Ontario considering letting pharmacists prescribe Paxlovid for COVID-19

Ontario is considering allowing pharmacists to prescribe the COVID-19 treatment drug Paxlovid in order to expand access, the province’s top doctor says.

Chief Medical Officer of Health Dr. Kieran Moore said recently that the health system will see a “triple threat” of COVID-19, a bad flu season and the resurgence of a childhood respiratory virus this fall and winter.

Finding ways to ensure greater availability of medication to keep people with COVID-19 out of hospital is of particular importance for more rural communities, he said.

“I do know the government is reviewing the ability of pharmacists to be able to prescribe this directly after a positive test,” Moore said in an interview with The Canadian Press.

“There was concern in particular in isolated areas. Where you may not have good access to a primary care physician, you may have access to a pharmacist. So that gap was looked at and I do believe they’re working aggressively on that.”

Multiple medical officers of health around the province have raised the issue, Moore said.

“I do think it is one solution in increasing the access,” he said.

A spokesperson for Health Minister Sylvia Jones said the province is “continuing to look at different ways to ensure Ontarians have access to as many tools as possible to stay healthy and prevent unnecessary visits to the hospital,” but offered no further details.

Justin Bates, CEO of the Ontario Pharmacists Association, said his group has been pushing for pharmacists in the province to be able to prescribe Paxlovid, as colleagues in many other provinces already can.

“Given our experience in point-of-care testing, our knowledge of medications – particularly complex medications like Paxlovid, where there’s a lot of drug-to-drug interactions – and more, I would say, in-depth consultation that’s required with patients, pharmacists are well-positioned to provide that as a turnkey solution,” he said.

Paxlovid is an antiviral medication taken orally within five days of symptom onset.

It is recommended for people at high risk of COVID-19 complications, such as people over 70 and certain immune compromised people, particularly those without at least three vaccine doses. It can be prescribed by a primary care provider or at a COVID-19 clinical assessment centre.

Having pharmacies as one more avenue for prescriptions will enable quicker access, and therefore keep more people out of hospital this winter, Bates said.

“The earlier you started in five days, the better in terms of preventing serious symptoms and illness whereby you would then need to go to the hospital or, even worse, into the hospital’s ICU,” he said.

Paxlovid is currently “sitting on shelves,” Bates said.

“The amount of volume going through the stores, anecdotally, is very low,” he said.

Moore said about 3,500 treatments of Paxlovid are currently being prescribed each week, noting demand appears to go up as COVID-19 activity rises.

Ontario has already announced that as of Jan. 1 it is expanding pharmacists’ prescribing powers to include medications for minor ailments such as conjunctivitis, dermatitis and hemorrhoids.

If the government further expands the powers to include not just Paxlovid, but all antiviral medications, pharmacists could also prescribe Tamiflu – which has fewer drug interactions than Paxlovid – ahead of what is expected to be a bad flu season, Bates said.

Dr. Zain Chagla, an infectious disease specialist at St. Joseph’s Healthcare in Hamilton, said he thinks it’s a great idea to have pharmacists prescribe Paxlovid, saying it could prevent people from being hospitalized for COVID-19.

“These are preventable health-care outcomes,” he said.

“There really does need to be more of a push to get it more accessible and pharmacies have done an incredible job helping with COVID vaccines … The major issue with Paxlovid is drug interactions and so, having pharmacists prescribing it makes total sense ”