COVID-19 antivirals: Access Criteria

Access criteria current as at 18 July 2022

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8 August 2022 update: Flowchart for eligibility added 

Medicine availability in New Zealand

Molnupiravir (Lagevrio): currently available

Nirmatrelvir with ritonavir (Paxlovid): currently available

Remdesivir (Veklury): currently available

These criteria are being continually reviewed and updates will be considered as evidence is updated. Always check criteria before prescribing.

Check the COVID-19 treatment portfolio page for the latest information on availability and distribution.

Access criteria

Access criteria – from any relevant practitioner.

Approvals are valid for patients where the prescribing clinician confirms the patient meets the following criteria and has endorsed the prescription accordingly:

All of the following:

Notes:

Consider molnupiravir or remdesivir if nirmatrelvir with ritonavir is unsuitable or unavailable.

* As per Ministry of Health criteria(external link) of ‘severe immunocompromise’ for third primary dose of COVID-19 vaccine

** People with high risk medical conditions identified by the Ministry of Health(external link)

^ ‘Primary Course’ defined as receiving at least two doses of vaccination against COVID-19.

# Supplemental oxygen to maintain oxygen saturation >93% or at or above baseline for patients with chronic resting hypoxia

How to interpret the access criteria

We have developed an online tool to help you assess whether your patient is eligible for funded COVID-19 antiviral treatments under section 4 of the access criteria.

Access criteria assessment tool

We have updated the heat maps to help healthcare professionals interpret criterion 4.2 and 4.3 of the access criteria and identify eligible patients. These heat maps along with other resources have been developed to assist with interpretation of the access criteria.

Some factors in the criteria now have greater emphasis and may be counted more than once. This reflects the factors that are most predictive of poor outcomes from COVID-19 infection, including age and people who have not completed a primary course of vaccination against COVID-19.

We will continue to monitor the evidence as it becomes available, as well as available supply and update the criteria as required.

Vaccination status

In May 2022, the Ministry of Health changed the definition of what it means to be vaccinated against COVID-19 to include all recommended COVID-19 vaccinations, including any booster dose(s) if and when eligible. 

More information on what being 'up-to-date' with your vaccinations means is available on the Ministry of Health website(external link) 

From 18 July 2022, we have updated references to ‘Fully Vaccinated’ in the access criteria or guidance information below to mean that a person has completed a primary vaccination course against COVID-19. For most people this means they have received two doses of COVID-19 vaccination. 

Heat maps to identify eligible patients under 4.2 and 4.3

The following table gives this information non-visually. But the tool is probably more easily navigated by screen reader..

Table representation of the heat maps showing counts of high-risk conditions required to meet criterion 4.2 or criterion 4.3, depending on other factors 

Ethnicity Vaccination status Aged less than 50 Age between 50 and 64 Age between 65 and 74 Age 75 or over
Māori or Pacific Not completed primary course 3 0 0 0
Completed primary course 4 3 2 0
Other ethnicities Not completed primary course 4 3 0 0
Completed primary course 5 4 3 0

For clarity, no specific factors (under criterion 4.2 and criteria 4.3) are required to access these treatments. 

A person of Māori or Pacific ethnicity with any combination of at least four factors from 4.2.1. 4.2.2, 4.2.3 and 4.2.4 would meet criterion 4.2. This could include the factors named in the criteria (4.2.2, 4.2.3 or 4.2.4) or be any combination of the high-risk conditions listed on the Ministry of Health website (4.2.1).  

A person of another ethnicity with any combination of at least five factors from 4.3.1. 4.3.2, 4.3.3 and 4.3.4 would meet criterion 4.3. This could include the factors named in the criteria (4.3.2, 4.3.3 or 4.3.4) or be any combination of the high-risk conditions listed on the Ministry of Health website (4.3.1). 

Below are some examples of scenarios for eligibility: 

Please note these examples have been drafted as per the high-risk medical conditions listed on the Ministry of Health website as of 14 July 2022. These risk factors may change over time. Please refer to the Ministry of Health website(external link) for the most up to date risk factors. 

Example 1: Patient is 35 years old, has severe mental illness, diabetes that isn’t well controlled, has chronic lung disease, hypertension which isn’t well controlled and a BMI of 40.

This patient has five risk conditions (as on the Ministry of Health website) and therefore meets criterion 4.3. If the patient meets the other criteria the patient is eligible for treatment. 

