There are no legal impediments to NHS England prescribing PrEP, the Court of Appeal has ruled in a landmark decision today.
PrEP (pre-exposure prophylaxis) is a daily treatment of HIV drug Truvada used to prevent the acquisition of HIV. The related treatement PEP (post-exposure prophylaxis), which is taken for one month after a possible transmission of the virus, is currently available on the NHS from A&E departments and GUM clinics, but PrEP is not.
Previously, NHS England had claimed it didn’t have the legal authority to prescribe the groundbreaking treatment, which some advocacy groups claim is 99% effective at preventing HIV. NHS England had tried to claim that responsibility for preventative health fell on the shoulders of local authorities, and that they should be provide it from local budgets. But the Court of Appeal decided the NHS could pay for the drug.
Currently an estimated 14,000 people might be eligible to receive PrEP via a prescription. Previously, only the 500 men on a clinical trial (called PROUD) or those who imported the drug from overseas (legal for personal use) had access to the drug. Private prescriptions are also available from some select pharmacies, but at a cost of around £400 per month (importing the drug costs £40-80 per month in comparison).
The NHS responded to say that while the judgement shows the NHS can fund the drug, it isn’t obliged to do so. It will, however, engage in further discussions to decide whether to do this.
‘[W]e will discuss with local authorities how NHS-funded Prep medication could be administered by the sexual health teams they commission,’ said an NHS spokesperson.
But cost remains an issue for the NHS. ‘[W]e will immediately ask the drug manufacturer to reconsider its currently proposed excessively high pricing, and will also explore options for using generics.’
Local Government Association’s wellbeing board chairman Izzi Seccombe said, ‘We now hope this decision will provide much-needed clarity around the roles of councils and the NHS on prevention services.’
She added, ‘It is time for NHS England to stop delaying and finally determine whether to commission this treatment, which could greatly reduce the risk of HIV infection.’
— National AIDS Trust (@NAT_AIDS_Trust) November 10, 2016
NAT CEO Deborah Gold said of the judgement, ‘HIV is a critical issue in the UK where over 4,000 people acquire HIV every year.
‘PrEP works, it saves money, and most importantly it has the power to prevent HIV acquisition for thousands of people, at the same time as beginning to end the HIV epidemic.
‘This judgement brings that possibility one step closer.’
She also called on NHS England to make ‘a balanced and evidence-based decision on PrEP’.
HIV activist and writer Philip Christopher Baldwin said of the decision, ‘I’m really pleased by the Court of Appeal decision in favour of PrEP. The Court of Appeal has determined that there is no legal impediment to NHS England funding PrEP. NHS England had argued that it was not responsible for PrEP. The NHS had claimed that, as PrEP is a preventative treatment, it is the responsibility of local authorities. We are now one step closer to PrEP being rolled out nationally. PrEP is a pill that can be taken once a day, when taken correctly, is nearly 100 % effective in preventing HIV. There are 6,151 new HIV diagnoses each year in the UK. PrEP is an important tool in the fight against HIV.’