Community pharmacies to supply antiviral treatments to high-risk COVID-19 patients

Scottish community pharmacies will be able to dispense the antiviral molnupiravir to patients at high risk of severe illness or death from COVID-19.

Community pharmacies in Scotland will be paid £45 per item to dispense the COVID-19 antiviral molnupiravir to eligible patients, the government has announced.

A circular, published by the Scottish government on 13 January 2022, said that this would be supplemented with up to £12 to cover the cost of home delivery where needed.

The announcement of funding for community pharmacies follows the Scottish government’s deployment, in December 2021, of new medicines to treat COVID-19 in non-hospitalised patients who are at high risk of severe illness or death from the virus.

Under UK-wide guidance, patients belonging to at least one of ten high-risk cohorts, who have received a positive polymerase chain reaction (PCR) test for COVID-19 and felt unwell with symptoms within the past five days, should receive sotrovimab, a neutralising monoclonal antibody (nMAB) treatment, as the first-line treatment option.

However, where an nMAB is contraindicated or the administration of an nMAB is not possible, patients may be treated with a five-day course of the antiviral molnupiravir.

According to the government circular, participation of community pharmacy contractors in supplying and delivering monupiravir is at the discretion of local health boards.

“Health Boards may seek to utilise part of the community pharmacy network for the safe and effective dispensing and home delivery of molnupiravir, and any future COVID-19 antivirals, to individuals who are suitable for treatment,” the document says.

Where they are used, the circular says the government “has agreed a service fee per dispensed item of £45”.

A spokesperson for NHS Greater Glasgow and Clyde health board told The Pharmaceutical Journal on 14 January 2022 that “selected community pharmacies across NHS Greater Glasgow and Clyde have been used to supply and deliver COVID-19 antiviral treatment molnupiravir to eligible patients” since 22 December 2021.

“The community pharmacy network remains a vital part of our continued delivery plan moving forward,” they added.

To access the new COVID-19 medicines, each health board in Scotland has set up a dedicated contact number that eligible patients can call to check if they are suitable for these new treatments.

Eligible patients will then be invited to a day clinic at a local hospital for assessment, prescription and treatment.

In December 2021, the UK government ordered 1.8 million doses of molnupiravir and 2.5 million doses of antiviral PF-07321332/ritonavir (Paxlovid; Pfizer). This followed an earlier order, in October 2021, of 80,000 courses of molnupiravir and 250,000 courses of PF-07321332/ritonavir.

Claire Anderson, president of the Royal Pharmaceutical Society, said the organisation “would support community pharmacies across the whole of Great Britain being commissioned to dispense molnupiravir, as is the case in Scotland”.

“Community pharmacies can provide convenient access to the medicine, especially as these treatments need to be administered as soon as practically possible after receiving a positive PCR test and symptom onset,” she said.

Unlike in Scotland, community pharmacies in England are not dispensing antiviral medicines for high-risk COVID-19 patients. These are instead being delivered through COVID-19 medicines delivery units.

According to an NHS England letter sent to general practices and community pharmacies on 9 December 2021, antivirals will “be dropped off to a patient’s home, either via a friend or family member of the patient, or via a delivery service”.

A spokesperson for NHS England confirmed to The Pharmaceutical Journal on 14 January 2022 that there were no current plans to change this system.

Meanwhile in Wales, a spokesperson for the government said molnupiravir is “supplied directly by the National Antiviral Service or in some cases from hospital pharmacy departments”.

“There are no plans to supply antivirals from community pharmacies at this stage,” they said.

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Last updated
The Pharmaceutical Journal, PJ, January 2022, Vol 308, No 7957;308(7957)::DOI:10.1211/PJ.2022.1.123730

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