Paxlovid: A guide for B.C. pharmacists
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Last updated: August 4, 2023
Nirmatrelvir/ritonavir (Paxlovid™) is an oral antiviral drug used to treat mild to moderate COVID-19 in adults who do not require hospitalization and are at high risk of progressing to serious illness. The use of Paxlovid is complicated by the large number of clinically important drug-to-drug interactions.
PharmaCare previously paid a fee (PAX-F) to pharmacists for following up and monitoring patients for adverse drug events. The PAX-F fee ended on March 31, 2023, although pharmacists are still encouraged to exercise their clinical judgment and expertise when treating patients with Paxlovid, as with any other drug.
Like other prescription drugs, Paxlovid must be dispensed in accordance with the College of Pharmacists of BC’s Community Standards of Practice, including but not limited to patient identification, review of PharmaNet, documentation, and counselling. When dispensing Paxlovid, pharmacists should ensure they have the knowledge, skills and abilities to do so. Pharmacists are reminded to review every prescription for completeness and appropriateness, and to review patient personal health information for potential drug therapy problems or therapeutic duplications.
Pharmacies can order publicly funded Paxlovid from their regular distributors. Consider carrying adequate Paxlovid courses to reduce treatment delays, as patients need to start treatment within 5 days of symptom onset.
- Publicly funded Paxlovid is available free of charge
- Prescribers are encouraged to use the standardized nirmatrelvir/ritonavir (Paxlovid™) 5-day treatment pack prescription form
Exceptional Plan Z coverage of Paxlovid is available for any patient receiving treatment in B.C., including anyone in the wait period for MSP or who lives in another province or country.
In PharmaNet, enter:
- Drug cost: $0.01 per pack
- Dispensing fee: $10 maximum
- Quantity: 1 pack (30 tablets for Paxlovid or 20 tablets for Paxlovid-Renal)
Please double check your local system settings when first entering a claim for Paxlovid before reporting issues to the PharmaNet Help Desk.
The Full Payment Policy applies to Paxlovid. Providers may not charge patients any costs associated with the dispense of Paxlovid.
- Provide patient with a copy of BCCDC’s Paxlovid™ Patient Information sheet
- Discuss any drug interaction management plans and adjustments to other medications as necessary
- Advise the patient to contact the pharmacy if they experience adverse events or worsening of their condition
- Advise the patient to contact 911 if their symptoms worsen
For information about patient eligibility, please consult BCCDC’s Practice Tool #4.
Patients requiring renal dose adjustments
Renal dose adjustments are required for patients with an eGFR between 30 and 59 mL/min. Paxlovid is contraindicated in those with an eGFR < 30 mL/min. Pharmacies can register for CareConnect access to view lab results; refer to PharmaCare Newsletter July 2021 or details.
A renal formulation of Paxlovid is available (DIN 02527804). However, if the renal formulation is not available, the regular formulation can still be used. Remove 1 nirmatrelvir 150 mg (pink tablet) from the morning dose and 1 from the evening dose of each daily card (circled in red, below) and discard. Enter the full pack size under Quantity.
Enter “renal” at the beginning of the SIG to indicate that the dose has been adjusted.
- Example: *Renal* Take 2 tablets in the morning and 2 tablets at night for 5 days
If the patient has renal dose adjustments and DDI(s), enter “renal” and “DDI” at the beginning of the SIG.
- Example: *DDI* *Renal* Take 2 tablets in the morning and 2 tablets at night for 5 days
Patients with drug-drug interactions (DDI)
Paxlovid has many drug-drug interactions. It is recommended to refer to at least 2 interaction checkers before dispensing. Examples include BCCDC’s Practice Tool # 3, Lexicomp and University of Liverpool’s interaction checker.
Enter “DDI” in PharmaNet at the beginning of the SIG to indicate DDI(s) and associated management plans
- Example: *DDI* Take 3 tablets in the morning and 3 tablets at night for 5 days
Pharmacists dispensing Paxlovid can claim a temporary $30 clinical assessment fee (PAX-A: PIN 66128340), in addition to the standard dispensing fee. Pharmacists can claim the PAX-A fee after assessing the Paxlovid prescription, including completing a drug-drug interaction (DDI) check with two independent sources, even if no drug therapy problem is identified.
Document and communicate with the prescriber, as needed, following usual pharmacy procedures or systems. No additional documentation is required to claim the PAX-A fee, however an optional prescriber communication form is available.
The claim for the PAX-A fee must be submitted on the same day as the Paxlovid drug claim from the same pharmacy. Only one fee can be claimed per treatment course.
- Assess the Paxlovid prescription for completeness and appropriateness
- Include *DDI* and/or *Renal* in the SIG for the Paxlovid dispense where needed
- Communicate with the prescriber as needed to resolve drug therapy problems, including any DDIs or recommended management plans
- An optional form may be used to document DDIs and associated management plans.
- Submit the PAX-A claim the same day as the Paxlovid claim using PIN 66128340
|DIN / PIN||66128340|
|Drug cost, mark-up, fee (if needed)||$0|
|PRACT ID Ref||P1 – College of Pharmacists of BC|
|PRACT ID||Pharmacist College ID|
|SIG||start DDI and/or Renal (where applicable), followed by the pharmacy's 10-digit phone number|
Refusal to fill
It is recommended to ask the prescriber for a Paxlovid prescription so that a Refusal to Fill fee can be claimed if a pharmacist determines it is inappropriate or unsafe to dispense Paxlovid after the clinical assessment. When submitting a Refusal to Fill claim, document with the appropriate intervention code (such as "CI- Significant Drug Interaction (Drug-to-Drug)") to communicate to others in the patient's circle of care that an assessment has been done but the drug has not been dispensed. Pharmacists cannot claim a PAX-A fee or a dispensing fee when Paxlovid is not dispensed.
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Read about the ongoing Canadian adaptive platform trial of treatments for COVID in community settings at https://cantreatcovid.org/about/
Regional BC Cancer Centre pharmacists are available to answer questions between the hours of 8am - 4pm Monday through Friday; emails sent on weekends and statutory holidays will be responded to by a pharmacist the following working day. Refer to the table below for contacting the correct centre:
|Centre||Pharmacist consult line|
Phone: 604-851-4710 ext. 645242
Phone: 250-712-3900 ext. 686758
|Prince George||Email: email@example.com
Phone: 604-930-4002 #2
Phone: 604- 877-6098 ext. 672632
Phone: 250-519-5500 ext. 693795
St. Paul's Hospital Ambulatory Pharmacy (HIV)
Prescription form and coverage criteria
BCCDC Clinical Practice Guide and Practice Tools
Dispensing Paxlovid - A Guide for B.C. Community Pharmacists
- Where can I find the Counselling Checklist for Pharmacists?
In Practice Tool #4 on the BCCDC website
- Can I dispense Paxlovid to patients who are out of province or out of country?
As of February 14, 2022, Exceptional Plan Z coverage of Paxlovid is available for any patient receiving treatment in B.C.. They may be in the wait period for MSP, or they may live in a different province or country.
- Can patients get more than one course of Paxlovid?Paxlovid is indicated to reduce the risk of hospitalization in patients with mild to moderate COVID-19 with symptom onset within 5 days. Treatment is for a total of 5 days. If a patient remains symptomatic after 5 days of treatment, another course of Paxlovid is not indicated. Evidence does not support an additional course of Paxlovid for patients previously treated with Paxlovid who are reinfected with COVID-19.