Push to assess COVID-19 treatment eligibility prior to infection

A new college resource has been published to help GPs assess their patients’ eligibility for oral COVID-19 treatments before they are infected.

The ‘prescribing workflow’ guidelines set out how GPs can carry out assessments ‘to expedite access’ to medications if a patient subsequently tests positive for COVID-19. 
 
The guidelines cover the use of molnupiravir, which is sold as Lagevrio, and nirmatrelvir plus ritonavir, branded as Paxlovid, which are now both listed under the Pharmaceutical Benefits Scheme (PBS).
 
The two treatments were provisionally approved by the Therapeutic Goods Administration in January, with supplies arriving in the country shortly afterwards.
 
Recently the Government launched a campaign to raise awareness of the both medications, with the Minister for Health and Aged Care expressing concerns that they were not being used enough.
 
While the possibility of pre-emptory assessments for the COVID-19 treatments has been discussed previously, this is the first time guidelines on how to do so have been published.
 
‘It is recommended that, where possible, GPs engage patients who may be eligible for COVID-19 oral treatments to determine their eligibility and suitability prior to contracting COVID-19,’ the college’s advice states.
 
The treatments are aimed at preventing more vulnerable patients, particularly the elderly, from progressing from mild or moderate COVID-19 to more severe illness that requires hospital treatment.
 
General practices should ‘consider identifying and contacting patients who may be eligible for oral treatments for COVID-19 in the event they test positive to COVID-19’, the advice states. The guidelines raise the possibility of general practices running a clinical search to identify patients who meet the criteria.
 
The assessment for suitability can be carried out using existing Medicare Benefits Schedule (MBS) items for general attendances, the college guidance states.
 
The advice also includes details of MBS telehealth phone consultation items lasting more than 20 minutes, which were recently introduced on a temporary basis to help GPs and other medical practitioners to assess eligibility for the drugs.
 
Nirmatrelvir plus ritonavir in particular has a long list of contraindications and drug interactions, which are likely to make consultations longer and more complex.
 
Additionally, the college advice highlights that those who test positive to COVID-19 are exempt from the existing relationship rule, meaning they do not need to have seen a GP within the past 12 months to access telehealth consultations.
 
Last month, PBS eligibility criteria for the two treatments were broadened significantly to allow more people to take them. Access was opened to everyone aged 70 and older who tests positive to COVID-19 regardless of any additional risk factors.
 
Eligibility
Access to PBS-subsidised prescriptions is available for adults who have mild to moderate COVID-19 confirmed by a PCR or medically verified rapid antigen test and who can start treatment within five days of symptom onset, if they:

• are aged 70 or older.
• are aged 50 or older with other risk factors for severe disease.
• are aged 30 and older and are of Aboriginal or Torres Strait Islander origin with two further risk factors for severe disease.
• are aged over 18 and moderately to severely immunocompromised.

“Oral COVID-19 Lagevrio Paxlovid treatments”