The NHS will now pick up the bill for oseltamivir and zanamivir, the Department of Health and Social Care (DH) and NHS England have announced in a joint circular published today (December 14).

 

The antivirals may now be dispensed "at NHS expense" by community pharmacists to prevent and treat influenza for people in “at-risk” groups or those “at risk of severe illness”, according to the circular. It follows UK Health Security Agency (UKHSA) data that points to the virus "circulating in the community", it said

 

According to UKSHA data published this week, influenza positivity has increased to 5.6%, in comparison to 2.4% last week.

 

Read more: Pharmacies to dispense COVID antivirals for £2.50 ‘nominal’ reimbursement

 

Pharmacists have been instructed by DH and NHSE to issue antivirals “promptly” – oseltamivir should be initiated within 48 hours of the onset of symptoms, while zanamivir should also be started within 48 hours or within 36 hours of the onset of symptoms for children over the age of five.

 

If faced with short stock and unable to fill a prescription, pharmacists have been asked to “consider how best to assist patients” by calling round to other pharmacies and to arrange collection by the patient or stock transfer from pharmacies with stock.

 

 

Must have SLS endorsement

 

 

Community Pharmacy England (CPE) noted that community pharmacies that receive FP10 NHS prescriptions “written generically or by brand” for oseltamivir (Tamiflu®) or zanamivir (Relenza®), which are on the the selected list scheme (SLS), must have these prescriptions “endorsed SLS by the prescriber”. 

 

Read more: NHSE announces pharmacies can dispense COVID-19 antivirals from April

 

CPE said that without a SLS endorsement, which cannot come from pharmacy staff, “the prescription should not be dispensed and will not be passed for payment by NHS Prescription Services”. 

 

 

How did we get here?

 

 

The news mirrors an announcement made last November, when England’s chief medical officer, Chris Whitty and chief pharmaceutical officer for England, David Webb, announced that oseltamivir and zanamivir may be supplied by community pharmacists “at NHS expense”.

 

In May, C+D reported that CPE, then the Pharmaceutical Services Negotiating Committee, (PSNC) had announced a new approach to the supply of COVID-19 antivirals set out by the DH and NHSE. 

 

Read more: DH permits pharmacies to supply antivirals combatting flu after cases spike

 

Under this plan community pharmacies were able to dispense molnupiravir 200mg capsules (Lagevrio 200mg capsules), nirmatrelvir 150mg tablets and ritonavir 100mg tablets (Paxlovid 150mg/100mg tablets) for a £2.50 “nominal” reimbursement.

 

This was presaged by NHSE guidance published in late December 2022, which permitted integrated care boards (ICBs) to commission community pharmacies – as well as hospital pharmacies – to dispense oral COVID-19 antiviral medicines from April 2023.

 

But Scotland stole a march on its southern neighbour in January 2022, when it was revealed that thirteen pharmacies in the Greater Glasgow and Clyde area had been contracted to supply the COVID-19 antiviral molnupiravir.