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Paxlovid goes on PBS as GPs urged to avoid private prescribing

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GPs have been urged to avoid private prescriptions as one of the Federal Government’s key tools in managing COVID-19 moves on to the Pharmaceutical Benefits Scheme (PBS).
 
The oral antiviral nirmatrelvir plus ritonavir (sold as Paxlovid) can now be prescribed by GPs, with stock arrivals imminent or already having taken place at most community pharmacies.
 
It means there are now two oral antiviral treatments with the PBS molnupiravir (sold as Lagevrio) having been added to the PBS at the beginning of March.
 
Both treatments first entered the healthcare system in Australia through the National Medical Stockpile.
 
While the listing will expand the availability of the medications, GPs have been warned that supply is limited and that they should only prescribe the medications to those eligible under the PBS criteria.
 
According to those guidelines, the following groups are considered the most at risk of severe disease and are the only ones who should currently be considered for the treatments if they are confirmed with COVID-19:

• patients aged 65 or older, with two other risk factors for severe disease
• those aged 75 or older with one other risk factor
• Aboriginal or Torres Strait Islander origin are aged 50 and older with two further risk factors for severe disease
• any patient over the age of 18 who is moderately to severely immunocompromised.

In a Department of Health webinar on Monday (2 May), the Deputy Chief Medical Officer Professor Michael Kidd said the drugs needed to be targeted carefully.

‘We’re discouraging private prescriptions because we don’t have an unlimited supply of either Paxlovid or Lagevrio,’ he said.

‘It’s currently been manufactured for delivery all around the world, so it does need to be prioritised for those people who are most at risk of becoming severely unwell if infected with COVID-19.’

He also said the cost of more than $1000 per treatment course might mitigate against the likelihood of private prescriptions.

The Federal Government ordered 300,000 treatment courses of molnupiravir last year, and has now committed to a total of 1 million courses of nirmatrelvir plus ritonavir

Both oral antivirals are designed to be taken within five days of diagnosis or onset of symptoms and are intended to stop mild or moderate cases becoming more severe and requiring hospitalisation.
 
Professor Kidd again reiterated the broad spectrum of potential patients who could qualify for the prescription under the banner of being moderately or severely immunocompromised. These range from people with HIV/AIDS to those with intellectual and physical disabilities.
 
The nirmatrelvir plus ritonavir treatment has already been used widely in hospital settings, with more than 40,000 prescriptions dispensed as of early last month. Last week, it was confirmed that more than 12,000 prescriptions of molnupiravir have been made since it became available on the PBS.
 
Molnupiravir was widely distributed to aged care facilities when stocks became available earlier this year.
 
Paxlovid contraindications
Professor Kidd also highlighted the significant differences between the contraindications that apply for the two separate treatments.
 
‘The big caution with Paxlovid is that, unlike Lagevrio, [it] has a lot of contraindications with a large number of other medicines,’ he said during a COVID-19 response update webinar for primary care professionals last week.
 
‘You need to look very carefully through the list of medicines that your patient is taking and make sure there are no contraindications.
 
‘If there are contraindications, please do not prescribe.’
 
He also responded to a query received during the webinar about pausing contraindicated medications to allow the new oral antiviral to be administered, which he strongly advised against.
 
‘We are not recommending temporarily withholding a contraindicated medication,’ he said.
 
‘Part of the reason is that the washout period for many of those medications would be too long to allow us to safely administer Paxlovid.’
 
If nirmatrelvir plus ritonavir is contraindicated due to conflicting medication, he advised that molnupiravir be considered.
 
He also reminded those watching the webinar that nirmatrelvir plus ritonavir was contraindicated in patients with severe renal or hepatic impairment.
 
Neither of the oral anti-viral medications should be prescribed to pregnant or breastfeeding women.
 
Among the resources available for GPs is a risk classification tool devised by the COVID-19 Evidence Taskforce, which is designed to help assess the appropriate treatment options for patients.
 
Professor Michael Kidd also appeared on the Good GP podcast with Dr Sean Stevens last Friday to discuss the new PBS listing.
 
Full details on the nirmatrelvir and ritonavir (Paxlovid) listing can be found on the PBS website. The full list of contraindications can be found on the product information published on the TGA website.
 
Full details on molnupiravir (Lagevrio) can also be found on the PBS website. Product information is published on the TGA website.

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COVID-19 COVID-19 treatments Paxlovid PBS Pharmaceutical Benefits Schedule

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