COVID-19 antivirals: Access Criteria
Access criteria current as at 14 September 2022
On this page
22 March 2023:
Pharmac is considering changes to the availability of molnupiravir. We expect to provide further details about a consultation in the week beginning 27 March.
Molnupiravir remains available for dispensing and distribution as required.
Medicine availability in New Zealand
Molnupiravir (Lagevrio): currently available but under review
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.
Rural PSO oral antivirals
Paxlovid (nirmatrelvir with ritonavir) and Lagevrio (molnupiravir) can be ordered on rural PSO.
Access criteria
COVID-19 Antivirals access criteria flowchart [PDF 1.8 MB]
Access criteria – from any relevant practitioner.
Approvals are valid for patients where the prescriber confirms the patient meets the following criteria and has endorsed the prescription accordingly:
All of the following:
- Patient has confirmed (or probable) symptomatic COVID-19, or has symptoms consistent with COVID-19 and is a household contact of a positive case;
AND - Patient’s symptoms started within the last 5 days (if considering nirmatrelvir with ritonavir or molnupiravir) or within the last 7 days (if considering remdesivir);
AND - Patient does not require supplemental oxygen#;
AND - ANY of the following:
- Patient is immunocompromised* and not expected to reliably mount an adequate immune response to COVID-19 vaccination or SARS-CoV-2 infection, regardless of vaccination status; or
- Patient has Down syndrome; or
- Patient has sickle cell disease; or
- Patient has had a previous admission to Critical Care or High Dependency care directly as a result of COVID-19; or
- Patient is aged 65 years or over; or
- Patient is Māori or Pacific ethnicity AND aged 50 years or over; or
- Patient is aged 50 years or over AND has not completed a primary course^ of COVID-19 vaccination; or
- Patient has any combination of three or more high-risk medical conditions for severe illness from COVID-19 identified by Manatū Hauora - Ministry of Health**;
AND
- Not to be used with other COVID-19 antiviral treatments.
Notes:
Consider molnupiravir or remdesivir if nirmatrelvir with ritonavir is unsuitable or unavailable
* As per Manatū Hauora - Ministry of Health criteria(external link) of ‘severe immunocompromise’ for third primary dose of COVID-19 vaccine
** People with high risk medical conditions(external link) identified by Manatū Hauora - Ministry of Health
^ ‘Primary Course’ defined as receiving at least two courses 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.
Access criteria assessment tool
We have updated the heat maps to help healthcare professionals interpret criterion 4 of the access criteria and identify eligible patients.
We will continue to monitor the evidence as it becomes available, as well as available supply and update the criteria as required.
Heat maps to identify eligible patients under criteria 4.5 to 4.8
Green boxes reflect the updated access criteria from 14 September 2022.
Table representation of the heat maps, showing numbers of high risk medical conditions needed in criteria 4.5 to 4.8
| Age less than 50 |
Age between 50 and 64 |
Age over 65 |
||
|---|---|---|---|---|
| Māori or Pacific | Completed primary course | 3 | 0 | 0 |
| Not Completed primary course | 3 | 0 | 0 | |
| Other ethnicities | Completed primary course | 3 | 3 | 0 |
| Not Completed primary course | 3 | 0 | 0 |
When people are severely immunocompromised, have Down syndrome, sickle cell disease, or previous critical care or high dependency admission directly for COVID-19 (ie. criteria 4.1 to 4.4), there is no need for any added high risk medical conditions. Below are some example scenarios for eligibility:
Examples are based on the high risk medical conditions listed on the Manatū Hauora - Ministry of Health website as of 12 September 2022. These risk factors may change over time. Please refer to the Manatū Hauora website(external link) for the most up-to-date high risk medical conditions.
Example 1: Person is Māori, aged 52 years old and has completed a primary course of vaccination.
This person meets criterion 4.6. If they meet the other criteria, then they are eligible for treatment.
Example 2: Person is of European ethnicity aged 64 years old, has completed a primary course of vaccination and has diabetes, a chronic lung condition, and a BMI over 35.
This person has three risk conditions (as on the Manatū Hauora website) and therefore meets criterion 4.8. If they meet the other criteria, then they are eligible for treatment.
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. The Access Criteria will continue to be available on Te Pātaka Whaioranga - Pharmac’s website and 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 - Health New Zealand hospitals at no cost, as they have been purchased directly by Te Pātaka Whaioranga - Pharmac. COVID-19 treatments are funded from a dedicated budget allocated by the Government. That means COVID-19 treatment costs do not come from the annual budget for New Zealand’s medicines (the Combined Pharmaceutical Budget).
Nirmatrelvir with ritonavir and molnupiravir
Nirmatrelvir with ritonavir and molnupiravir will continue to be listed in Section B and Part II Section H of the Pharmaceutical Schedule.
Supply of nirmatrelvir with ritonavir and molnupiravir is currently available to order only by selected community pharmacies and Te Whatu Ora hospitals. This process is being managed by Manatū Hauora - Ministry of Health. More information is available on the Manatū Hauora - Ministry of Health website(external link).
Supply to community pharmacies is currently managed through one wholesaler, ProPharma and Te Whatu Ora hospitals can order from OneLink as required. More deliveries will continue to arrive throughout 2022. The XPharm rule applies to these treatments in the community as Te Pātaka Whaioranga - 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.
Nirmatrelvir with ritonavir and molnupiravir have been purchased directly by Te Pātaka Whaioranga - Pharmac and there will be no standard dispensing fee or patient co-payment. Pharmacies will be reimbursed by COVID-19 Care in the Community funding through Te Whatu Ora. Information regarding the claiming mechanism for this payment to pharmacies will be available from Te Whatu Ora.
Remdesivir
Remdesivir will continue to be listed in Part II Section H of the Pharmaceutical Schedule.
Supply of remdesivir will continue as it is now and is available to order by Te Whatu Ora hospitals through OneLink. Wholesale stock is held and distributed to Te Whatu Ora hospitals by OneLink in Auckland.
Level 1 hospitals can order and administer remdesivir. Te Whatu Ora hospitals are able to provide remdesivir to both inpatients and outpatients.
Te Whatu Ora hospitals will not be invoiced for supply because this stock has been purchased directly by Te Pātaka Whaioranga - Pharmac.
More information
COVID-19 treatment portfolio (includes distribution and stock availability)(external link)
Decision to simplify Access Criteria for antiviral COVID-19 treatments (September 2022)
Schedule listing for nirmatrelvir with ritonavir (Paxlovid)(external link)