Example 2: Patient is of Māori ethnicity aged 55 and has not completed a full course of vaccination.

This patient has four factors and therefore meets criterion 4.2. If the patient meets the other criteria the patient is eligible for treatment. 

Example 3: Patient is of Pacific ethnicity aged 68, has hypertension and diabetes and has completed a primary course of vaccination (at least two doses of vaccination against COVID-19).

This patient has four factors and therefore meets criterion 4.2. If the patient meets the other criteria the patient is eligible for treatment. 

Example 4: Patient is immunocompromised and is not expected to reliably mount an adequate immune response to COVID-19 vaccination or SARS-CoV-2 infection, regardless of vaccination status. This patient meets criterion 4.1.1. If the patient meets the other criteria the patient is eligible for treatment. 

For clarity, no specific factors (under criterion 4.2 and criteria 4.3) are required to access these treatments. 

A person of Māori or Pacific ethnicity with any combination of at least four factors from 4.2.1. 4.2.2, 4.2.3 and 4.2.4 would meet criterion 4.2. This could include the factors named in the criteria (4.2.2, 4.2.3 or 4.2.4) or be any combination of the high-risk conditions listed on the Ministry of Health website (4.2.1).  

A person of another ethnicity with any combination of at least five factors from 4.3.1. 4.3.2, 4.3.3 and 4.3.4 would meet criterion 4.3. This could include the factors named in the criteria (4.3.2, 4.3.3 or 4.3.4) or be any combination of the high-risk conditions listed on the Ministry of Health website (4.3.1).  

Information for people with COVID-19

If you have, or suspect you have COVID-19 and are at high risk of developing severe illness from COVID-19, test early and please get in touch with your health care provider. They are best placed to let you know what your treatment options are. Treatments must be started within short timeframes from onset of symptoms. You can find more information on the Ministry of Health website(external link)

Pharmacists can now dispense funded Paxlovid and Lagevrio without a prescription. You will still need a clinical assessment. These medicines may not be appropriate for everyone, even if you meet Pharmac’s eligibility criteria.

Read the Te Whatu Ora media release(external link) about this change or talk to your pharmacist for more details.  

Accessing supply of antiviral treatments

Access to antiviral treatments will continue under the current arrangements that are in place. 

The antiviral COVID-19 treatments are not accessed via a standard Special Authority. Instead, prescriptions must be endorsed by the prescriber confirming that the patient meets the Access Criteria. These Access Criteria are linked to Health Pathways. This approach allows us to easily make changes to the criteria if required in a timely manner. 

Antiviral treatments are supplied to pharmacies and Te Whatu Ora Hospitals at a cost of $0. The XPharm rule applies to these treatments in the community as Pharmac has purchased these medicines directly. Community pharmacies are not able to claim subsidy through normal claiming systems as alternative funding arrangements have been established.  There is no standard dispensing fee or patient co-payment. Pharmacies will be reimbursed by COVID-19 Care in the Community funding through Te Whatu Ora District Offices. Information regarding the claiming mechanism for this payment to Pharmacies is available from Te Whatu Ora District Offices.

Paxlovid and (Lagevrio) molnupiravir 

Supply is available to order only by selected community pharmacies and Te Whatu Ora Hospitals. This process is being managed by the Te Whatu Ora. (external link) More information is available from the Ministry of Health(external link)

Supply to community pharmacies is currently managed through one wholesaler, ProPharma. Te Whatu Ora Hospitals can order from Onelink as required.

More deliveries will continue to arrive throughout 2022 and the access criteria have been designed to help to support prescribers to target treatment to those most in need and most likely to benefit.

Remdesivir

Remdesivir will continue to be listed in Part II Section H of the Pharmaceutical Schedule.

Access to remdesivir will continue as it is now. Supply is managed through one wholesaler, OneLink. Te Whatu Ora hospitals can order stock direct from Onelink.

Level 1 hospitals are able to order and administer remdesivir and Te Whatu Ora Hospitals are able to provide remdesivir to both inpatients and outpatients. 

Te Whatu Ora Districts will not be invoiced for supply because this stock has been purchased directly by Pharmac.  

For more information visit our COVID-19 treatment portfolio page. 

More information

COVID-19 treatment portfolio (includes distribution and stock availability)(external link) 

Updated Access Criteria for antiviral COVID-19 treatments

Schedule listing for nirmatrelvir with ritonavir (Paxlovid)(external link)

Schedule listing for molnupiravir (Lagevrio)(external link)