COVID-19 oral antiviral PBS eligibility criteria update – November 2022

On 1 November 2022, changes were made to the General Schedule (S85) Authority Required (Streamlined) listings for specific patient groups with mild-to-moderate COVID-19 at high risk of progressing to severe disease for two oral antiviral medicines:^1,2

• molnupiravir (Lagevrio)
• nirmatrelvir plus ritonavir (Paxlovid).

The listing changes were recommended at the November 2022 PBAC Meeting where the PBAC considered options to support the use of these COVID-19 oral antivirals for patient populations.

1 November 2022

For people at least 18 years of age who are 'moderately to severely immunocompromised', the population criteria have been expanded to include those with^1,2:

• any significantly immunocompromising condition(s) where, in the last 12 months the patient has received an anti-CD20 monoclonal antibody treatment

For people aged ≥ 30 years and who identify as Aboriginal or Torres Strait Islander, the patient population criterion: High risk, was expanded to include the following condition^1,2:

• past COVID-19 infection episode resulting in hospitalisation

Currently, for the clinical criteria around COVID-19 testing^1,2:

• Patient must have received a positive polymerase chain reaction (PCR) test result; OR
• Patient must have received a positive rapid antigen test (RAT) result

The population criteria were updated to include a note that states: “Where a RAT is used to confirm diagnosis, available information about the test result, testing date, location and test provider (where relevant) should be recorded on the patient record”.

For the molnupiravir listing^1,2:, an administrative note has been added, stating that molnupiravir should be considered for use only if nirmatrelvir and ritonavir is contraindicated or otherwise unsuitable.

Authority Required (Streamlined) code changes

Changes to Authority Required (Streamlined) codes from the 1 November 2022 to the 1 January 2023 are in the table below^1,. These changes to the Schedule of Pharmaceutical Benefits are effective from 1 January 2023.