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Eligibility for oral COVID-19 treatments
The Pharmaceutical Benefits Advisory Committee (PBAC) recommended changes to the Pharmaceutical Benefits Scheme (PBS) eligibility criteria of the oral treatments Lagevrio® (molnupiravir) and Paxlovid® (nirmatrelvir and ritonavir) for First Nations people. This took effect from 1 November 2022.
At its November 2022 intracycle meeting, the PBAC recommended that the PBS eligibility criteria further expand to include patients with any significantly immunocompromising condition where in the last 12 months, the patient has received anti-CD20 monoclonal antibody treatment and patients who have been previously hospitalised with COVID-19 disease if subsequently re-infected. The latest recommendations from the PBAC commenced 1 January 2023.
Antiviral treatments taken as capsules or tablets may help stop COVID-19 infection from becoming severe. Courses of these antiviral treatments need to be started as soon as possible after symptoms from COVID-19 begin.
People at higher risk of severe illness are eligible for antiviral treatments.
Learn more about oral antiviral treatments for COVID-19.
Senior Australians and First Nations people
If you test positive for COVID-19, you may be eligible for antiviral treatments if you are:
- 70 years of age or older, regardless of risk factors and with or without symptoms.
- 50 years of age or older with 2 additional risk factors for developing severe disease or have had past COVID 19 infection resulting in hospitalisation.
- First Nations people, 30 years of age or older and with 1 additional risk factor for developing severe disease or have had past COVID-19 infection resulting in hospitalisation.
Risk factors include:
- living in residential aged care
- living with disability with multiple conditions and/or frailty (but not limited to living in supported accommodation)
- neurological conditions like stroke or dementia and demyelinating conditions e.g. multiple sclerosis, Guillain-Barre Syndrome
- chronic respiratory conditions including COPD, moderate or severe asthma
- obesity or diabetes (type I or II requiring medication)
- heart failure, coronary artery disease, cardiomyopathies
- kidney failure or cirrhosis
- living remotely with reduced access to higher level healthcare
- past COVID-19 infection episode resulting in hospitalisation.
People aged 18 years or older
If you test positive for COVID-19 and are moderately to severely immunocompromised, you may be eligible for antiviral treatments.
Conditions include:
- blood cancer or some red blood cell disorders (thalassemia, sickle cell disease)
- transplant recipient
- primary or acquired (HIV) immunodeficiency
- chemotherapy or whole-body radiotherapy in the last 3 months
- high dose corticosteroids or pulse corticosteroid therapy in the last 3 months
- immunosuppressive treatments in the last 3 months
- anti-CD20 monoclonal antibody treatment in the last 12 months/li>
- cerebral palsy or Down Syndrome
- congenital heart disease
- living with disability with multiple conditions and/or frailty.
View the Lagevrio® and Paxlovid® fact sheets on the PBS website for the full list of risk factors.
From 1 January 2023, following the PBAC’s recommendation, patients who have been previously hospitalised with COVID-19 disease are eligible for antiviral treatments if subsequently re-infected.
More information on the PBAC’s latest recommendations.
How to get COVID-19 oral treatments
If you test positive, you should contact your doctor for advice about eligibility first.
If your doctor recommends oral antiviral treatments, you will need a prescription.
The medications are available at your local pharmacy with a prescription.
Your doctor can send the pharmacist your prescription electronically so the medications can be either collected by a friend or family member or delivered to your home.
Find your nearest pharmacy with the oral treatments.
Finding an available GP appointment
To aid timely access to these treatments by vulnerable individuals, Medicare telehealth services are now available with any GP for patients with a confirmed COVID-19 diagnosis in the past 7 days. A long telehealth (phone) consultation by a GP for prescribing COVID-19 antiviral treatments is also available until 31 December 2023
If you can't get an appointment quickly to talk about treatments, you can call HealthDirect's free helpline on 1800 022 222 or use the Service Finder to search for one near you.
Who should not have antiviral COVID-19 treatments?
If you are pregnant or breastfeeding you should not have oral COVID-19 treatments. Instead, ensure you are up to date with your COVID-19 vaccinations.
If you have severe kidney or liver disease you should not have Paxlovid® COVID-19 treatment. Talk to your healthcare provider about alternative oral treatments.
COVID-19 treatments and fertility
If you are prescribed the oral treatment Paxlovid® for COVID-19 and you are also taking prescribed birth control 'the pill', you should use extra contraception as the treatment may affect how the pill works.
Also, it is recommended you use effective forms of contraception:
- during treatment and for 4 days after with Lagevrio®
- during treatment and for 7 days after with Paxlovid®.
Men should use contraception during and for 3 months after taking Lagevrio®.
Talk to your healthcare provider about contraceptives and what is best for your situation.