Lessons from the COVID-19 Antiviral Support Line for Clinicians

By Mark Keri, BA, CAPM

The Pharmacists in Primary Care Network Program (the Program) is pleased to have supported the roll-out of Paxlovid (nirmatrelvir/ritonavir) in BC through the COVID-19 Antivirals Support Line for Clinicians (the Support Line). Paxlovid became available in BC in February 2022 for patients who meet specific eligibility criteria.  Paxlovid is available at no charge to eligible patients while in B.C., regardless of their Medical Services Plan coverage or usual place of residence. 

Paxlovid is approved by Health Canada for patients in the community setting who test positive for COVID-19, have mild to moderate symptoms and are at high risk for severe illness. Treatment within 5 days of symptom onset reduces risk of hospitalization¹. Since ritonavir is a potent CYP3A4 inhibitor, Paxlovid is prone to many drug interactions of clinical significance.  Careful patient assessment by a pharmacist is a critical clinical step in the Paxlovid assessment process.

The Support Line was created as a bridge service in the early days of Paxlovid availability in BC to help health care providers navigate complex patient assessments, evolving eligibility requirements and processes, and the urgency of getting Paxlovid treatment started for high-risk patients.  

From its launch on Feb. 14, 2022 until its end on June 24, 2022, pharmacists from the Program handled over 500 calls to support patient assessment and appropriate prescribing of Paxlovid. The Support line received 361 calls from physicians, 103 calls from pharmacists and 39 calls from nurse practitioners.

In addition to support with appropriate prescribing and managing clinically relevant drug interactions, callers often needed help with the prescribing process and navigating Paxlovid access. Early on, the supply of Paxlovid was limited and prioritizing access was necessary, leading to frustration with changing eligibility and instructions for prescribing Paxlovid. Many prescribers did not know how to use the Paxlovid prescription form, or where to send the prescription. The team at the Support Line guided callers to locate and use the prescription form appropriately and in some cases, called multiple community pharmacies to help the prescriber find a location with Paxlovid in stock.

Later, questions about how to categorize patients by level of clinical vulnerability, and the potential need for repeat prescriptions for patients with persistent or “rebound” symptoms became more common. Throughout the time of service, the Support Line team helped callers apply criteria and guidelines to specific complex patients. 

The Support Line team learned some important lessons the past few months that are worth sharing:

1 - Comprehensive, high-quality training and resources are available from the BCCDC, The Ministry of Health, the University of Liverpool COVID-19 Drug Interactions Checker and the British Columbia College of Pharmacists.

2 – While general guidance from regulators and experts is important, individualized pharmacist assessments are necessary to support appropriate medication use in complex cases.

3 – Callers need access to pharmacists who are up-to-date on the latest information, particularly when information and processes are evolving and changing.

4 – Some patients taking cancer or HIV therapies needed extra assessment that is available via:

BC Cancer:

• 604-877-6000 x 67-2515 (voicemail only)
• Monday to Friday, 8:00 am to 4:00 pm PST; weekends 9:00 am to 5:00 pm PST

St. Paul's Hospital Ambulatory Pharmacy (HIV):

• 1-888-511-6222

As clinical guidance and processes stabilized, health care providers became more familiar with using Paxlovid, and processes for community pharmacists to claim a Paxlovid Assessment (PAX-A) were established, the need for clinical support through the Support Line lessened and the Line was stopped effective June 24, 2022. Health care providers with questions about Paxlovid for a specific patient are now encouraged to contact the patient’s local community pharmacist for assistance.  The Ministry of Health has also made a phone line available to support Paxlovid prescribers and pharmacists at 1-844-915-5055 (available Monday – Friday, 8:30 am-4:30 pm). Paxlovid is one more example of how the COVID-19 pandemic has highlighted the important role for pharmacists in the care of British Columbians.