Wisconsin DHS Health Alert #43: Wisconsin has Adequate Supply of Oral and IV Antiviral Therapies for COVID-19 to Offer Treatment to Patients at Risk for Severe Disease
Bureau of Communicable Diseases
May 3, 2022
Key Points
- Oral antiviral medications for the treatment of COVID-19 are now widely available across Wisconsin. Consult the DHS therapeutics locator map to find pharmacies with supply on hand.
- Providers should encourage symptomatic patients who may be at risk for severe disease to test as soon as possible and seek treatment if diagnosed with COVID-19.
- Paxlovid and Verkuly (remdesivir) are the preferred medications for treatment of non-hospitalized patients with COVID-19 based on recent guidance the National Institutes of Health.
- Health systems are encouraged to develop protocols for identifying COVID-positive patients who are at risk for severe disease and referring them for treatment. Integrating pharmacy consultation into treatment pathways can assist prescribers with selecting appropriate medications and managing drug-drug interactions.
Background:
In December 2021, Paxlovid and Lagevrio (molnupiravir) received emergency use authorization (EUA) from the Food and Drug Administration for the treatment of patients with mild-to-moderate COVID-19 who are at risk for progression to severe disease. Supplies of these medications were initially very limited, and DHS encouraged healthcare providers to utilize NIH patient prioritization tiers. Since that time, availability of these medications has increased significantly across Wisconsin.
Prompt diagnosis is critical to ensuring patients are treated within the window of eligibility. Providers should encourage symptomatic patients who may be at risk for severe disease to test as soon as possible and seek treatment if diagnosed with COVID-19. CDC has compiled a list of medical conditions associated with higher risk for severe COVID-19 that can be consulted when considering patients for treatment.
Availability of Oral Antiviral Medications:
Since January, a total of 12,740 patient courses of Paxlovid and 2,888 courses of Lagevrio have been distributed to healthcare facilities in Wisconsin. As of April 27, only 23% of Paxlovid and 6% of Lagevrio courses have been dispensed to patients. Supplies are now sufficient to treat patients with mild-to-moderate COVID-19 who are at risk for progression to severe disease.
Oral antivirals are available at pharmacies across the state, including many community pharmacies, selected Walgreens and Walmart pharmacies, and all CVS locations. Healthcare providers can consult the DHS therapeutics page to find pharmacies with medications on hand.
NIH Recommendations for Treatment of Non-hospitalized Adults with COVID-19
The following treatments are recommended by the National Institutes of Health for non-hospitalized patients with COVID-19. Consult the NIH website for the latest information, as treatment guidelines are continually revised.
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Preferred Therapies: In order of preference
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Paxlovid (nirmatrelvir/ritonavir) 300mg/100mg orally twice daily for 5 days, initiated within 5 days of symptom onset. Dosage adjustment required for renal impairment.
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Verkuly (remdesivir) 200 mg IV on Day 1, followed by RDV 100 mg IV once daily on Days 2 and 3, initiated within 7 days of symptom onset
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Alternative Therapies: For use only when preferred therapies are not available. Listed in alphabetical order
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Bebtelovimab 175 mg as a single IV injection, initiated within 7 days of symptoms onset
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Lagevrio (molnupiravir) 800 mg PO twice daily for 5 days, initiated within 5 days of symptom onset
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Treatment Protocols for COVID-19 Therapeutics
Health systems are encouraged to develop treatment protocols for patients with mild-to-moderate COVID-19 who are at risk for progression to severe disease. Integration of pharmacy consultation into treatment pathways may assist prescribers in selecting the appropriate medications and managing drug-drug interactions. The US Department of Health and Human Services has developed a treatment algorithm which can be used a starting point for protocol development.
Additional information:
DHS Therapeutics Map
Paxlovid (ritonavir-boosted nirmatrelvir) Fact Sheet for Healthcare Providers
Lagevrio (molnupiravir) Fact Sheet for Healthcare Providers
Verkuly (remdesivir) Fact Sheet for healthcare providers
CDC: Underlying Medical Conditions Associated with Higher Risk for Severe COVID-19
NIH Therapeutic Management of Nonhospitalized Adults With COVID-19
HHS COVID Therapeutics Decision Aid
Sincerely,
Jonathan Meiman, MD
Chief Medical Officer and State Epidemiologist
Environmental and Occupational Health
Division of Public Health
Wisconsin Department of Health Services
Ryan Westergaard, MD, PhD, MPH
Chief Medical Officer and State Epidemiologist
Bureau of Communicable Diseases
Division of Public Health
Wisconsin Department of Health Services
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