Product Details
Paxlovid
Nirmatrelvir + Ritonavir150 mg & 100 mg
Tablet
20-Dose Co-Pack
DIN/PIN/NPN
02527804
Manufacturer
Pfizer Canada Inc.
Formulary Listing Date
2024-05-17
Unit Price
1288.8800
Amount MOH Pays
1288.8800
Coverage Status
Limited Use Product
ODB Formulary Therapeutic Classification
Therapeutic Note
NO
ATC Code
J05AE30
Interchangeable Products
NOLU Clinical Criteria
LU Code | Auth. Period | Clinical Criteria |
---|---|---|
673 | 5 days to align with funded treatment duration. | For the treatment of mild-to-moderate coronavirus disease 2019 (COVID-19) in patients 65 years of age or older with:
Paxlovid (DIN: 02527804) is intended for patients with renal impairment or on dialysis. If Paxlovid (DIN: 02524031) is being dispensed for such patients, it requires dose adjustment. Treatment decisions should be individualized based on the prescriber's assessment of patient risk because not all medical or social vulnerabilities carry the same risk. Prescribers should consult Ontario Health Recommendations for Antiviral Therapy for Adults with Mild to Moderate COVID-19 (April 2024). Pharmacists and prescribers should be informed of and stay current with a drug product's official indications in accordance with Health Canada's approved product monograph. Some aspects of the above criteria may differ from the official indications as described in the product monograph for Paxlovid. The Executive Officer's funding of drug products is informed by advice from expert committees that consider evidence regarding the safety, clinical efficacy, and cost-effectiveness of drug products. Note: The funded treatment is one dose pack* for a treatment duration of 5 days. *Dose pack for DIN: 02524031 is package of 30 tablets divided in 5 daily-dose blister cards containing 4 nirmatrelvir tablets (150mg each) and 2 ritonavir tablets (100mg each). *Dose pack for DIN: 02527804 is a package of 20 tablets divided in 5 daily-dose blister cards containing 2 nirmatrelvir tablets (150mg each) and 2 ritonavir tablets (100mg each). |
674 | 5 days or 10 days to align with funded treatment duration. | For the treatment of mild-to-moderate coronavirus disease 2019 (COVID-19) in immunocompromised* patients 18 years of age or older regardless of vaccine status or prior COVID-19 infections with:
* Prescribers should consult Ontario Health Recommendations for Antiviral Therapy for Adults with Mild to Moderate COVID-19 (April 2024). Examples of immunocompromised include:
Paxlovid (DIN: 02527804) is intended for patients with renal impairment or on dialysis. If Paxlovid (DIN: 02524031) is being dispensed for such patients, it requires dose adjustment. Treatment decisions should be individualized based on the prescriber's assessment of patient risk because not all medical or social vulnerabilities carry the same risk. Pharmacists and prescribers should be informed of and stay current with a drug product's official indications in accordance with Health Canada's approved product monograph. Some aspects of the above criteria may differ from the official indications as described in the product monograph for Paxlovid. The Executive Officer's funding of drug products is informed by advice from expert committees that consider evidence regarding the safety, clinical efficacy, and cost-effectiveness of drug products. Note: The funded treatment is one dose pack** for a treatment duration of 5 days. In exceptional circumstances, the funded treatment is two dose packs** for a treatment duration of 10 days based on prescriber clinical judgement in consultation with an infectious disease specialist. Pharmacy operators must obtain and retain appropriate documentation to support claims for such extended therapy. For guidance, prescribers may consult Ontario Health - Frequently Asked Questions on Antiviral Therapy for Adults with Mild to Moderate COVID-19 (April 2024). NOTE: ** Dose pack for DIN: 02524031 is package of 30 tablets divided in 5 daily-dose blister cards containing 4 nirmatrelvir tablets (150mg each) and 2 ritonavir tablets (100mg each). ** Dose pack for DIN: 02527804 is a package of 20 tablets divided in 5 daily-dose blister cards containing 2 nirmatrelvir tablets (150mg each) and 2 ritonavir tablets (100mg each). |
675 | 5 days to align with funded treatment duration. | For the treatment of mild-to-moderate coronavirus disease 2019 (COVID-19) in patients 18 to 64 years of age with at least 1 risk factor* associated with more severe COVID-19 outcomes with:
The risk of progression to severe COVID-19 depends on the quantity of underlying medical conditions and how controlled the medical conditions are. * When assessing risk factors, prescribers may want to consult Ontario Health Recommendations for Antiviral Therapy for Adults with Mild to Moderate COVID-19 (April 2024). Examples of risk factors include:
Note for consideration: Certain medical or social vulnerabilities may confer an increased risk of disease progression because affected individuals may experience challenges in recognizing, communicating or acting on progressive COVID-19 symptoms. People who are at a high risk of poor outcomes from COVID-19 based on social determinants of health should be considered priority populations for access to antivirals. Individuals at high risk include Indigenous people, Black people, other members of racialized communities; people experiencing intellectual, developmental, or cognitive disabilities; people who use substances regularly (e.g., alcohol); people who live with mental health conditions; and people who are underhoused. Paxlovid (DIN: 02527804) is intended for patients with renal impairment or on dialysis. If Paxlovid (DIN: 02524031) is being dispensed for such patients, it requires dose adjustment. Treatment decisions should be individualized based on the prescriber's assessment of patient risk because not all medical or social vulnerabilities carry the same risk. Pharmacists and prescribers should be informed of and stay current with a drug product's official indications in accordance with Health Canada's approved product monograph. Some aspects of the above criteria may differ from the official indications as described in the product monograph for Paxlovid. The Executive Officer's funding of drug products is informed by advice from expert committees that consider evidence regarding the safety, clinical efficacy, and cost-effectiveness of drug products. Note: The funded treatment is one dose pack** for a treatment duration of 5 days. NOTE: ** Dose pack for DIN: 02524031 is package of 30 tablets divided in 5 daily-dose blister cards containing 4 nirmatrelvir tablets (150mg each) and 2 ritonavir tablets (100mg each). ** Dose pack for DIN: 02527804 is a package of 20 tablets divided in 5 daily-dose blister cards containing 2 nirmatrelvir tablets (150mg each) and 2 ritonavir tablets (100mg each). |