Three antiviral therapies are currently FDA approved or authorized for outpatient treatment of COVID-19 infection and recommended by the NIH COVID-19 Treatment Guidelines Panel. They are not approved for pre- or post-exposure prophylaxis. Importantly, they retain full activity against the current variant mix in California.
Note: The FDA has removed the requirement for a positive SARS-CoV-2 viral test in order to prescribe these medications. Although the agency still strongly recommends the use of viral testing to help diagnose COVID-19 this change allows for providers to consider treatment in the rare instances where an individual with a known exposure who develops signs and symptoms consistent with COVID-19 presents with a negative test. See FDA product specific FAQs for more information.
|Antiviral Medication (in order of preference)
|Mode/duration of Administration
|Start time from symptom onset
|Approved (adults) EUA (age 12-17)
|Oral twice daily for 5 days
|Age ≥12 who weigh ≥40kg
EUA fact sheet
|IV infusion daily for 3 days
|Adults and children age ≥28 days who weigh ≥3kg
|Oral twice daily for 5 days
|Adults ≥18 (not recommended in pregnancy)
Paxlovid (nirmatrelvir tablets and ritonavir tablets, co-packaged for oral use), given within 5 days of symptom onset, is the preferred treatment for adults and pediatric patients (12 years of age and older weighing at least 40 kg) with symptomatic COVID-19 and risk factors for progression. It is taken orally twice a day for 5 days.
Most commonly used medications can be safely co-administered with Paxlovid
- Paxlovid can alter the concentrations of other drugs, so it is important to assess for potential drug-drug interactions.
- Many commonly used medications can be safely co-administered with Paxlovid despite its drug-drug interaction potential. See NIH guidance Drug-Drug Interactions Between Ritonavir-Boosted Nirmatrelvir (Paxlovid) and Concomitant Medications and the Liverpool COVID-19 Drug Interactions website
- The Infectious Disease Society of America offers guidance on simple steps that can be taken to avoid significant interactions with commonly prescribed medications, such as brief suspension or dose reduction.
HHS Paxlovid website includes prescribing information, FAQs, and other resources for providers and patients.
English | Español | 简体中文 | 繁體中文 | العربية | հայերեն | អក្សរខ្មែរ | 日本語 | Русский | Tiếng Việt | فارسى | Tagalog
Paxlovid Patient Assistance Program (PAP):
- Through December 31, 2024, individuals covered under federal programs, such as Medicare or Medicaid, and uninsured patients are eligible for the PAP and can receive Paxlovid at no cost.
- This includes all patients publicly insured through Medicare (with or without Part D, Part B, or Part C and inclusive of Medicare Advantage), Medicaid/CHIP, TRICARE, and patients insured through the VA Community Care Network.
- Participating PAP dispensing sites will be reimbursed for any product dispensed, along with a dispensing fee.
- Retail pharmacies that would like to learn more about participating in the USG PAP can email the program vendor at PharmacyNetworkContract102101@assistrx.com.
- Concurrently, Pfizer is operating a Paxlovid Co-Pay Savings Program for eligible privately (commercially) insured patients.
- The Co-Pay program is accessible through Paxlovid.com for patients and Paxlovid.pfizerpro.com for health care providers.
- USG distributed EUA-labeled product with an expiration date of December 2023 or later is eligible to be returned via the Pfizer return process. For each course of EUA-labeled Paxlovid that is returned, Pfizer will provide the USG with a credit for an NDA-labeled course.
- These "refreshed" courses will supply a USG PAP operated by Pfizer and will also supply federal entities.
- Returns will be accepted through January 31, 2024.
Other resources: Pharmacist Authority to Prescribe
Remdesivir (Veklury) is the only treatment approved for children under 12 years of age. It is given as an IV infusion for a total of 3 days initiated as soon as possible and within 7 days of symptom onset.
In clinical trials, remdesivir reduced the risk of hospitalization or death by 87% among high-risk unvaccinated patients with COVID-19 treated within 7 days of symptom onset (Gottlieb, 2021).
