Private antivirals for covid: what GPs need to know

EXCLUSIVE: A course costs at least $1000 on private prescription but GPs can prescribe it to patients prepared to pay.

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GPs should “use their own judgment” when asked to privately prescribe covid antivirals says RACGP President Adjunct Professor Karen Price.

The Department of Health and Aged Care has confirmed that doctors can prescribe the antivirals to patients who have not tested positive to covid and/or do not meet the criteria for a PBS-subsidised course of the drugs – although they will be required to pay the full cost of at least $1000.

“Clinicians need to use their own judgement as to the appropriateness of a private prescription, and remember you are under no obligation to privately prescribe, just as with any medicine,” Professor Price told The Medical Republic.

“Patients who request a private prescription need to cover the full market cost of the medicine, they won’t receive the subsidy from the pharmaceutical benefits scheme.

“And it’s also important to keep in mind that, while private prescriptions are allowed, the priority is to ensure that eligible people can access these medicines, so stock and resources should be prioritised for those most at-risk and in need of these treatments.”

The clarification follows a recent primary care covid response webinar hosted by deputy chief medical officer Professor Michael Kidd. In a Q&A session he was asked whether patients aged 60 years and over could request a prescription for antiviral treatment if they were travelling overseas.

“They can request it and you can write a private prescription,” Professor Kidd said.

“You may not write a PBS authority prescription for someone who does not have a positive PCR or rapid antigen test medically verified. But you can write a private prescription. It will cost them $1000-plus for a course of antivirals if they wanted to take that with them.

“Obviously we are prioritising the oral antiviral treatments through to people who are actively infected with covid-19 and need those treatments right now.”

Professor Price said the eligibility criteria to access these covid antivirals molnupiravir (Lagevrio) and nirmatrelvir-ritonavir (Paxlovid) via the PBS was recently expanded to include people 70 years and over, people 50 years and over (or Aboriginal and Torres Strait Islander people 30 years or over) with two or more risk factors for severe disease, and immunocompromised people 18 years or over – all of who must test positive to covid to be eligible.

“Oral antivirals are an important breakthrough in our fight against covid-19,” she said.

“As the Department of Health has stated, GPs are able to privately prescribe these oral treatments to patients who make a request but do not meet the eligibility criteria – such as people who want a prescription prior to travel.”

A Department of Health and Aged Care spokesman pointed to the PBS eligibility criteria for Lagevrio and Paxlovid, and reaffirmed that patients must have received a positive PCR test or RAT (verified by a medical practitioner or nurse practitioner) to be eligible for the subsidised drugs.

“Doctors can also write a private (non-PBS) prescription for these products,” he told The Medical Republic.

“In this case, the PBS criteria do not apply and it is up to the prescriber’s professional judgement as to whether prescription of the product is suitable for a given patient. 

“This includes professional judgement about evidence of covid-19 infection. There is no subsidy for non-PBS scripts, individuals have to pay the full price of the drugs. The government does not control the prices of medicines on the private market. 

“In its communication to peak medical groups, the Department of Health has emphasised the importance of prioritising PBS usage over private scripts, to ensure adequate supply of products remains available for patients at higher clinical needs and who meet the PBS eligibility criteria.” 

In addition to supplying the drugs through the PBS, the federal government has deployed supplies of both antivirals to all state and territory health departments through the National Medical Stockpile for supply to high priority groups.

The government also pre-placed supplies in residential aged care facilities (Lagevrio only), Aboriginal Community Controlled Health Services and the Royal Flying Doctor Service to ensure the most vulnerable can readily access these treatments across Australia, the spokesman said.

In the webinar, Professor Kidd revealed about 150,000 courses of Paxlovid or Legavrio have been dispensed through community pharmacy on PBS authority, written by GPs or authorised nurse practitioners.

About 33,000 of those were in the seven days to July 28. Of the total, 123,000 prescriptions have been for Lagevrio, and 27,000 have been Paxlovid.

Some 9.2 million covid cases have now been reported in Australia, with more than 8.8 million of these occurring in 2022. There have been more than 11,300 deaths, more than 9000 of those occurring this year.

“The number of people in hospital with covid is stabilising,” Professor Kidd said.