COVID-19 antiviral treatments: Access and referrals

Antiviral treatments for COVID-19

Nirmatrelvir plus ritonavir (Paxlovid®) and molnupiravir (Lagevrio®) 

Nirmatrelvir plus ritonavir (Paxlovid®) and molnupiravir (Lagevrio®) are oral antiviral medications which reduce SARS-CoV-2 replication. When commenced within five days of symptom onset, in patients at high risk of progressing to severe illness, nirmatrelvir plus ritonavir and molnupiravir have been shown to reduce hospitalisations and death from COVID-19 by approximately 88% and 30% respectively.

Oral antivirals are available for eligible patients under the Pharmaceutical Benefits Scheme (PBS) for eligible patients.

Further PBS information

Remdesivir

Remdesivir is an intravenous antiviral which inhibits SARS-CoV-2 replication. When given within seven days of symptom onset remdesivir decreased hospitalisation in outpatients with mild COVID-19 by 72%. Three intravenous doses of remdesivir on consecutive days is recommended.

Remdesivir, provisionally registered in Australia for treatment of COVID-19 in adults and adolescents.

Patient eligibility

The COVID-19 Medication Management of Mild Illness in the Outpatient Setting Clinical Guideline (PDF 1415KB) provides guidance on patient eligibility criteria and treatment options.

For the latest updates to PBS eligibility, please check the Pharmaceutical Benefits Scheme (PBS) website.

Access to antivirals from the National Medical Stockpile

Remdesivir, nirmatrelvir plus ritonavir (Paxlovid®), and molnupiravir (Lagevrio®) are currently available in South Australia from the National Medical Stockpile (NMS) for patients not eligible for PBS supply. Note – the NMS is under review and this information will be updated shortly.

Note: PBS access to oral antiviral therapy including for Prescriber’s Bag supply and eligible patients who are clinically appropriate for treatment with oral medication should NOT be referred via this pathway, except where needing specific consideration of NMS treatments not available via PBS (e.g. remdesivir or non-Medicare non-PBS patients).

Refer your patient

To refer COVID-19 positive adult patients to SA Health for consideration of treatment with available medicines from the Commonwealth’s National Medical Stockpile for the early intervention of COVID-19, complete referrals through the COVID-19 Outpatient Treatment Referral Portal

This process will require information about you as the referrer and will require the patient to be on hand when entering information.

Please see the patient education information and speak to your patient regarding the treatment chosen as part of the referral process.

When not to use this form

The following patients should NOT be referred for treatment using this form:

  • Patients who are eligible for PBS supply of oral antiviral treatment AND who are clinically appropriate for treatment with oral medication, except where needing specific consideration of NMS treatments not available via PBS (e.g. remdesivir or monoclonal antibody infusions)
  • Patients under 18 years of age, or
  • Patients with a new or increased oxygen requirement. (Note: patients who are ordinarily on oxygen and do not have an increased need ARE eligible for referral).

What happens after the referral is made?

Step 1: Application submitted by referring clinician.

Step 2: Review of application by clinical team (and follow up with referrer, if required).

Step 3: If referral meets the criteria, patients who decide to proceed will be contacted by SA Health staff to discuss treatment options and arrange access to treatment.

Step 4: You will be advised by the relevant treating facility to inform you of the progress of the referral.