The Pharmaceutical Benefits Advisory Committee has recommended changes to the PBS eligibility criteria for both molnupiravir (Lagevrio®), and nirmatrelvir and ritonavir (Paxlovid®) effective Monday, 11 July 2022.

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.   Treatment is now recommended if commenced within five days of symptoms for the following groups:

• People 50 years of age or older, with two additional risk factors for developing severe disease;
• People 30 years of age or older, identifying as Aboriginal or Torres Strait Islander, with two additional risk factors for developing severe disease;
• People 18 years of age or older, with moderate to severe immunocompromise; and
• People 70 years of age or older (including asymptomatic cases). 
  
  

Additional information can be found in the following PBS fact sheets for Lagevrio, Paxlovid and Information for prescribers and pharmacists. Please disseminate these among your networks, to ensure all eligible consumers can be assessed for their suitability to receive treatment.

More information, including information targeting consumers, is available here.

Availability of COVID antivirals at community pharmacies

All PBS registered pharmacies must either stock or be prepared to order the COVID antivirals. If the pharmacy does not have stock on hand and a patient presents with a prescription the pharmacy may either:

• Phone other pharmacies in the area to ascertain whether they have stock. If stock was found at an alternative pharmacy, they may send the patient to the alternative store or the stock can be transferred between the stores.
• Order in stock from a wholesaler. Under the Community Services Obligation wholesalers must provide the stock within 24 hours of the regular order cut-off time. Some very remote postcodes may not receive supply within 24 hours of the order cut-off.
• Pharmacists may also wish to confirm ‘sale or return guarantee’ arrangements with their wholesaler.

Patients who are not eligible for PBS medicines may be eligible for an antiviral from the state or territory medical stockpile. State health authorities are best placed to advise on the availability and access to their stockpiles.

Confirmation of positive test

Patients referred to GPs or GPRCs through the healthdirect anti-viral pathways in NSW, QLD and SA have registered their positive RAT with their state health authority, and no further confirmation is required. GPs who are uncertain about the COVID status of their other telehealth patients may ask to view an sms/ email confirmation from the state health authority. 

The Department will continue to promote COVID anti-viral treatments to prescribers and consumers, including the changes to the eligibility criteria.