New Brunswick to expand eligibility for COVID-19 medication Paxlovid

New Brunswick plans to expand eligibility for the antiviral drug treatment for COVID-19, Paxlovid, starting Monday.

It also plans to give all primary care providers the authority to prescribe it "in an effort to increase uptake," and make it available at all pharmacies.

"The Department of Health is in the process of expanding its eligibility for Paxlovid which will be communicated in the near future," spokesperson Bruce Macfarlane confirmed in an emailed statement to CBC Friday morning.

Later in the afternoon, the government issued a news release, announcing increased access to the drug.

Paxlovid is for adults in the early days of infection who have mild to moderate symptoms of COVID-19 who are at high risk of deteriorating into severe illness, including hospitalization or death.

It's designed to help the body fight off the SARS-CoV-2 virus, reduce symptoms from an infection and shorten the period of illness.

Eligibility for the drug at no cost has expanded in New Brunswick to include:

• People aged 50 to 59 who are partially or "under vaccinated," meaning they don't have all the vaccine doses they are eligible for
• People aged 50 to 59 who either live in a long-term care home or receive home care, or are from or live in a First Nations community

Until now, people from these groups had to be aged 60 to 79 to receive Paxlovid, said Macfarlane.

Other groups who are currently eligible include:

• People 80 and older
• People 18 and older who are immunocompromised by active or recent cancer treatment within the past months, a solid organ transplant, a stem cell transplant within the past years, moderate to severe primary immunodeficiency or advanced or untreated HIV infection, or moderate to severe immunosuppressive treatment, such as biologic medications or high-dose systemic corticosteroids

The province has received 3,550 treatment courses of Paxlovid, but only 323 people have received the drug so far.

Interactions with other drugs a factor

Macfarlane says "a number of factors" account for such a small percentage being dispensed.

"These antivirals have some significant drug interactions with commonly prescribed drugs, contraindications (exclusions) with certain medical conditions, along with limited amounts available in Canada," he said.

Initially, Paxlovid was provided in New Brunswick to people listed among priority groups who met the eligibility requirements, determined by an assessment team comprised of pharmacists and specialist consultants, said Macfarlane.

It was then made available to patients "on a case-by-case basis," based on their medication profile and assessment, he said.

"But moving forward [it] will be prescribed by primary care practitioners, for those who meet the eligibility criteria, in the province in an effort to increase uptake."

To be effective, Paxlovid must be taken within five days of developing symptoms.

Primary care providers who can now prescribe the drug without the need for a team assessment include doctors and nurse practitioners, Macfarlane said.

People who don't have a primary care provider, or timely access to their provider, should call TeleCare 811 or visit evisit NB for an online consultation with a nurse practitioner or doctor, he said.

Asked whether the province is considering following the lead of Quebec and will give pharmacists the authority to prescribe Paxlovid to improve access, Macfarlane replied, "Not at this time." Quebec is the only jurisdiction in Canada to have done so.

All pharmacies can get drug

New Brunswick is, however, following Quebec's lead by making Paxlovid doses available for distribution to all pharmacies instead of just the current 55.

Vaccination remains the best course of action to protect New Brunswickers from severe effects of COVID-19, Dr. Jennifer Russell, chief medical officer of health, said in a statement.

But improving access to antiviral treatments like Paxlovid will further the fight against COVID-19 and provide another option for preventing severe outcomes, she said.

Macfarlane could not provide any information or statistics on the success of the treatment in the province so far.

Nor could he provide any breakdown on the 323 people who have been provided the treatment to date. "As we have greater experience and numbers who have used Paxlovid, we will be able to break down the usage by age, but this information is not available at this time, just the total," he said.

It's unclear when the province is going to get another shipment of Paxlovid, said Macfarlane.

As of March 31, Health Canada said it has shipped enough doses for 150,000 people to the provinces and territories, allocated on a per capita basis.

Paxlovid combines a new antiviral drug developed by Pfizer called nirmatrelvir with an existing antiretroviral drug named ritonavir.

Nirmatrelvir interferes with the proteins the coronavirus needs to multiply and stops it from infecting more cells. Ritonavir slows the breakdown of nirmatrelvir so it stays in the body long enough to do its job. 

A full course of treatment requires a patient to take 30 pills — two nirmatrelvir and one ritonavir taken together twice a day for five days.

In November, Pfizer reported that Paxlovid reduced the risk of hospitalization or death by 89 per cent compared to a placebo in non-hospitalized high-risk adults with COVID-19.