COVID antivirals will be pharmacist-only not pharmacy-only

The Pharmaceutical Society of New Zealand has confirmed that associate health minister Ayesha Verrall made a mistake yesterday when she said COVID-19 antivirals will soon be made available as pharmacy-only medicines.

In fact, pharmacies will be able to supply the antivirals ritonavir (Paxlovid) and molnupiravir (Lagevrio) as pharmacist-only medicines, which means they will not be able to be dispensed without consultation with a pharmacist who has had appropriate training.

If the medicines became pharmacy-only, this would mean any pharmacy staff member could supply them.

During an announcement of changes to antiviral access criteria yesterday, Dr Verrall said: “We will make antiviral drugs available at pharmacies as pharmacy-only medications. This requires changes to regulation, and because these drugs have side effects we will also offer training modules before this is taken up. So this change will be phased in over the coming fortnight.”

This created confusion among pharmacists as they had been informed that morning in a PSNZ practice update that the medicines would be becoming pharmacist-only.

But today Pharmaceutical Society president Rhiannon Braund confirmed that the PSNZ email is correct, and the antivirals will be pharmacist-only.

The service specifications, required training and access criteria for pharmacy are yet to be developed, Professor Braund says.

During the briefing yesterday, minister Verrall also incorrectly stated that patients would become eligible for the antivirals at age 57 if they had tested positive for COVID, when the correct age of eligibility is anyone over 75 who had tested positive.

The Royal New Zealand College of General Practitioners, while welcoming the widening of access criteria for Paxlovid, has raised concerns around patient safety and the meeting of quality standards, issues which the college doesn’t believe have been properly addressed.

In a media release, RNZCGP president Samantha Murton says: “For many patients, their complex range of medications and health issues require a comprehensive clinical assessment before any medication is prescribed.

“We have reservations that best practice can’t be followed in this scenario and could affect people especially those on other medications or with complex medical needs.”

“The key issues around de-restricting Paxlovid are:

“1. This is a complex clinical decision when prescribing for some patients.

“2. There is currently no secure and efficient way to notify the usual prescriber that a patient has been given Paxlovid, which means there’s no safeguard to address contraindications.

“3. The proposed approach allows any health practitioner with prescribing rights to prescribe a medication that has potentially serious side effects. This is very different to how other de-restricted medications are normally prescribed.

“4. Adjusting other medications that interact with Paxlovid is a clinical decision and time needs to be taken to discuss this. Also, many patients on multiple medications may struggle to adjust to these changes.

“Until these issues are solved, the college does not agree with de-restriction, and it would not be in the interests of patient and community safety to go ahead with this. We will continue to work with Te Whatu Ora on these issues.”

Dr Verrall and the Ministry of Health have been approached for comment.