NHS cannot fund anti-HIV PrEP drug plan

NHS England has reiterated it cannot commission preventative HIV drug, PrEP (pre-exposure prophylaxis), explaining that the onus falls on local authorities

PrEP is a way of using anti-retroviral drugs, usually used for treating people with diagnosed HIV, to stop viral transmission.

The paper on PrEP, discussed at the Specialised Services Commissioning Meeting on 31 May 2016, highlighted that: “Provision of services to prevent the spread of sexually transmitted infection is a legally specified public health function of local authorities and a role that is explicitly legally assigned to them.”

Including PrEP for consideration in competition with specialised commissioning treatments as part of the annual CPAG prioritisation process could present risk of legal challenge from proponents of other ‘candidate’ treatments for sexually transmitted infections, according to NHS England.

On 21 March 2016, a statement was placed on the NHS England website that explained PrEP could not be considered for the specialised services annual prioritisation process due to this legal restriction.

Ian Green, chief executive of the Terrence Higgins Trust, said to the BBC: "Today is a shameful day for HIV prevention.

"This country used to lead the way in the fight against the HIV epidemic, but today, our national health service has washed its hands of one of the most stunning breakthroughs we've seen - a pill which, if taken correctly, is almost 100% effective in preventing HIV.

“It defies belief that, after 18 months of false hope, delays and u-turns in the battle to see PrEP made available on the NHS to people at high risk of HIV, today we are in a worse position than when we started."

However in an email to EPM an NHS England spokesperson said: “We have listened carefully to stakeholders and will continue to work with Public Health England and other partners on reducing HIV transmissions, but our external legal advice is clear that NHS England does not have the legal power to commission PrEP.”

The NHS has also said it: “Remains committed to working with other commissioners to explore the possible provision of PrEP.

“This includes working in partnership with Public Health England to run a number of early implementer test sites, backed with up to £2m investment over the next two years, to research how PrEP could be commissioned in the most clinically and cost effective way.”