Oral treatments for COVID-19 – Prescribing information for GPs

Introduction

Two antiviral medicines, Paxlovid (nirmatrelvir plus ritonavir) and Lagevrio (molnupiravir) are listed on the Pharmaceutical Benefits Scheme (PBS) as Authority Required (Streamlined) items, enabling eligible patients to access these medicines from their local pharmacy where available. As per the PBS listing, treatment with Lagevrio "must be for use when nirmatrelvir (&) ritonavir is contraindicated".

Both medicines require a prescription from a GP, physician or nurse practitioner who meets the prescribing requirements before they can be issued.

Not everyone who tests positive for COVID-19 will need treatment with oral antivirals. GPs are well placed to make decisions with their patients on the appropriateness of these medicines to treat COVID-19 based on the person’s individual risk for disease progression, medical history, current medicines, age and COVID-19 vaccination status − including time since vaccination. See individual listing for each medicine for further information on eligibility and prescribing.

To reduce spread of COVID-19, a person who has tested positive for the virus should not attend in person to collect these medicines. Alternate collection or delivery will need to be arranged. You can now check which pharmacies stock each of these medicines.

Telehealth consultations will be sufficient in many cases to determine if treatment is appropriate, including via normal after-hours medical deputising services. It is recommended medical deputising GPs and nurse practitioners work in partnership with the usual treating GP or physician to determine if treatment is appropriate.

A prescription needs to be issued for the medicine to be administered. When medicines have been pre-placed in RACFs and ACCHOs, the recommendation for recording and dispensing prescriptions is to follow the same process for other orders when medicines that are held in stock are issued (for example, antibiotics). Some RACFs and ACCHOs will do this differently, and how prescriptions are handled, and the medicines allocated, will depend on the local processes in place, and local state or territory requirements.

The two treatments should not be prescribed for the same person at the same time.

As with all medicines, patients or carers will need to provide informed consent for these medicines to be prescribed. GPs working with patients in RACFs or those at higher risk of severe illness from COVID-19, may find it helpful to pre-emptively discuss these medicines with their patients, even if they do not have COVID-19, to determine eligibility criteria and obtain pre-consent for these medicines to be prescribed in the event they test positive for COVID-19.

A subsequent discussion is advised at the point at which the patient requires the medicine to confirm the pre-consent is still applicable.

If a patient experiences an adverse event that you think may be related to the prescribed medicine, you can report this directly to the Therapeutic Goods Administration or via your normal state or territory reporting channels.
Under Prescriber Bag arrangements, prescribers can order up to two packs of Paxlovid and two packs of Lagevrio from a community pharmacy, once per month, provided they do not already have the maximum quantity on hand.

Prescriber Bag Supplies are intended for use in urgent circumstances for patients who are at a high risk of developing severe COVID-19 and who are unable to fill a PBS prescription from a community pharmacy in a timely manner.
This event attracts CPD points and can be self recorded

Did you know you can now log your CPD with a click of a button?

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