Reimbursement fee for Covid antivirals ‘derisory and unsafe’

Plans for community pharmacy to dispense Covid-19 antivirals for a reimbursement fee of £2.50 per item, plus the single activity fee (SAF), have been condemned as ‘derisory’ and ‘unsafe’.

The medicines will be supplied free to pharmacies from a central government supply and will be ordered via, and distributed solely by, Alliance Healthcare.

Community pharmacy will be able to dispense molnupiravir 200mg capsules, also known as Lagevrio, as well as nirmatrelvir 150mg tablets and ritonavir 100mg tablets, which together make up the treatment Paxlovid.

The Pharmaceutical Services Negotiating Committee (PSNC) said that the £2.50 payment represented a ‘nominal reimbursement amount’ in recognition of the fact that, since the product would be distributed to pharmacies free of charge, contractors would not be able to retain a margin on it as they might on other items purchased to fulfil a prescription.

While PSNC said that ‘ministers have decided that this will follow the business as usual approach to medicines supply, with prescribers in general practices being asked to prescribe the medicines and prescriptions being dispensed in community pharmacies’, the negotiator commented that in practice, the activity undertaken by pharmacies should not actually be regarded as ‘business as usual’.

They said that contractors would need to undertake ‘additional elements of activity’ in relation to dispensing these prescriptions, but could not add further detail on what this would be.

‘Additionally, we believe work undertaken by contractors related to the Covid-19 pandemic should attract additional funding, over and above the baseline community pharmacy funding,’ the negotiator said.

‘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,’ said PSNC chief executive Janet Morrison.

She added: ‘Money is needed to safely resource additional work.’

Meanwhile, contractor Mike Hewitson told The Pharmacist that the plan and associated payment was ‘not only derisory, it’s actually unsafe’.

He said that while he had no problem with community pharmacists supplying antivirals in principle, the £2.50 plus SAF payment for dispensing the item was not adequate for the time-sensitive nature of supply and the ‘significant’ time needed to undertake clinical checks while dispensing.

‘Paxlovid in particular has [a] huge number of drug interactions with other medicines, which means that any pharmacies receiving the prescription is going to need to spend quite a lot of time reviewing whether patients take any of the interactive medicines,’ he told The Pharmacist.

‘Largely these medicines will be prescribed to patients who are vulnerable and who may, by definition, be taking lots of other medicines.’

‘Not only are they time sensitive, so they often have to be prioritised over other activity, they also require significant amounts of pharmacists’ time’, he said.

He added that pharmacists ‘have a duty of care, in law, to ensure the safety of prescribing’, and that it wasn’t good enough to say that the prescriber or practice pharmacist had checked the safety of the prescription. ‘The person who’s accountable is the pharmacist who’s signing it off at the end of the process,’ he said.

He also raised concerns that the new national directive might lead to existing local services – which may be better funded and resourced, including more access to patient notes – being withdrawn.