Exclusive: NHS England U-turn on funding of council HIV drugs

The national commissioner sent a circular yesterday stating that its position was to reimburse for antiretroviral (ARV) drugs used for post exposure prophylaxis (PEP).

PEP involves a course of ARV medication which can stop someone developing an HIV infection after they have been exposed to the virus. Use of the drugs following high risk sexual exposure to HIV is known as “PEPSE”.

Earlier this month HSJ broke the news that NHS England had circulated a letter in Yorkshire and the Humber saying it would only pay for the drugs in a limited set of circumstances.

The letter said: “If a provider is not part of an [accident or emergency] or a trust providing HIV [services] then we would not expect them to be involved in the dispensing of ARVs and therefore would not be reimbursing them.

“Therefore, if they are a standalone provider of [genitourinary services] and they can separately account for PEP then this should be invoiced to local authorities.”

Public health leaders criticised NHS England’s decision to stop reimbursing drugs provided by council services.

They said the decision would create a “postcode lottery” because some councils would have to stop dispensing the drugs.

Concerns were also raised about the fragmentation of services, because individuals may need to go to A&E to obtain PEP but would then have to go to council-commissioned services if they wanted STI screening.

However in a circular sent yesterday and obtained by HSJ, NHS England indicates that its policy is to fund the drugs in all circumstances.

“The circular confirms NHS England’s position which is to reimburse for ARVs used for PEPSE/PEP,” it says.

The circular acknowledges that “questions have emerged about how NHS England can monitor and validate spend and transact reimbursement with providers that do not hold an NHS contract, do not have an HIV care and treatment service and / or do not have an A&E department”.

It goes on to say that “guidance” will be made available to help specialised commissioning teams in their work with “local authority sexual health commissioners and affected providers” to establish arrangements “for reporting, monitoring, validation and quality and safety assurance to inform reimbursement”.

“In the meantime, teams should ensure the provider landscape for PEPSE is fully mapped and connections made.”

The circular concludes: “NHS England’s commissioning responsibility for PEPSE remains unchanged.

“The focus remains on the importance of local collaboration between NHS England and local authority commissioners in providing sexual health and HIV services which meet the needs of the local population and improve outcomes”.

NHS England’s move was welcomed by Andrew Furber, the president of the Association of Directors of Public Health.

Dr Furber said: “This provides welcome clarity for directors of public health and the basis for working with NHS England to put effective arrangements in place to the benefit of those at risk of HIV infection.”

The U-turn comes a little over a week after NHS England announced it was reconsidering a decision not to fund another preventative drug for HIV after it was threatened with legal action by the National Aids Trust.

NHS England has been contacted for comment.