Antiviral treatments for COVID-19
Published on: 22nd December 2021 | Updated on: 3rd May 2023
This page contains information on the use of antiviral treatments against COVID-19.
Vaccines remain the primary defence against COVID-19, but early in December 2021 the UK Government announced that it had also made available other new treatment options for COVID-19 for eligible groups of patients.
Thousands of the UK’s most vulnerable people will be among the first in the world to access cutting-edge antiviral and antibody treatments. These new treatments are used in the earliest stages of infection and often taken at home. They must be administered as soon as possible after a confirmed COVID-19 positive PCR test has been received.
Accessing supplies of COVID-19 antivirals
The Department of Health and Social Care (DHSC) and NHS England (NHSE) announced in April 2023, a new approach to the supply of COVID-19 antivirals to patients living in the community.
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. However, pharmacy contractors will be able to order the antivirals free of charge from the Government’s stockpile, via Alliance Healthcare.
Currently, eligible patients can access COVID-19 antivirals via Covid Medicines Delivery Units.
NICE issued guidance at the end of March 2023 on the use of several COVID-19 antivirals, which includes some products being prescribed in primary care for eligible patients. The NHS has a requirement to implement this NICE recommendation within 90 days of its publication.
Accessing supplies of COVID-19 antivirals
Earlier in the pandemic, the UK Government purchased large quantities of several COVID-19 antiviral products and these have been stockpiled for future use.
DHSC has signed an agreement with Alliance Healthcare to distribute two of these products to community pharmacies in England:
- Molnupiravir 200mg capsules (Lagevrio 200mg capsules)
- Nirmatrelvir 150mg tablets and Ritonavir 100mg tablets (Paxlovid 150mg/100mg tablets)
The products will be supplied free of charge to contractors.
Further information on ordering the products will be available from Alliance Healthcare in due course.
Reimbursement for dispensed products
The usual Drug Tariff fees will be paid in relation to the dispensing of prescriptions for these products.
As the stock has been supplied free of charge from the Government stockpile, contractors will not be reimbursed based on the manufacturer’s list price, which is typically the case for proprietary medicines. Contractors will receive a nominal reimbursement amount of £2.50, which DHSC has set to recognise the purchase margin contractors would ordinarily retain on products they had purchased to fulfil a prescription.
Community Pharmacy England’s view
Community Pharmacy England has been discussing the proposed approach to distribution of COVID-19 antivirals with NHS England and DHSC for many months. During these discussions, we have maintained a stance that the supply of these products should not be considered business as usual, as there will be additional elements of activity which contractors need to undertake in relation to dispensing these prescriptions.
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.
NHS England and DHSC have not been willing to accept the arguments put forward by Community Pharmacy England and consequently the decision by Ministers to pursue the business as usual approach is an imposition of policy, rather than a negotiated agreement with Community Pharmacy England.
Commenting on this decision by Ministers, Janet Morrison, Community Pharmacy England CEO, 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 C-19 antivirals, but Ministers were not willing to agree to our legitimate request.
“We previously warned Ministers that without additional funding, the roll-out of additional services and the PQS 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.
“The same argument applies to additional workload falling on the sector: more money is needed to safely resource additional work.”
The PANORAMIC study
A national study ‘PANORAMIC’, run by the University of Oxford, is recruiting around 10,000 UK patients at risk of serious illness from COVID-19 to have the opportunity to take the antiviral molnupiravir at home after receiving a positive PCR test.
Molnupiravir has shown in clinical trials to reduce the risk of hospitalisation or death for at-risk, non-hospitalised adults with mild to moderate COVID-19 by 30% and Ronapreve reduced the risk by 70%.
The PANORAMIC study, which is currently for molnupiravir, aims to allow researchers to gather further data on the potential benefits this treatment brings to vaccinated patients, and will help the NHS to develop plans for rolling out the antiviral to further patients.
It’s open to anyone in the UK, provided they:
- receive a positive PCR test;
- feel unwell with symptoms of COVID-19 that started in the last five days; and
- are aged 50 and over or 18 to 49 with an underlying health condition that puts them more at risk of severe COVID-19.
If eligible, people who receive a positive PCR test will be contacted by the study team or a local healthcare professional, for example their GP, to sign up to the trial. Alternatively, people can sign up themselves through the study’s website.
Taking part in the study will require participants to complete a daily diary for 28 days through the PANORAMIC website or receive a phone call from the trial team on days 7, 14 and 28 to speak about their symptoms. The first set of results from the trial are anticipated in early 2022.