How to Get Paxlovid for COVID-19 Treatment

Since the start of the COVID-19 pandemic, antiviral treatments like Paxlovid have become crucial in managing the disease, especially for those at high risk of severe illness. With ongoing advancements in COVID-19 treatments, Paxlovid offers a promising option to reduce the risk of hospitalization and death when taken early. This article provides an overview of Paxlovid's role in the current landscape of COVID-19 care.

What Is Paxlovid?

Paxlovid is an oral antiviral medication. It comes as a kit containing two medications: nirmatrelvir and ritonavir. The pharmaceutical company Pfizer developed Paxlovid during the COVID-19 pandemic and was granted emergency use authorization (EUA) by the FDA to lower the risk of hospitalization and death in severely ill people.

How Does Paxlovid Work?

Nirmatrelvir is a protease inhibitor that blocks the action of an enzyme that the SARS-CoV-2 virus needs to replicate in the human body. Ritonavir is a cytochrome P450-3A inhibitor that is also used to treat human immunodeficiency virus (HIV). Ritonavir boosts the effects of nirmatrelvir by decreasing nirmatrelvir’s breakdown so that it stays in the body longer. Co-administration of nirmatrelvir and ritonavir is necessary to increase the blood level of nirmatrelvir and help it reach the target therapeutic range.

How Effective is Paxlovid?

Paxlovid (nirmatrelvir/ritonavir) is effective against all the major variants of the SARS-CoV-2 virus. The EPIC-HR trial revealed that if appropriate treatment with Paxlovid (nirmatrelvir/ritonavir) is started within 5 days of symptom onset, it reduces the risk of COVID-19-associated hospitalization or death by almost 90%. The study demonstrated that Paxlovid is comparable to remdesivir and better than molnupiravir.

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When Was Paxlovid Granted Full Approval?

Paxlovid was fully approved in May 2023 when the U.S. Food and Drug Administration (FDA) approved Pfizer's new drug application (NDA). The FDA had previously granted emergency use authorization (EUA) to Paxlovid in December 2021 for use in adults and pediatric patients 12 years of age and older weighing at least 40 kg (88 pounds) who are at high risk of progression to severe COVID-19, including hospitalization and death.

EUA-labeled Paxlovid is no longer authorized for emergency use after March 8, 2024, regardless of expiration date or label. 

However, as part of the transition from emergency use authorization (EUA) to new drug application (NDA) authorization, the emergency use of NDA-labeled Paxlovid continues to be authorized for the treatment of mild to moderate COVID-19 in pediatric patients who meet the eligibility criteria (at least 12 years of age, weighing at least 40 kg or 88 pounds, and at high risk of severe illness).

How Do You Qualify for Paxlovid?

To be eligible for a Paxlovid prescription, you must meet the following criteria: 

• Be at least 12 years old and weigh at least 88 pounds 

• Have recently tested positive got COVID-19 

• Have moderate COVID-19 symptoms that began within the last 5 days, such as:

  • Fever

  • Chills

  • Cough

  • Shortness of breath or trouble breathing

  • Body aches

  • Headache

  • Fatigue

  • Loss of taste or smell 

  • Sore throat

  • Congestion or runny nose

  • Nausea, vomiting, diarrhea

• Have one or more factors that put you at high risk of developing severe disease, including hospitalization or death

Who Should Take Paxlovid?

Anyone can get seriously sick with COVID-19, but some people are at an increased risk. Your health care provider may give you a Paxlovid prescription if you are at high risk of serious illness. Common high-risk factors for severe illness include:

• Older adults (age 65 years and above).

• People with lifestyle factors such as smoking.

• Those with underlying health conditions such as obesity, diabetes, heart disease, chronic lung conditions, chronic kidney disease, cancer, a weakened immune system, developmental disabilities, and more.

• People who are unvaccinated or not up-to-date on COVID-19 vaccinations. 

Do You Need a Prescription for Paxlovid?

Paxlovid is not available over-the-counter. You need a prescription from a healthcare provider to obtain this oral antiviral medication. In addition to your primary care provider, you can also get a Paxlovid prescription through telehealth platforms if you have tested positive for COVID-19.

Testing for COVID-19 can help a healthcare professional make a diagnosis and start treatment with Paxlovid if needed. You can find free testing options at FDA-authorized COVID-19 centers or pick up a test kit locally at your pharmacy for at-home tests.

Where to Get Paxlovid?

You can obtain a prescription for Paxlovid with a:

• Telehealth appointment on telehealth platforms after video consultation with a telehealth provider

• In-person visit with a primary care physician

• Urgent care providers

• Community health center

• Retail health clinic

Paxlovid is available at most pharmacies, including Walgreens, CVS Pharmacy, Rite-Aid, Walmart, Safeway, Kroger, Publix, and others.

Can A Pharmacist Prescribe Me Paxlovid?

The U.S. Food and Drug Administration (FDA) expanded access to COVID-19 treatment by authorizing state-licensed pharmacists to prescribe Paxlovid to eligible patients under the Emergency Use Authorization (EUA), with some limitations. To receive a Paxlovid prescription from a pharmacist, you may need to provide medical records, laboratory blood work results, and a list of your medications. If necessary, the pharmacist may refer you for clinical evaluation by a physician or other healthcare professional. Ultimately, whether or not a pharmacist can prescribe Paxlovid will vary based on the laws of your state.

