Community pharmacies in England will be able to dispense the COVID-19 antivirals molnupiravir (Lagevrio; Merck Sharp & Dohme) and nirmatrelvir/ritonavir (Paxlovid; Pfizer) from May 2023, the NHS has said.
According to a notice on the NHS Business Services Authority (BSA) website, the May 2023 Drug Tariff has been amended to include reimbursement prices for the medicines, which are currently only available to non-hospitalised, vulnerable patients from COVID-19 medicines delivery units.
The NHS BSA notice said that “pharmacy contractors will be able to obtain the … antivirals at no cost from Alliance Healthcare”, adding that “a single activity fee will be paid in the usual way and, for each pack, reimbursement will be £2.50”.
This comes after The Pharmaceutical Journal reported in October 2022 that, under draft guidance from NHS England, community pharmacies could be commissioned to dispense COVID-19 oral antivirals by integrated care boards.
Under current advice from the National Institute for Health and Care Excellence, Paxlovid can be used for the treatment of COVID‑19 in adults who do not require supplemental oxygen and are at increased risk for progression to severe COVID‑19.
Molnupiravir can be given to adults in the highest risk group who have tested positive for, or had symptoms of, COVID-19 in the past week. However, in draft guidance, published in February 2023, NICE did not recommend molnupiravir for treatment of acute COVID-19 owing to uncertainties over effectiveness against Omicron variants and cost effectiveness.
A final decision will be made after the manufacturers’ appeals have been heard by an independent appeal panel at the beginning of May 2023.
In a statement published on 27 April 2023, the Pharmaceutical Services Negotiating Committee (PSNC) said that it had argued against considering the supply of these products by community pharmacies as “business as usual, as there will be additional elements of activity which contractors need to undertake in relation to dispensing these prescriptions”.
Janet Morrison, chief executive of the PSNC, said that “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 COVID-19 antivirals, but ministers were not willing to agree to our legitimate request,” she said.
“We previously warned ministers that, without additional funding, the roll-out of additional services … was neither feasible nor affordable.”
Her comments follow the government’s changes to the National Health Service (Pharmaceutical and Local Pharmaceutical Services) Regulations 2013, which the PSNC said in a statement were “imposed on the sector” without agreement from pharmacy negotiators.
The changes include the national roll out of tier 1 of the Pharmacy Contraception Service on 24 April 2023; the expansion of the Community Pharmacist Consultation Service to include referrals from emergency departments and urgent treatment centres from 15 May 2023; and a reduced Pharmacy Quality Scheme.
The changes will also enable contractors to close for rest breaks and manage closures through integrated care boards, and allow 100-hour pharmacies to reduce their core hours from 25 May 2023.
Morrison said that the changes “are divisive”.
“While the allowance to change core hours may bring some small relief to contractors of 100-hour pharmacies, PSNC was clear that any change like this needed to be matched with provisions for all other contractors who are facing the same pressures. We believe that it is unwise for the NHS to interfere with the level playing field for contractors in such a crushing economic climate,” she said.
Gareth Jones, director of corporate affairs at the National Pharmacy Association, said: “It is not equitable that 100-hour pharmacies are the only contracts to be given special consideration, when the whole sector is underfunded and needs help to manage down costs. There is very little here to help the vast majority with 40-hours pharmacies, who are also facing unprecedented challenges.”