Previously, eligible patients could access COVID-19 antivirals via COVID Medicines Delivery Units (CMDU).

But the pharmacy negotiator last week announced (April 27) a new approach to the supply of COVID antivirals set out by the Department of Health and Social Care (DH) and NHS England (NHSE).

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The new plans will “follow the business as usual approach to medicines supply”, with GPs prescribing the medicines to patients living in the community and “prescriptions being dispensed in community pharmacies”, the Pharmaceutical Services Negotiating Committee (PSNC) said.

It remains unclear when the new approach will launch, although the drug tariff for May has been updated to reflect the changes.

The move comes after the National Institute for Health and Care Excellence (NICE) issued new guidance - which the NHS is required to implement within 90 days - at the end of March that includes some COVID antivirals being prescribed in primary care, it added.

“Free of charge”

Pharmacy contractors will “be able to order the antivirals free of charge from the government’s stockpile via Alliance Healthcare”, PSNC said.

The DH has signed an agreement with Alliance Healthcare to distribute Molnupiravir 200mg capsules (Lagevrio 200mg capsules) and Nirmatrelvir 150mg tablets and Ritonavir 100mg tablets (Paxlovid 150mg/100mg tablets) to community pharmacies in England, it added.

Further information on ordering will be available from Alliance Healthcare “in due course”, according to PSNC.

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It said that the “usual” drug tariff fees will be paid in relation to the dispensing of these prescriptions, but that contractors will not be reimbursed based on the manufacturer’s list price.

Instead, contractors “will receive a nominal reimbursement amount of £2.50, which the DH has set to recognise the purchase margin contractors would ordinarily retain on products they had purchased to fulfil a prescription”, it added.

Imposed policy

But PSNC warned that the supply of COVID antivirals “should not be considered business as usual as there will be additional elements of activity that contractors need to undertake in relation to dispensing these prescriptions”.

It said that it has “maintained” this stance throughout “many months” of discussions about the plans with NHSE and the DH.

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Work undertaken by contractors related to the COVID pandemic “should attract additional funding over and above the baseline community pharmacy funding”, it added.

And it said that the decision to “pursue the business as usual approach is an imposition of policy rather than a negotiated agreement with PSNC”.

“Working harder for less money”

“Pharmacy contractors and their teams should be fairly funded by the NHS and government for additional workload that results from the pandemic,” PSNC chief executive Janet Morrison said.

She added that the negotiator “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 [its] legitimate request”.

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She reiterated warnings to ministers that “without additional funding, the roll-out of additional services and the [pharmacy quality scheme] 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,” Ms Morrison said.

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

£2.50 “doesn’t cover a quarter” of costs

Commenting on the news via Twitter last week (April 28), Dorset contractor Mike Hewitson said that “pharmacists are already overwhelmed by ‘business as usual’”, which he stressed is “anything but usual right now”.

“Taking 10-15 minutes out to ensure each Paxlovid prescription is safe is going to be a challenge when the proposed £2.50 fee doesn’t even cover a quarter of our costs”, he added.

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Mr Hewitson warned that the move will add workload to pharmacy teams as they will have to  “clinically check due to [the] huge number of drug interactions” with “no way of confirming renal status in most patients”.

And he added that he is aware of “genuine concern about the prescribing of Paxlovid due to renal impairment and drug interactions”, with “many inappropriate referrals” coming from “overstretched” GP practices due to “uncertainty over eligibility”.

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