COVID-19 antivirals: Access Criteria
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Update: 13 May 2022
Medicine availability in New Zealand
Molnupiravir (Lagevrio): available from 5 May 2022
Nirmatrelvir with ritonavir (Paxlovid): currently available
Remdesivir (Veklury): currently available
These criteria are being continually reviewed and may be updated if evidence is updated and/or stock levels allow. Always check criteria before prescribing.
Check the COVID-19 treatment portfolio page for the latest information on availability and distribution.
Following the arrival of molnupiravir in New Zealand, we have widened access to three antiviral medicines used to treat COVID-19 from 5 May 2022. This means many more New Zealanders will be able to access these medicines. It is now easier to meet the access criteria for some at risk patient groups.
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:
- Patient has confirmed (or probable) symptomatic COVID-19, or has symptoms consistent with COVID-19 and is a household contact of a positive case;
- 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);
- Patient does not require supplemental oxygen#;
- The patient meets ONE 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;
- Patient has at least FIVE of the following factors:
- Any combination of high-risk medical conditions for severe illness from COVID-19 identified by the Ministry of Health** (with each individual condition counting as one factor)
- Māori or any Pacific ethnicity (counts as one factor)
- Patient is aged 65 years and over (counts as two factors, or three if patient has not completed a full course of vaccination), or is 50 years and over (counts as one factor)
- Patient has not completed a full course of vaccination*** (counts as one factor);
- The patient meets ONE of the following:
- Not to be used in conjunction with other COVID-19 antiviral treatments.
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
** People with high risk medical conditions identified by the Ministry of Health(external link)
*** ‘Fully Vaccinated’ defined as per the Ministry of Health definition.(external link)
# 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.
We have prepared heat maps to help healthcare professionals interpret criterion 4.2 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 are now weighted and may be counted more than once. This reflects the increased risk of severe COVID-19 for people aged 65 years and over and those who have not completed a full 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.
Table representation of the heat map to indicate the number of risk conditions required (as per criteria 4.2.1) to meet criteria 4.2 depending on other factors
50 and 64
65 and over
|Other ethnicities||Fully vaccinated||5||4||3|
|Not fully vaccinated||4||3||1|
|Māori or any Pacific ethnicity||Fully vaccinated||4||3||2|
|Not fully vaccinated||3||2||0|
For clarity, no specific factors (under criterion 4.2) are required to access these treatments. A person with any combination of at least five factors from 4.2.1. 4.2.2, 4.2.3 and 4.2.4 would meet criteria 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 medical conditions listed on the Ministry of Health website (4.2.1).
Example scenarios for eligibility
These examples include high-risk medical conditions listed on the Ministry of Health website on 7 April 2022. These conditions may change over time. Refer to the Ministry of Health website(external link) for the most up to date information.
To be eligible, a patient must meet criteria 1. 2. 3. & 5 and have the factors required in 4.
Example 1: Patient is Māori, aged 65 and has not completed a full course of vaccination. This patient meets criterion 4.2 and requires zero high-risk medical conditions to meet criteria because they meet other factors listed in 4.2.2, 4.2.3 and 4.2.4.
Example 2: Patient has severe mental illness, diabetes that isn’t well controlled, has chronic lung disease, hypertension, and a BMI of 40.
This patient has five high risk medical conditions (as listed on the Ministry of Health website) so they meet criterion 4.2.1.
Example 3: Patient is aged 67 and fully vaccinated, has chronic kidney disease, hypertension and a BMI of 37. Because of their age and vaccination status, having three high-risk medical conditions means they meet criterion 4.2.
Example 4: Patient is aged 73 and has not completed a full course of vaccination and has a chronic neuromuscular disease. Because of their age, ethnicity and vaccination status, their one high-risk medical condition means they meet criterion 4.2.
Example 5: 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.
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 DHB 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 DHBs. Information regarding the claiming mechanism for this payment to Pharmacies is available from DHBs.
Paxlovid and (Lagevrio) molnupiravir
Supply is available to order only by selected community pharmacies and DHB Hospitals. This process is being managed by the Ministry of Health. More information is available on the Ministry of Health website [PDF](external link)
Supply to community pharmacies is currently managed through one wholesaler, ProPharma. DHB 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.
Access to remdesivir will continue as it is now. Supply is managed through one wholesaler, OneLink. DHB hospitals can order stock direct from Onelink.
Level 1 hospitals are able to order and administer remdesivir and DHB Hospitals are able to provide remdesivir to both inpatients and outpatients.
DHBs will not be invoiced for supply because this stock has been purchased directly by Pharmac.
Currently remdesivir is not listed on in the Pharmaceutical Schedule because it has been supplied to DHBs under special arrangements. We intend to list remdesivir in Part II Section H of the Pharmaceutical Schedule from 1 June 2022. Remdesivir would be listed subject to the same restriction as Paxlovid and molnupiravir.
For more information about distribution and stock availability visit our COVID-19 treatment portfolio page.