Expanded Eligibility Criteria for Covid Oral Antiviral Treatments

Australian Medical Association

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.

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.

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). 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.

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

Further information including a list of risk factors can be found on the Department of Health’s website.

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