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Enhanced antivirals access a victory for patients


Bruce Willett


19/10/2022 4:31:28 PM

RACGP Vice President Dr Bruce Willett goes behind the scenes of a successful campaign to help GPs supply oral antivirals to at-risk patients.

Lagevrio COVID-19 oral antiviral treatments
Molnupiravir (Lagevrio) is one of two COVID-19 oral antiviral treatments GPs can prescribe. (Image: AAP Photos)

It has been a rough few days for many of us working in general practice.  
 
In Queensland, GPs are more concerned than ever about the implications of a Full Scope of Pharmacy Pilot, after the state government confirmed it had been finalised last week. While RACGP advocacy saw the project delayed and watered down, it still threatens to put patients’ well-being at risk in North Queensland.
 
Then to have the integrity of our entire profession called into question in multiple media outlets for the sake of cheap clicks feels like a gratuitous boot in the ribs while we are down.
 
So, at this time perhaps more than ever, I would like to take a moment to focus on the positives and acknowledge recent victories we have had for the care of our patients.
 
After months of behind-the-scenes advocacy, the Pharmaceutical Benefits Advisory Committee (PBAC) has now recommended that COVID-19 oral antivirals be added to the Prescriber Bag.
 
Pending final approval, this will mean GPs can prescribe and provide these drugs quickly, efficiently and – crucially – in the safest possible way to the people who need them most.
 
As the health professionals who know our patients best, we all understand how well we are placed to provide this care, and to mitigate the impact of the pandemic – which is set to go on for some time to come, regardless of the end of isolation restrictions.
 
As with all PBAC recommendations, it needs Federal Government sign off before it happens, which we hope can be expedited as soon as possible.
 
But this is set to be a genuine victory for our most vulnerable patients, particularly those in rural and remote areas where pharmacies have struggled to stock the drug, and who have not been able to access the drugs fast enough when time is of the essence.

The provision of Covid antivirals is a far more patient centred and practical solution than allowing pharmacists to both prescribe and dispense these medications with inadequate knowledge of the patient’s conditions.  
 
In my work for the college, I have come to understand only too well that behind these seemingly simple decisions is a vast mountain of legwork, negotiating, and awareness-raising that very rarely gets seen or recognised.
 
This is a case in point. To change the narrative for once, I want to thank the RACGP team who have tirelessly pushed on behalf of our patients’ wellbeing to get this across the line.
 
There have been letters to the Chief Medical Officer, the Federal Minister for Health and Aged Care, all his state counterparts, State and Territory Premiers, as well as to PBAC, to set out why GPs, with their unique knowledge of their patients, should have access to this essential service.
 
At that same time, we liaised with other organisations such as the AMA to amplify our voice and advocate for a patient-centred solution those in general practice know makes sense.
 
As well as having the best understanding of our patients, we have appropriate medical expertise to prescribe drugs that can help them get better faster – and in some cases, save their lives. This understanding is particularly relevant for a drug with such an array of contraindications as Paxlovid.
 
We also know we have the practice standards, medication management and control measures in place to supply patients with the right medicines at the right time.
 
The Prescriber Bag is usually for emergency situations. With the initiation of treatment so time sensitive, we argued strongly and successfully to PBAC that this is an acute situation which can rapidly become an emergency if supply issues are a barrier.
 
As well as PBAC, we also had to make sure decision makers were across these details when it mattered, particularly ahead of a National Cabinet meeting where we knew oral antivirals were going to be discussed.
 
There have been many other actions, also largely unseen, that have taken place to help facilitate the decision, as well as the care for the many thousands of at-risk patients that are still getting sick with COVID every day.
 
The college has helped develop workflows to ensure that immunocompromised and other COVID-19 patients most exposed to severe illness get the priority they need. Despite all the pressures general practices are under, these steps have ensured so many people have been able to get COVID-19 advice and treatment when they have required it most.
 
GPs around the country have pre-counselled and identified immunocompromised patients who would benefit most from timely access to the right COVID-19 oral antiviral.
 
This week too, amid the media furore around the so-called Medicare ‘rorting’ – and yes, those quote marks are deliberate – the Department of Health and Aged Care confirmed that COVID-19 patients will remain exempt from the existing relationship requirement, at least until the end of the year.
 
It is another decision that helps keep patient-centred general practice care at the heart of the response to the pandemic. We have been there from the beginning and will continue to fight for the best care for our patients.
 
For me, these are rays of light at a time the profession I love needs a bit of sunshine.
 
They are also reminders that the constant work behind the scenes to make things better for our patients will never stop – whatever the headlines say.
 
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Dr Ian Rivlin   20/10/2022 7:53:17 AM

Molnupiravir doesn't reduce death or admission to hospital. It only reduces - slightly - the duration of the disease. Paxlovid had so many interactions with other mediations that it's virtually useless. (Done most of the intended patients are in a plethora of other drugs). Considering that these drugs are $1200 each course, they're just making big pharma very, very rich and doing very little for anyone else.


Dr Ian   20/10/2022 12:55:24 PM

A lot of at risk are on benzodiazepines for sleep which reacts with Paxlovid though if you stop benzodiazepines and the dose is small and short acting and you wait a day Paxlovid could be prescribed in consultation with a pharmacist well versed in interactions .
And there are quite a few medications that require a lot of input to adjust .
Molnupiravir has had efficacy up to 35 % in a study in Hong Kong elderly and Paxlovid is still 85% protective .
But Remdesivir 85% effective ought not be forgotten in worrying at risk patients even if it means chasing up energetically to arrange the 3 day infusion in hospital in the home for example .


Dr Nikolai Alexandrov Manassiev   23/10/2022 12:57:55 PM

It is lost to most people, including most GPs, specialists, policy makers, assorted professors and talking heads, that the anti-virals molnupiravir and Paxlovid, have not been tested on Covid immunised patients. Howzat?