Health Alert Message for Healthcare Providers Availability of Oral Antivirals for Treatment of COVID-19

This message is to alert Idaho medical providers about the availability of oral antiviral medications to treat COVID-19.

Two oral antiviral medications are now available
In late December, the U.S. Food and Drug Administration (FDA) issued emergency use authorizations for two oral antivirals for the treatment of COVID-19. These two antivirals are Pfizer’s Paxlovid (nirmatrelvir and ritonavir, co-packaged) and Merck’s molnupiravir.

The oral antivirals are indicated for the outpatient treatment of mild-to-moderate COVID-19 in certain individuals with a positive SARS-CoV-2 viral test who are at high risk for progression to severe COVID-19. Both antivirals must be started within 5 days of symptom onset.

Supply is limited
The oral antivirals are in extremely limited supply. The U.S. Department of Health and Human Services (HHS) has purchased these medications and is working with state and territorial departments of health to coordinate their distribution. HHS ha established a federal pharmacy partnership program to stock and dispense these medications, and Idaho is coordinating with pharmacies that are part of this program.

Pharmacy locations
Given the constrained supply, only a small number of pharmacies in Idaho are receiving product at this time. These pharmacies are:

Working with the pharmacy
Prior to writing a prescription for a patient, the provider should call the pharmacy to ensure availability of the medication. If possible, the patient should designate another individual to pick up the prescription to avoid entering the pharmacy while infectious with COVID-19. Alternatively, some pharmacies may have curbside delivery available. Providers should also include a “do not dispense after” date on the prescription since both antivirals need to be started within 5 days of symptom onset.

Special considerations
Providers will want to familiarize themselves with the emergency use authorization Fact Sheets for Providers (see “Resources,” below) for each of these products.

• Paxlovid has significant drug-drug interactions. Consult the full prescribing information prior to prescribing this medication.
• See the Paxlovid Fact Sheet for Providers regarding concerns about hepatoxicity and HIV-1 drug resistance.
• Molnupiravir is authorized for use for certain high-risk individuals “for whom alternative COVID-19 treatment options authorized by FDA are not accessible or clinically appropriate.”
• The use of molnupiravir is not recommended during pregnancy or breastfeeding. There are special considerations when prescribing to females with childbearing potential and males of reproductive potential who are sexually active with females of childbearing potential. See the Fact Sheet for Providers for details.
• Molnupiravir is not authorized for use in patients younger than 18 years of age because molnupiravir may affect bone and cartilage growth.

Resources
Fact Sheet for Healthcare Providers, Molnupiravir:
https://www.fda.gov/media/155054/download
Fact Sheet for Healthcare Providers, Paxlovid:
https://www.fda.gov/media/155050/download
NIH COVID-19 Treatment Guidelines:
https://www.covid19treatmentguidelines.nih.gov/

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