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

On 1 September 2022 and 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).

See the NPS MedicineWise RADAR article Changes to COVID-19 oral antiviral PBS eligibility criteria – July 2022 for more details about the medicines and PBS listings.

1 September 2022

The clinical criterion:^3,4

• patient must not require hospitalisation at the time of prescribing
  
  was changed to:

• patient must not require hospitalisation for COVID-19 infection at the time of prescribing.

The purpose of the change was to clarify that treatment of patients who are hospitalised for another condition and test positive to COVID-19 while in hospital, are permitted to access these two oral antivirals through the PBS provided they meet the remaining eligibility criteria.^3,4

1 November 2022

For people aged ≥ 30 years and who identify as Aboriginal or Torres Strait Islander, the patient population criterion:^1,2

• high risk is defined as the presence of at least two of the following conditions
  
  was changed to:

• high risk is defined as the presence of at least one of the following conditions.

The listing change was recommended at the September 2022 PBAC Meeting where the PBAC considered options to support the use of these COVID-19 oral antivirals for patient populations who are ‘unvaccinated’ or ‘sub-optimally vaccinated’.⁵

Authority Required (Streamlined) code changes

Changes to Authority Required (Streamlined) codes on 1 September 2022 and 1 November 2022 are in the table below.^1,2,6