Community pharmacies are to be responsible for the supply of Covid-19 antivirals to patients under new rules imposed by the Government and NHS, with reimbursement set at a “nominal” rate of £2.50.

The changes, which were announced last week, will see these products prescribed by GPs and dispensed by pharmacies like other medicines, replacing the current system whereby they are accessible from dedicated Covid medicines units. However, the antivirals – Lagevrio 200mg capsules and Paxlovid 150mg/100mg tablets – will be available to order free of charge from a Government stockpile via Alliance Healthcare.

On top of the standard single activity fee of £1.27 Contractors will receive a “nominal” reimbursement amount of £2.50, a figure set by the DHSC “to recognise the purchase margin contractors would ordinarily retain on products they had purchased to fulfil a prescription”.

The PSNC said that in talks over “many months” it had opposed this “business as usual approach” on the grounds it would generate “additional elements of activity which contractors need to undertake in relation to dispensing these prescriptions,” and that in its view Covid-related services “should attract additional funding”.  As with several recent announcements from the DHSC, the move was imposed by Government without the PSNC’s agreement.

PSNC chief executive Janet Morrison 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.”

Dorset contractor Mike Hewitson raised concerns about the potential patient safety implications, tweeting: “Having sat in with the antiviral prescribing team, I saw genuine concern about the prescribing of Paxlovid due to renal impairment and drug interactions. Many inappropriate referrals from General Practice due to uncertainty over eligibility

“Now overstretched practices will be asked to prescribe. Then the pharmacies will be asked to subsidise the supply of Paxlovid which will take time to clinically check due to huge number of drug interactions. With no way of confirming renal status in most patients.

“Pharmacists are already overwhelmed by “business as usual” (which 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.”