The Pharmaceutical Benefits Advisory Committee has expanded the eligibility criteria for COVID-19 oral antiviral treatments, Paxlovid (nirmatrelvir and ritonavir) and molnupiravir (Lagevrio) effective from 11 July 2022.

It is important that primary care providers familiarise themselves with the updated criteria and pre-identify potential patients before they test positive for COVID-19 so medication options can be explored and included in their care plan to expediate treatment within that critical 5-day window from symptom onset (noting those over 70 years may commence treatment while asymptomatic following a positive test).

This decision is in response to the latest evidence on the effectiveness and safety of the medicines, the rate of uptake since they were made available on the PBS and the changing epidemiology of the virus.

Eligibility has been broadened to include people who have chronic respiratory issues due to conditions such as COPD, moderate or severe asthma and there is also greater access for adults living with disability who have multiple medical conditions.

Not being vaccinated has been removed as a risk factor from the criteria for prescription under the PBS.

The new eligibility includes updated age limits and risk factors summarised below.

Older Australians and Aboriginal and Torres Strait Islander people, who test positive for COVID-19.

• 70 years or older
• 50 years or older with 2 risk factors
• Aboriginal or Torres Strait Islander, 30 years or older and with 2 risk factors.

Risk factors include:

• living in residential aged care
• living with disability with multiple conditions and/or frailty (but not limited to living in supported accommodation)
• neurological conditions like stroke or dementia and demyelinating conditions e.g. multiple sclerosis, Guillain-Barre Syndrome
• chronic respiratory conditions including COPD, moderate or severe asthma
• obesity or diabetes (type I or II requiring medication)
• congestive heart failure, coronary artery disease, cardiomyopathies
• kidney failure or cirrhosis
• living remotely with reduced access to higher level healthcare.

People aged 18 years and older who are moderately to severely immunocompromised and test positive for COVID-19.

Conditions include:

• blood cancer or some red blood cell disorders (thalassemia, sickle cell disease)
• transplant recipient
• primary or acquired (HIV) immunodeficiency
• chemotherapy or whole-body radiotherapy in the last 3 months
• high dose corticosteroids or pulse corticosteroid therapy in the last 3 months
• immunosuppressive treatments in the last 3 months
• rituximab in the last 12 months
• cerebral palsy or down syndrome
• congenital heart disease
• living with disability with multiple conditions and/or frailty

Additional information can be found in the following link: PBAC Outcome Statement

Primary care providers will continue to play a pivotal role as the key contact for patient guidance on eligibility and risk factors and prescribing the best treatment where clinically appropriate.

Eligibility

For the COVID-19 oral antiviral treatments (Paxlovid® and Lagevrio®) to be prescribed on the Pharmaceutical Benefits Scheme (PBS), the patient must first test positive to COVID-19 through either a polymerase chain reaction (PCR) test result, or a rapid antigen test (RAT) result, verified by a medical practitioner or nurse practitioner. This requires the prescriber ensuring they are satisfied that the test for COVID-19 is valid. This is up to the judgement of the clinician, but could include the prescriber seeing an image of the patient’s RAT result, or receiving verbal advice from a known patient. The prescriber must also record the test result, date, location and provider (where relevant) on the patient’s record. More information can be found on the Department’s website at: www.health.gov.au using the search ‘Updated eligibility for oral COVID-19 treatments.’