NHS has power to fund PrEP HIV drug, Court of Appeal rules

NHS England has the power to fund a ‘game changing’ drug that can prevent HIV infection, the UK Court of Appeal has ruled.

The court upheld an earlier High Court judgment made in August 2016 saying that NHS England was wrong in the view it could not legally fund pre-exposure prophylaxis (PrEP) treatment, which is taken by people at high risk of HIV infection to protect against the virus.

The National AIDS Trust (NAT) brought the case before the High Court on 13 July 2016 after NHS England said PrEP came under the remit of local authorities because it is a preventative medicine.

Deborah Gold, chief executive of NAT, says: “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.

“We look forward to what we hope will be a balanced and evidence-based decision on PrEP by NHS England.”

In a statement, NHS England said the Court of Appeal’s judgment established that it had the “ability but not the obligation” to fund PrEP and also clarified that the NHS would not be expected to fund local authorities public health duties.

NHS England also said it would now formally consider whether to fund PrEP and discuss with local authorities how the drug could be administered by their sexual health teams. “We will immediately ask the drug manufacturer to reconsider its currently proposed excessively high pricing, and will also explore options for using generics,” the statement said.

Richard Torbett, executive director at the Association of the British Pharmaceutical Industry, a drug company association, comments: “We are pleased that this case has come to a close, and NHS England should now deliver a speedy resolution to its 2015–2016 decision-making process to ensure that patients who have been left in limbo can finally have access to a number of life-changing medicines and treatments.”

But, he adds: “Instead of attempting to negotiate pricing through press releases, we believe that NHS England should comprehensively assess the value of a medicine to patients, through a clearly laid out commissioning and decision-making process.”

The Local Government Association (LGA), which supported NAT in seeking a judicial review in August 2016, says it is pleased with Court of Appeal’s decision.

Izzi Seccombe, chair of the LGA’s community well-being board, says the LGA was disappointed when NHS England chose to appeal at great cost to the taxpayer and hoped the decision would bring much needed clarity on the roles of councils and the NHS on prevention services.

“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,” she says.