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™.

Overview

June 13, 2022

As of June 13, pharmacists dispensing Paxlovid™ can claim an additional assessment fee in addition to the standard dispensing fee. In addition, the follow-up fee is increasing.

New temporary $30 assessment fee (PAX-A)

The new fee takes into account Paxlovid’s complexity, the potential for drug-drug interactions (DDIs), and the extra time needed for clinical assessments.

The PAX-A fee can be claimed following an assessment of the Paxlovid prescription. This must include a DDI check with two independent sources, even if no drug therapy problem is identified.

  1. Assess the Paxlovid prescription for completeness and appropriateness
  2. Include *DDI* or *Renal* in the SIG field for the Paxlovid dispense, as needed
  3. Communicate with the prescriber as needed to resolve drug therapy problems, including any DDIs and recommended management plans 
  4. Keep records as usual -- an optional form in Appendix C in the Dispensing Paxlovid and monitoring adverse drug events: A guide for B.C. pharmacists guide may be used to document DDIs and associated management plans but is not required
  5. Submit the PAX-A claim the same day as the Paxlovid claim using PIN 66128340 
  • Enter the PAX-A PIN 66128340 in the DIN/PIN field
  • If necessary, enter $0 for drug cost, mark-up and fee
  • Enter 1 in the QTY field
  • In the PRACT ID Ref field, enter P1 – College of Pharmacists of BC 
  • In the PRACT ID field, enter your College ID
  • At start of SIG, enter the 10-digit phone number of the pharmacy where the service took place

Increased follow up fee of $25 (PAX-F)

As of June 13, 2022, the PAX-F fee will increase from $15 to $25. Follow-up should be conducted with the patient or caregiver 6 to 10 days after dispensing Paxlovid.

  1. All relevant information must be recorded in the SIG of the PAX-F claim using the codes outlined in Appendix A of the Dispensing Paxlovid and monitoring adverse drug events: A guide for B.C. pharmacists
  2. Moderate and severe ADEs must be recorded in the Adverse Reaction field in PharmaNet
  3. Follow-up and additional clinical information may be documented separately, following usual pharmacy procedures, systems, or forms already in place. A form in Appendix B in the Dispensing Paxlovid and monitoring adverse drug events: A guide for B.C. pharmacists may be used as a follow-up tool, but is not required

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, but not the PAX-A fee.

Ordering Paxlovid™

Pharmacies can order order directly through their distributor. Pharmacists should also have reviewed the Dispensing Paxlovid and monitoring adverse drug events: A guide for B.C. pharmacists guidance, which is 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. 

Other Resources