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. 

Overview

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