Expanded access to antiviral treatments for people at higher risk of severe COVID-19

To: All Physicians
Category: Physician Services
Written by: Provider Services Branch; OHIP, Pharmaceuticals and Devices Division
Date issued: April 21, 2022

Effective April 11, the Ministry of Health (the Ministry) has expanded access to COVID-19 antiviral treatments for people at higher risk of severe COVID-19, including Paxlovid (Nirmatrelvir/Ritonavir).

Individuals who develop COVID-19 symptoms (even if mild) and are at higher risk of severe COVID-19 are advised to seek testing and care immediately by contacting their primary care provider or visiting a clinical assessment centre. All physicians, including primary care providers and specialists, can prescribe Paxlovid.

Assessment and Prescribing

Treatment with Paxlovid must be started within five days of symptoms in most cases, where day 0 is the onset of symptoms.

Where possible, physicians are encouraged to prioritize assessments for patients who may be eligible for antivirals, given the timing constraints on administering treatment. This includes pre-assessing high-risk patients for eligibility for antivirals in advance of a positive COVID-19 test or symptoms.

To initiate treatment, patients must have tested positive for COVID-19. A rapid antigen test (self-administered or provider-administered), a PCR, or rapid molecular test are all acceptable testing options. Note that a negative rapid antigen test does not rule out the possibility of a COVID-19 diagnosis.

Consultation with a pharmacist experienced in managing nirmatrelvir/ ritonavir-related interactions may be helpful to mitigate any significant drug-drug interactions (including natural products). Please see guidance document “Nirmatrelvir/ritonavir (Paxlovid): What prescribers and pharmacists need to know” for more information.

Eligibility is based on clinical judgement. A patient may be higher risk of severe COVID-19, however based on a clinical assessment (and pharmacy consultation), a physician may determine that COVID-19 antiviral treatment is not appropriate for that patient.

Physicians should be aware of all available outpatient treatments for patients with mild symptoms, including, but not limited to, antiviral treatments. Alternate possible therapies include remdesivir, fluvoxamine or budesonide. Refer to the Ontario Science Table’s clinical practice guideline summary for details.

Paxlovid is available at community pharmacy locations

Beginning April 12, 2022, the Ministry is making it easier for eligible individuals with a prescription to access Paxlovid by expanding dispensing locations to include participating pharmacies across the province. A list of pharmacies that are dispensing Paxlovid is available at Ontario.ca/antivirals. The list will be regularly updated as the list of participating pharmacies expands.

The cost of Paxlovid is covered by the province at no cost to patients with a prescription.

Resources for providers

Clinical guidance on use and highest priority populations for Paxlovid and other treatments is available from the Science Advisory Table. The Science Advisory Table’s recommendations identify populations who would get the most benefit and can be used by health care providers, along with their clinical judgement, to make decisions on when to prescribe antivirals.

For more information about COVID-19 antivirals, please visit the Ministry’s COVID-19 Antiviral Treatments webpage: Ontario.ca/antivirals. Patients can also access Ontario’s antiviral screener tool to help determine if they are at higher risk and should be assessed for treatment.

Ontario Health has developed resources for primary care providers and other health care providers caring for patients in the community. Please visit Ontario Health’s website for this guidance and other COVID-19 health system response materials.

The Centre for Effective Practice also has COVID-19 clinical guidance available for primary care providers at: COVID-19: Clinical Guidance for Primary Care Providers | Centre for Effective Practice-Digital Tools (cep.health).


COVID-19 antiviral treatment; Paxlovid; COVID-19

Contact information

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