PBAC urges COVID-19 antivirals’ removal from doctor’s bag

A review of Prescriber Bags has recommended the removal of two medications – the COVID-19 antivirals molnupiravir and nirmatrelvir–ritonavir – saying the ‘clinical landscape had evolved’ since they were added in late 2022.
 
The review by the Pharmaceutical Benefits Advisory Committee (PBAC) acknowledged there may be ‘disparate views’ on the medications’ removal.
 
However, Dr Michael Tam, a member of the RACGP Expert Committee – Quality Care, said he is ‘not surprised’ by their removal.
 
Dr Tam told newsGP he believes the proposed removal of the medications is primarily due to cost and wastage.
 
At $2193.08 and $2217.08 respectively, molnupiravir and nirmatrelvir–ritonavir are the two most expensive items in the Prescriber Bag.
 
‘There is no question that the two antivirals are expensive medications,’ Dr Tam said.
 
‘They represent, in fact, the majority of this doctor bag budget, and there has been a very big jump in the total expenditure from 2022–23 to 2023–24,’ he said.
 
He said neither medication has ‘particularly long shelf lives’, so it makes sense for pharmacies to provide them ahead of doctor’s bags.
 
‘Simply because any one pharmacy will have greater demand, it’s easier to manage,’ Dr Tam said.
 
‘It’s easier to manage the stock, it’s less likely that there’ll be wastage through medicine sitting on a shelf and just going out of date.
 
‘There may still be some situations where someone will need a medicine, but it probably couldn’t be justified through that expense to the doctor’s bag.’
 
More than 165,000 COVID-19 cases have been reported this year. As of 7 October, there were seven COVID-19 cases in intensive care units nationally, compared to 40 on the same date in 2022.
 
In 2022, at the height of the pandemic, the RACGP lobbied hard to successfully get COVID antivirals into the Prescribers Bag.
 
‘We knew definitely at those times that the medicines made a difference, particularly to people at high risk,’ Dr Tam said.
 
‘When those medicines were first available, there was a very clear imperative that we wanted people who were ill to have access to them ASAP. The situation is not quite the same now.’
 
He said the majority of the Australian population is now either fully immunised, has survived one or more infections of COVID, or both.
 
‘The risk from any single episode of infection from COVID is much less than compared to when we were early during the pandemic, when there were many people who were either naive to infection, had not been immunised, or could not be immunised,’ he said.
 
‘The risks to people then were substantially higher. There will still be people who would be at risk, who would benefit from the medicines, but the risk isn’t quite as high. And so I think the necessity of having that emergency access through the doctor’s bag is also probably less.’
 
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antiviral medication antivirals COVID-19 doctor bag molnupiravir nirmatrelvir–ritonavir PBS prescriber bag