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Pharmacy minister urged to let sector dispense hepatitis C treatments

Rekha Shah: Drug users in our pilot said they would prefer to access treatment in a pharmacy
Rekha Shah: Drug users in our pilot said they would prefer to access treatment in a pharmacy

A group of clinicians has called on pharmacy minister Seema Kennedy to amend legislation to allow pharmacies to dispense hepatitis C treatments.

The London Joint Working Group (LJWG) – a group of clinicians and voluntary sector representatives working to eliminate the virus in drug users in the capital – wrote to Ms Kennedy and the Department of Health and Social Care (DH) last month outlining its “preferred model” for hepatitis C treatments.

The LJWG has been “exploring options” to meet the World Health Organisation’s goal of eliminating hepatitis C by 2030, including the “introduction of a community pharmacy hepatitis C treatment service”, it said in the letter, seen by C+D.

Despite the success of the first two phases of a pilot in London pharmacies – which saw drug users’ saliva and blood tested for hepatitis C – the group’s plans for the third phase, to trial community pharmacists providing treatment on a supervised basis, has “come to an impasse”, the LJWG explained.

“Current legislation and regulation…only allows hepatitis C drugs to be dispensed within a hospital pharmacy or via a provider contracted homecare service,” it said.

Currently, any high-cost drug funded by NHS England’s specialist drug budget – such as those used in hepatitis C treatment – “must be initiated through a secondary care provider”, and as such, community pharmacies would not be reimbursed for these medicines, the LWJG said.

Patient group directions are also not an option because of legislative barriers, the group explained.

“Change is needed in the commissioning and legal frameworks relating to the dispensing of high-cost drugs…[so] patients are able to access treatment in all settings,” the LWJG stressed.

Ministerial support

The London pilot caught the attention of pharmacy minister at the time Steve Brine, who visited a pharmacy offering the service last year. Two months after his visit, he told MPs in parliament he was “impatient” to see the service “scaled out”.

Rekha Shah, pharmacy immunisations lead for Kensington, Chelsea and Westminster local pharmaceutical committee, told C+D last month that 75% of patients involved in the second phase of the pilot (see below) were in favour of receiving treatment in a community pharmacy, “as it would be much easier to access and hence they would be more likely to complete the course successfully”.

“However, current regulations are proving to be a substantial barrier” for moving to the next stage of the pilot, she told C+D at the time.

Ms Shah is hoping the current pharmacy minister Ms Kennedy will echo Mr Brine’s support for the service and “we will get somewhere with this soon”.

C+D has asked the DH if it received the letter and when it plans to respond.

What happened during London’s hepatitis C pilot? 

Eight pharmacies in London took part in piloting a service that launched in November 2017, testing intravenous drug users, who use needle exchange services in community pharmacies, for hepatitis C. The theory was that pharmacies are an accessible place for these patients, as it is often hard for them to reach treatment in GP practices.

In this first phase, run by the London Joint Working Group, pharmacists offered these patients a saliva test via a mouth swab, and referred those who tested positive to secondary care for formal diagnosis and treatment.

Half of the patients who were seen during the three-month period tested positive for the virus.

In phase two, which launched in July 2018 in eight pharmacies across six London boroughs, pharmacists offered patients a more accurate blood test, which assesses if the virus is active. A total of 184 patients were tested, with 24% returning positive tests and 15% attending tertiary centres to access curative treatment.

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