Paxlovid (antiviral for treating COVID-19)

What is Paxlovid™?

Paxlovid™ (nirmatrelvir-ritonavir) is an oral antiviral medication for some adults who have COVID-19 that are at higher risk of severe illness.

Who is eligible to get Paxlovid™ in PEI?

Not everyone who tests positive for COVID-19 would benefit from antiviral treatment. Paxlovid™ is for individuals who have severe or moderate immunosuppression that put them at higher risk of more severe outcomes such as hospitalization or death, and who do not have any contraindications for the treatment (such as being on certain medications that can’t be used at the same time as the treatment). In 2024, most people have been vaccinated or have already had COVID-19. In comparison to the early part of the pandemic, the chances of being hospitalized or dying from COVID-19 are now very low for the general population. Unless you are moderately to severely immunocompromised, Paxlovid™ is unlikely to make you feel better faster.

You may be recommended to take anti-viral treatment, IF you have a positive test result, AND are experiencing COVID-19 symptoms that developed within the last 5 days, AND meet the criteria below:

• Age 18 and over with severe or moderate immunosuppression (regardless of COVID-19 vaccine status).

Who is considered severely or moderately immunosuppressed?

Conditions resulting in severe immunosuppression include:

• Solid organ transplant recipients
• Treatment for malignant hematologic condition
• Bone marrow, stem cell transplant or transplant-related immunosuppressant use
• Receipt of anti-CD20 agents or B-cell depleting agents (such as rituximab) in the previous 2 years
• Severe primary immunodeficiencies

Conditions resulting in moderate immunosuppression include:

• Treatment for cancer including solid tumors
• Significantly immunosuppressing drugs (e.g., biologic in the last three months, oral immune suppressing medication in the last months, oral steroid [20mg/day of prednisone equivalent taken on an ongoing basis] in the last month, or immune-suppressing infusion or injection in the last three months)
• Advanced HIV infection (treated or untreated)
• Moderate primary immunodeficiencies
• Renal conditions (i.e., hemodialysis, peritoneal dialysis, glomerulonephritis and dispensing of a steroid)

How long has Paxlovid™ been used in Canada?

Paxlovid™ received approval by Health Canada in January 2022 and was provided at no cost by the federal government to provinces and territories until May 2024.

In April 2024, the Canadian Agency for Drugs and Technologies in Health (CADTH) Canadian Drug Expert Committee (CDEC) provided new recommendations with eligibility criteria for cost coverage of Paxlovid™. Based on recent clinical and observational trials in conjunction with the estimated cost associated with one treatment of Paxlovid (~$1300 CAD), CADTH recommends that patients who test positive for COVID-19 and who are severely or moderately immunocompromised should be reimbursed for Paxlovid™.

What if I am not considered moderately to severely immunocompromised – will I still benefit from Paxlovid™?

In 2024, most people have been vaccinated or have already had COVID-19. In comparison to the early part of the pandemic, the chances of being hospitalized or dying from COVID-19 are now very low for the general population. Unless you are moderately to severely immunocompromised, Paxlovid™ is unlikely to make you feel better faster.

Do I have to pay for a Paxlovid™ prescription in PEI?

As of May 27, 2024, if you are moderately to severely immunocompromised and have been prescribed Paxlovid, you may be eligible for cost assistance under one of PEI’s publicly funded Drug Programs. Usual copays or deductibles for eligible program participants will apply.

Catastrophic Drug Program
Family Health Benefit Drug Program
Financial Assistance Drug Program
Nursing Home Drug Program
Seniors' Drug Program

Some private insurance companies may offset the cost of Paxlovid for those who are eligible.

How can I get a prescription for Paxlovid™ in PEI?

Call your family physician/nurse practitioner or a participating community pharmacist to discuss your eligibility.

The screening and prescribing process for those who may be eligible to receive the Paxlovid™ treatment can take time. If you think you meet the eligibility criteria, call a local pharmacist or your primary care provider in advance to help ensure you are screened and begin treatment within five days of experiencing COVID-19 symptoms.

What are some of the side-effects related to Paxlovid™?

Some of the most commonly reported side effects include a bad (metallic) taste in the mouth, nausea, and diarrhea. More information about side effects can be found on Health Canada’s website for Paxlovid™. Serious side effects should be reported to a healthcare provider. If you need emergency medical help, stop taking the medication and call 9-1-1.

How does Paxlovid™ work?

Paxlovid™ contains two antiviral medications co-packaged together, nirmatrelvir and ritonavir. Paxlovid™ stops the virus from multiplying. Two randomized clinical trials did not show that Paxlovid™ can reduce symptom duration or prevent COVID-19 after exposure. Currently, there is also no evidence that early treatment with Paxlovid™ for acute COVID-19 infection can prevent long-COVID. We also do not know whether Paxlovid™ prevents hospitalization of typical residents in long-term care.

What is COVID-rebound?

COVID-rebound is a term being used for a brief return of symptoms between 2 to 8 days after initial recovery from illness. The phenomenon has been observed in people who have taken Paxlovid™ although it may also occur as a normal progression of infection in some people regardless of treatment. Paxlovid™ continues to be recommended for early stage treatment of people at higher risk for severe illness and hospitalization, and there is no evidence that rebound infections are more severe or require additional treatment at this time.

Where can I find out more information about Paxlovid™?

Additional information on Paxlovid™ can be found on Health Canada’s webpage.

Currently, there are two ongoing open label trials (one in the UK and one in Canada) assessing the effectiveness of Paxlovid™ in adults testing positive for COVID-19. These studies will help to gain more information about the effectiveness of Paxlovid™ in a highly vaccinated population infected with today’s Omicron variants.