The Department of Health and Social Care (DHSC) has said that it is working towards supplying Covid antivirals through primary care routes, such as community pharmacies.

Several Covid-19 treatment options are licensed for use in the community, including molnupiravir and nirmatrelvir/ritonavir, procured by the government’s Antivirals Taskforce, as well as the monoclonal antibody treatment, sotrovimab, and the intravenous antiviral, Remdesivir.

Patients at highest risk from Covid due to their immune system can access treatments directly from Covid Medicine Delivery Units (CMDUs) if they test positive from the virus.

DHSC said ongoing work around the transition includes discussions with the Pharmaceutical Services Negotiating Committee (PSNC). PSNC confirmed talks with DHSC and NHS England are ongoing. The Pharmacist has approached NHSE for comment.

Currently, antivirals are available in the community through a national study called PANORAMIC, which is open to individuals with Covid who are aged 50 and over, or aged 18 and over with an underlying medical condition that can increase the risk of developing severe Covid-19.

On top of this, up to 1.8 million of the highest-risk patients in England are being digitally identified as eligible for this early Covid treatment. If they are eligible and receive a positive Covid-19 test result, they will be contacted by a clinician from a Covid Medicine Delivery Unit.

By the end of October, around 105,700 patients in the UK had received these Covid treatments, including around 2,100 in the last week of October.

Recent legislative changes have made it possible for centrally procured Covid treatments and vaccinations to be made available to community pharmacies free of charge, without the need to go through the normal medicines reimbursement process.

In October, amendments to the National Health Service (Pharmaceutical and Local Pharmaceutical Services) Regulations 2013 provided a legal basis for making certain medicines centrally stocked and supplied free of charge to community pharmacies, without the need to reimburse them under the standard NHS arrangements. It applies to Covid vaccinations, treatments and associated equipment such as vials where they have been provided free of charge to pharmacies – such as when they have been centrally procured, like the two treatments procured by the Antivirals Taskforce.

The impact report for the Health and Social Care Act, released last month, suggests that this approach would increase efficiency, as community pharmacies won’t need to purchase these products from wholesalers. A similar exemption has been in place since 2017 for unlicensed medicines (specials).

However, DHSC added in the report that ‘the aim of the provision is not to radically change NHS pharmaceutical service provision or payment mechanisms to community pharmacies or the pharmaceutical supply chain that they use’, but instead is to ‘strengthen the legal basis for scenarios when the usual supply routes are bypassed’.

Martin Sawe, the executive director of the Healthcare Distribution Association, which represents medicines suppliers, said that the Act recorded in legislation what has already been happening since the first Covid-19 vaccines were developed.

In the UK, Covid vaccines for use in primary care are purchased by the NHS directly from manufacturers. In England, they are then sent to wholesaler-run storage hubs and distributed by suppliers to vaccine sites around the country, including community pharmacies. In Scotland, Wales and Northern Ireland, the vaccines are stored and distributed by the NHS.

Mr Sawe said that for wholesalers, the different method had no financial impact. He said: ‘Either way, reimbursement or this method of distributing, [Covid] vaccines and COVID antivirals are free. Both ways use the same wholesale distributor companies. So we haven't been cut out, it’s exactly the same route, just different ways of being paid.’

While the legislation set a precedent that could be used in future pandemics, it currently only provides for covid-related medicines, vaccines and equipment, he added.

Any future pandemic scenario – for instance, in the case of a different virus like monkeypox – would require parliamentary approval relating to the supply of different drugs, a process that could take up to three weeks, he said. The Pharmacist has approached DHSC for confirmation on this.

The legislation also does not cover flu vaccinations, which are supplied under the normal reimbursement scheme.