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Guidance on prescribing COVID antiviral medications

19 August 2022 | Avant Media

As doctors face escalating patient demand for COVID treatment after the expansion of the eligibility criteria for oral COVID antiviral medications, we provide advice to support correct prescribing and outline changes to telehealth arrangements.

Under the PBS authority criteria, patients with mild to moderate COVID who are at higher risk of severe illness are eligible for the two PBS subsidised antiviral medications, molnupiravir (Lageviro) and nirmatrelvir and ritonavir (Paxlovid). The medications decrease the risk of the infection becoming severe and to be most effective, treatment must start within 5 days of symptom onset.

In line with the Department of Health’s advice, where possible doctors should consider identifying potential patients in their care before they test positive for COVID so medication options can be explored and included in their care plan. However, PBS subsidised prescriptions for COVID antiviral medications cannot be written in advance.

New eligibility criteria for PBS subsidised COVID antivirals

People who are COVID positive confirmed by a PCR test or RAT, not in hospital and who are aged:

  • 70 years or older regardless of risk factors and with or without symptoms
  • 50 years or older with 2 risk factors
  • 30 years or older for Aboriginal or Torres Strait Islander people with 2 risk factors
  • 18 or older with moderate to severe immunocompromise, at risk of progression to severe disease.

For more information on the risk factors and conditions included in the definition of “moderately to severely immunocompromised,” view the PBS information:

Contraindications, risks and precautions

It’s essential that you are familiar with the contraindications for each medication you are considering prescribing. Depending on the medication, this may include pregnancy, breastfeeding, other medications and co-morbidities.

You should have a thorough discussion of the risks, precautions and benefits (including the possibility of no benefit) from the medication, along with precautions when the medication has been prescribed, and document that discussion. 

You should ensure you warn patients where there are risks associated with falling pregnant whilst taking the medications and document this in the clinical record. For example, Lagevrio is currently a category D medication in pregnancy. Document advice given to your patients regarding the recommendations for contraception both during and after treatment. For example, the current recommendation is that males use an adequate form of contraception for 3 months after treatment with Lagevrio.

For more information on the contraindications for these medications view the Lagevrio and Paxlovid factsheets.

For more information, view our FAQ: ‘What should you do when considering prescribing oral antiviral medication for treatment of COVID?’.

Requests for private prescriptions

If you are providing a PBS prescription, is important your patient fits the stipulated PBS authority criteria, and this is recorded in your clinical record.

If your patient does not fit the PBS authority criteria, you may be asked to provide a private (non-PBS) prescription. If you provide a private prescription, your patient should be informed of the significant cost, along with the risks and benefits of taking the medication.

You should only prescribe according to the TGA provisional approval – which is currently for use in adults who do not require initiation of oxygen, and who are at increased risk of progression to hospitalisation or death.

Confirming a patient is COVID positive

Patients who are COVID positive confirmed by a PCR or RAT, are eligible for PBS subsidised COVID antiviral medications, subject to the other eligibility criteria set out above.

The Health Department’s PBS compliance team advises doctors to use their clinical judgement when confirming a patient is COVID positive. This includes documenting that the patient reported being COVID positive and had symptoms.

If you know the patient well and the patient says they tested positive to COVID on a RAT, consider prescribing the antiviral medications rather than seeking more evidence.

Changes to telehealth arrangements

There have been recent changes to some MBS telehealth arrangements that recognise the potential for a higher proportion of telehealth use by doctors due to the impact of COVID.

These include deferring the introduction of the new prescribed pattern of service (30/20 phone rule) under the Professional Services Review (PSR) Scheme, which will now start on 1 October 2022. Under these new arrangements, a GP or consultant physician who provides 30 or more phone attendances on each of 20 or more days in a 12-month period would be referred to the PSR.

The 80/20 rule has also been expanded to include all face-to-face, video and phone consultations. This change commenced from 1 July 2022.

There are also two temporary MBS items available until 31 October 2022 for GPs and other medical practitioners (OMPs) working in general practice settings. These MBS item numbers are for phone consults longer than 20 minutes (over 25 minutes for OMPs) to assess patients with a current confirmed COVID diagnosis for suitability to receive a COVID antiviral.

Resources

Fact sheet: Changes to PBS eligibility for COVID treatments - Information for prescribers and pharmacists

National COVID-19 Clinical Evidence Taskforce (covid19evidence.net.au) – particularly the clinical flowchart ‘Disease-modifying treatments for adults with COVID-19’.

Royal Australian College of General Practitioners - Oral antiviral treatments for COVID-19 (racgp.org.au).

NPS MedicineWise – Antiviral treatments for COVID-19 (nps.org.au)

Australian Department of Health - Oral treatments for COVID-19 (health.gov.au). 

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