Paxlovid™ Resources for Pharmacists

British Columbia has funded the oral antiviral drug Paxlovid™ (nirmatrelvir/ritonavir) to treat mild-to-moderate COVID-19 in adults who do not require hospitalization and are at high risk of progressing to serious illness. Select community pharmacies will be able to dispense Paxlovid™

This page is a resource for B.C. community pharmacists for information on Paxlovid™.

Expiry Date Extensions

In June 2023, Pfizer Canada issued updates to its extension on shelf life for Paxlovid™ from 18 months to 24 months. Please see detailed list of affected lot numbers and extended expiry dates here.

Disposal:
Pharmacies with expired Paxlovid™ kits can dispose of them using their regular drug disposal processes. 

Paxlovid™ Coverage under Plan Z (Assurance) for B.C. residents

As of May 28, 2024, PharmaCare has listed Paxlovid under Plan Z to replace the federal government supply which ended in March 2024. Plan Z (Assurance) will provide full coverage of Paxlovid for B.C. residents with active Medical Services Plan (MSP) coverage. Exceptional Plan Z coverage (e.g., patients who live outside of B.C. or Canada) for Paxlovid will no longer be available. As the federal government supply is no longer provided, pharmacies are to obtain Paxlovid supplies from their wholesaler.

Pharmacists and prescribers are reminded that Paxlovid is only beneficial to patients considered at higher risk of progressing to serious illness, such as those who are severely immunosuppressed.

The Ministry of Health has added prescribing guidance to the Paxlovid prescription eForm that prescribers are strongly encouraged to use.

More information is available PharmaCare newsletter from May 28.

Please note: the BCPhA has recently retired the Paxlovid community pharmacy listing formerly found on bcpharmacy.ca.

Apr. 10, 2024

As recently encouraged in the PharmaCare Newsletter, pharmacies are asked to continue to support patient access to public Paxlovid supply across B.C.’s urban and remote areas as the federal government winds down its Paxlovid program. Pharmacists are encouraged to order only what is needed and try to help people find supply if they are out of stock.

Most distributors still have some supply of the renal impairment dose packs that will expire on May 31, 2024. These can continue to be dispensed until May 26, 2024 (to account for the 5 days of treatment).

BC PharmaCare continues to work on listing the commercial supply as a program benefit before the federal stock expires.

Adjusting Paxlovid packages

To use renal impairment dose packaging (DIN: 02527804) for patient requiring full dose:

  • Dispense 2 renal impairment dose packages. From 1 package, remove 1 ritonavir 100 mg (white tablet) from both the morning and evening dose of each daily card and discard the extra ritonavir tablets

Disposal of expired product

  • Pharmacies that still have any inventory of the federal supply that expired in March 2024 should dispose of it as they would normally dispose of medications in their pharmacy, usually through a medication disposal bin. Do not return expired product to the distributor

For more information, please see the Paxlovid: Guidance for B.C. Pharmacists.

Feb. 7, 2024

Temporary $30 Paxlovid assessment ended Dec. 31, 2023

The temporary $30 Paxlovid assessment fee (PAX-A) ended on Dec. 31, 2023. PAX-A was introduced with the advent of Paxlovid, in June 2022, for pharmacist assessment of complex patients prescribed Paxlovid. The fee accounted for the time required, in the midst of the pandemic, to review and assess multiple drug-drug interaction (DDI) checks and to support prescribers and patients in managing DDIs.

Paxlovid follow-up fee ends 

The Paxlovid temporary follow-up fee (PAX-F) ended on March 31, 2023. The information collected by B.C. pharmacists through the PAX-F initiative played an important role in Paxlovid pharmacovigilance and monitoring. The data collected is now sufficient for evaluation purposes, and results will be reported in the future. For full details see PharmaCare newsletter March 2023. 

PharmaCare is continuing the PAX-A fee until the end of 2023. Watch for advance notice in future PharmaCare Newsletters about the end of PAX-A. 

Refusing to fill Paxlovid™

If a pharmacist determines it is inappropriate or unsafe to dispense Paxlovid to a patient with a valid prescription, they may claim a refusal to fill fee. Pharmacists cannot claim the PAX-A fee or a dispensing fee when Paxlovid is not dispensed. 

Ordering Paxlovid™

Pharmacies can order Paxlovid directly through their distributor. Pharmacists should review Paxlovid: A guide for B.C. pharmacists available on the Ministry of Health's website.

The order minimum for Paxlovid is 5 kits. Pharmacies with inventory will be listed on the BC Pharmacy Association website. If your pharmacy is out of inventory (based on orders and dispenses) your pharmacy will be removed from the list.

March 23, 2022

The eligibility criteria for Paxlovid™ is available on the BCCDC website. An updated prescription form is also available. 

PharmaCare has stated pharmacists are only following up on 45% of eligible Paxlovid™ dispenses. Pharmacists are required to follow up with the patient and bill in PharmaNet on day 6 to 10 after the date of dispense of Paxlovid™. 

When counselling a patient, inform them that a pharmacist will call them within this timeframe for follow-up and monitor any adverse drug events (ADEs). If the patient cannot be contacted/reached after 3 attempts, please document in the patient’s profile on your local system as usual. 

During the follow-up, record the number of days therapy was completed, and if stopped early, the reason for stopping. Document any ADEs, including the severity and management of each ADE. A temporary $15 PAX-F Clinical Service fee for follow-up can be claimed per Paxlovid™ course. The Association has provided a Paxlovid SIG follow-up claim template pharmacies may use for this purpose. 

PharmaCare states a small number of claims so far have contained errors in the SIG code used to document follow up. The most common omission is a missing ‘Stopped Early/ Reason’ code (i.e. NA – Not stopped early- Adverse Effects). 

  • Example: 888-348-9284_5_ADE1MP should be 888-348-9284_5_NA_ADE1MP indicating the patient did not stop early but did experience ADEs.

For more information on the procedure for follow-up, documentation, and how to enter data in PharmaNet, refer to Dispensing Paxlovid and Monitoring Adverse Drug Events: A Guide for B.C. Community Pharmacists. 

A reminder that publicly funded Paxlovid™ is available free of charge to eligible patients for the treatment of mild to moderate COVID-19 and to prevent hospitalization. Pharmacies need to order the product directly from their regular distributor in advance. 

Since the drug should be started within 5 days of symptom onset to be effective, participating pharmacies are required to have 1 treatment course in your pharmacy in case you receive a prescription. After you receive the product, prescribers will be able to locate your pharmacy on the list of pharmacies that stock the medication when determining where to fax the prescription. 

Resources