Given the emergence of variants resistant to mAbs, providing remdesivir in the outpatient setting may be of particular importance for facilities and providers that see large numbers of immunosuppressed patients such as transplant and oncology centers, or high-risk pediatric populations. Providers are encouraged to order remdesivir to have on hand for patients unable to take Paxlovid.
- FDA approved for the treatment of COVID-19 in adults and pediatric patients (28 days of age and older weighing at least 3 kilograms) who are:
- Hospitalized, or
- Not hospitalized and have mild-moderate COVID-19 and are at high risk for progression to severe COVID-19, including hospitalization and death.
Note: In December 2022, the FDA revised the remdesivir labeling to remove having a positive SARS-CoV-2 viral test result from the indication.
- For information regarding purchasing or how to access remdesivir, please email email@example.com, or call 1-800-746-6273 or reach out directly to your AmerisourceBergen representative.
- HHS is asking providers who administer outpatient Veklury (remdesivir) to add their infusion site to the COVID-19 Therapeutics Locator in order to improve public awareness and product access. Only information provided by the infusion site will be visible on the locator. Infusion sites can opt out of being on the locator at any time. Infusion sites can learn more and opt into the therapeutics locator here.
- CMS has created the Healthcare Common Procedure Coding System (HCPCS) code J0248 for reimbursement when administered in an outpatient setting. This code is available for use by all payers and is effective for dates of service on or after December 23, 2021. Additional information is available here.
Molnupiravir (Lagevrio) is authorized as an alternative therapy when Paxlovid and remdesivir are not available, feasible to use, or clinically appropriate. It is given as 800 mg (four 200 mg capsules) taken orally every 12 hours for 5 days. Treatment started as soon as possible after diagnosis of COVID-19 and within 5 days of symptom onset.
- Molnupiravir is a nucleoside analogue that inhibits SARS-CoV-2 replication by viral mutagenesis.
- Due to concern for side effects and decreased risk reduction compared to other available medications, molnupiravir should only be used if other treatments are not available or not clinically appropriate.
- Guidance is now available on the provider fact sheet for the preparation and administration of molnupiravir via nasogastric and orogastric tube.
- Several studies have shown a risk reduction in severe disease after molnupiravir treatment with the most significant benefit in those at highest risk or elderly (≥75 years of age). In addition, there is evidence of more rapid symptom resolution and viral load reductions in people treated with molnupiravir. See table below.
- Use in adults 18 and older only. Not recommended in pregnancy. If the provider and patient choose to use the product during pregnancy, it is advised that the patient be registered in the Merck Pregnancy Surveillance Program.
- Females of childbearing potential should use a reliable method of contraception correctly and consistently, as applicable, for the duration of treatment and for 4 days after the last dose of molnupiravir.
- Males of reproductive potential who are sexually active with females of childbearing potential should use a reliable method of contraception correctly and consistently during treatment and for at least 3 months after the last dose.
- Providers should carefully review the Fact sheet for health providers before prescribing to ensure that the patient’s condition warrants treatment, that there are no drug interactions, and that there are contraindications to therapy.
Lagevrio Patient Assistance Program:
- The Merck Patient Assistance Program (a 501c3 non-profit organization) provides Lagevrio free of charge to patients who meet its eligibility criteria and who, without assistance, could not otherwise afford the product.
- This product is ONLY available through an URGENT NEED request. Health Care Providers must call 800-727-5400 and tell the program representative that they are making an Urgent Need Request for LAGEVRIO.
- You may also check eligibility on MerckHelps.
- If you are interested in procuring free USG supplied product as you continue to build out your transition plans to the commercial market, please contact DPH-Therapeutics@ph.lacounty.gov. If you already receive weekly surveys from the DPH therapeutics team you can also request free USG doses through that process. We will continue to support the provider community while our supplies last. Providers will have to attest that doses will be offered free of charge and that they are not already receiving free doses from other government sources.
- Commercial products can be obtained through your preferred wholesale distributor.
- This information is intended for medical providers. Information for the public is available here.
- Patients who are unable to access oral COVID-19 therapeutics through their own provider or who do not have health insurance can be referred to a Test to Treat program or the DPH Public Health Call Center/Tele-Health service, which provides testing, consultation, and prescriptions. 1-833-540-0473 - open 7 days a week, 8:00 am-8:30 pm.