgeries. It confirmed that work has been done in this area, without specific pilots starting.
A spokesperson for the Scottish government told The Pharmaceutical Journal that it recognised that more action was needed “to increase awareness and uptake of PrEP, particularly for people who may face barriers to accessing sexual health services”.
“Further evidence is required to understand whether primary care pathways would reach patients who are not currently using sexual health services.
“The Scottish government’s ‘HIV transmission elimination delivery plan’ sets out a range of actions to address this, including exploring expanding access through primary care, community pharmacies, an online PrEP (ePrEP) clinic pilot, and outreach-based models,” they added.
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Financial constraints
One significant barrier to the provision of PrEP access via pharmacies that cannot be avoided is cost.
The authors of an opinion article in The Pharmaceutical Journal estimated that the most common form of PrEP prescribed in the UK — emtricitabine/tenofovir disoproxil — would cost pharmacies or other primary care providers at least 30 times as much to provide as it does for sexual health services.
The NHS drug tariff for the drugs is £4,260 for 12 x 30 tablets of 200mg/245mg, compared with their estimated purchase price via secondary care of between £120 and £140 for the same drugs.
However, in England, PrEP prescribed via a sexual health clinic is reimbursed by NHS England at a cost negotiated with the manufacturer under the terms of the ‘NHS commercial framework for new medicines’.
However, access to PrEP under this framework — and via the medicines procurement and supply chain — is currently limited to secondary care providers.
The Terrence Higgins Trust added that the cost at which generic PrEP is purchased and reimbursed under these policies is not publicly available; however, it is known to be very significantly less than the drug tariff reimbursement price.
The University of Bristol policy briefing said that “clear reimbursement mechanisms” must be established for pharmacies if they are to successfully provide PrEP.
One way of doing this, as The Pharmaceutical Journal opinion piece suggested, would be to modify the NHS Drug Tariff price through negotiations with pharmacy contractors, although it accepted that this would likely bring the tariff price below the list price, heaping more economic pressure on already beleaguered community pharmacies.
The Terrence Higgins Trust report has called for action to be taken by the DHSC and NHS England, “working in collaboration with local authorities, to agree a change in policy so that community pharmacy is enabled to access PrEP via the medicines procurement and supply chain”.
“If this is not possible through an agreement of all parties, DHSC should support an amendment to forthcoming health legislation to change these rules and create a framework for a service,” it added.
Alternative solutions
Other options to provide PrEP through pharmacies could be available.
One option is the integration of primary care and sexual health services, such as ‘Umbrella’ in Birmingham, which links sexual health clinics, community pharmacies and general practices. Although The Pharmaceutical Journal opinion piece warned that PrEP care is not limited to a single attendance, so any pathway would need to account for regular attendances.
The Terrence Higgins Trust report makes several recommendations that it suggests could widen PrEP access via pharmacies, including one that a patient group direction should be developed to allow community pharmacists, as part of a commissioned service, to dispense PrEP.
PrEP uptake is increasing, with over 111,000 people now using it, but we know we need to go further
Spokesperson for the Department of Health and Social Care
It has also called on local authorities to immediately explore commissioning community pharmacies to refer into existing pathways (in advance of any expansion to actual dispensing).
Whatever method is chosen, if the UK government is to achieve its target of zero HIV admissions by 2030, then much speedier progress on providing PrEP via community pharmacies will be needed.
A spokesperson for the DHSC said: “PrEP uptake is increasing, with over 111,000 people now using it, but we know we need to go further.
“Backed by £170m, our HIV action plan aims to meet our ambition to end new HIV transmissions by 2030 by investing heavily in prevention, testing and treatment.
“This government is making PrEP easier to get, exploring remote access, improving outreach to black and ethnic minority communities, and we have introduced a game-changing injectable for people who are unable to take oral PrEP.
“We are also investing £4.8m in a new HIV prevention programme, as well as helping to raise awareness of PrEP and other HIV prevention interventions among the groups hit hardest.”
Read more: ‘The role of pharmacy in HIV pre-exposure prophylaxis’