How To Take Paxlovid

Dosing and Schedule of Paxlovid Prescription

Paxlovid comes as a kit containing two different tablets of nirmatrelvir and ritonavir. The recommended dose of Paxlovid is 300 milligrams (mg) nirmatrelvir (two 150 mg tablets) and 100 mg ritonavir (one 100 mg tablet). All three tablets should be taken together by mouth twice daily for 5 days. Finish the entire prescription of Paxlovid even if your symptoms improve.

Your healthcare provider may prescribe a lower dose (one 150 mg nirmatrelvir tablet with one 100 mg ritonavir tablet) if you have moderate renal impairment (decreased kidney function).

Drug Interactions To Know

Drug interactions between Paxlovid and other medications can make the medicine less effective or lead to serious adverse effects. Some medications that can interact with Paxlovid include:

• Alpha-blockers such as alfuzosin and tamsulosin

• Anti-anginal drugs such as ranolazine

• Medications prescribed for heart rhythm abnormalities (antiarrhythmics), such as amiodarone, quinidine, flecainide, propafenone, and dronedarone

• Cancer drugs such as apalutamide and others

• Anticoagulants such as warfarin, rivaroxaban, dabigatran, and apixaban

• Anticonvulsants such as phenytoin, phenobarbital, carbamazepine, and primidone

• Antidepressants such as bupropion and trazodone

• Antifungal drugs such as voriconazole, itraconazole, and ketoconazole

• Anti-gout medications such as colchicine

• Certain HIV medications 

• Antibiotics such as clarithromycin and erythromycin

• Tuberculosis (TB) medications

• Antipsychotics such as pimozide, lurasidone, quetiapine, and clozapine

• Calcium channel blockers such as verapamil, amlodipine, diltiazem, and others

• Heart medications such as digoxin, eplerenone, ivabradine

• Certain corticosteroids such as betamethasone, dexamethasone, and others

• Herbal products such as St. John’s Wort

• Statins such as atorvastatin (cholesterol-lowering drugs)

• Hormonal contraceptives

Note: This list does not include all the potential drug interactions of Paxlovid. Give your healthcare professional a complete list of your current medications to avoid potentially dangerous interactions.

Side Effects

Common side effects of Paxlovid include:

• Change in taste sensation

• Diarrhea

• Headache

• Stomach pain

• Nausea

• Vomiting

• High blood pressure

Warnings

Paxlovid may not be safe for people with the following conditions:

• Kidney problems

• Liver problems

• Human immunodeficiency virus (HIV) infection

• Women who are pregnant or breastfeeding

Tell your healthcare provider if you are on combined hormonal contraceptives (birth control pills). Paxlovid can make hormonal birth control less effective. Your doctor may recommend an alternate form of birth control during Paxlovid treatment. 

Rarely, Paxlovid can cause severe allergic reactions. Seek emergency medical attention if you develop serious side effects such as: 

• Skin rash, hives, blistering or peeling skin

• Painful mouth sores or genital sores

• Difficulty breathing

• Swelling of the lips, tongue, throat, or face

• Hoarseness

• Anaphylaxis (throat closing)

• Signs of liver injury (stomach pain, nausea, jaundice or yellowing of the skin or eyes, pale stools, dark urine, itchy skin)

Costs and Financial Assistance

How Much Does Paxlovid Cost?

Pfizer has set the cost of its COVID-19 antiviral treatment, Paxlovid, at $1,390 for a five-day course. This list price does not include rebates and other discounts offered to insurers, pharmacy benefit managers, or the manufacturer’s patient assistance program. The U.S. government bought 24 million Paxlovid kits and paid around $530 per course. It was made available to Americans at no cost.

Financial Assistance Options 

People with private health insurance may be eligible to save on Paxlovid costs by enrolling in the drug manufacturer’s PAXCESS Co-Pay Savings Program. The program can reduce the cost of a Paxlovid prescription to $0 for certain individuals with private insurance reimbursement.

Government Patient Assistance Program

As part of a government initiative, Paxlovid was free for everyone until 2023. It was also free for people enrolled in the Medicare and Medicaid programs until the end of 2024. Paxlovid will remain free for uninsured and underinsured patients until 2028.

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Alternatives and Additional Resources

Other COVID-19 Treatments

The U.S. Food and Drug Administration (FDA) has approved certain antiviral medications for people who have tested positive for COVID-19 and are at a high risk of severe disease. These prescription antiviral medications prevent the virus from multiplying in the body. They must be started within 5 to 7 days after COVID-19 symptoms appear. Antiviral drugs approved for COVID-19 treatment include:

The FDA also authorized monoclonal antibodies to treat mild-to-moderate COVID-19 during the pandemic (the emergency use authorization for some of these products has been subsequently withdrawn). Examples include: 

• Evusheld (tixagevimab with cilgavimab)

• PEMGARDA (pemivibart) 

• ACTEMRA (tocilizumab) 

• Bamlanivimab 

• Bamlanivimab and etesevimab

• Bebtelovimab 

• REGEN-COV (casirivimab and imdevimab administered together) 

• Sotrovimab 

Staying Updated On COVID-19 Vaccination and Treatments

• Mayo Clinic (further reading on Coronavirus Disease)

• CDC COVID-19 Data Tracker

• FDA-Approved COVID-19 Medications and Treatments

• CDC: Up-to-date information on COVID-19 Vaccines