Ontario pharmacists want ability to offer antivirals to patients with COVID-19

Pharmacists across Ontario have played an important part in the province's COVID-19 response, from testing to vaccination. Now they want the ability to offer antivirals to patients with the virus in a test-to-treat program. 

Currently, Ontario residents can only access antivirals — medication designed to help the body fight off the SARS-CoV-2 virus, reduce symptoms from an infection and shorten the period of illness — at a provincial testing centre after confirmation of a positive molecular test.

At pharmacies across the United States, a test-to-treat program is slated to begin this week.

Justin Bates, the CEO of the Ontario Pharmacists Association (OPA), said the association is in active discussion with the Ministry of Health about bringing this program to Ontario.

The federal government purchased one million doses of Pfizer's antiviral medication, Paxlovid, in January and though changes would need to be made for the program to work in Ontario, some pharmacists want to help.

It would simplify the process for patients to access Paxlovid, said Jen Belcher, a pharmacist and owner of Loyalist Pharmacy.

"When things are complicated for a patient ... that reduces the likelihood that they'll be able to access it," she said.

Paxlovid consists of two antiviral drugs packaged together: nirmatrelvir and ritonavir. Patients take three pills twice a day: two of nirmatrelvir and one of ritonavir. In total, the full course of treatment requires you take 30 pills over the span of five days. Nirmatrelvir is a new drug developed by Pfizer-BioNTech, while ritonavir is an existing drug often used in the treatment of HIV/AIDS.

800 pharmacies offer molecular testing

Of the 5,000 pharmacies in Ontario, 800 offer the molecular testing needed to confirm a positive case of COVID-19. On top of that, pharmacists would also need the authorization to prescribe antivirals. 

And while this program would create an added responsibility for some pharmacies, Belcher said she's confident many would want to participate because "we know there's a need in our communities."

Pharmacy owner Kyro Maseh said given the number of COVID-19 hospitalizations at this time, the proposed program would be useful for patients having "a tough time getting a hold of their physician."

"Physicians are spread too thin, and this is a medication that requires to be administered in a very timely fashion, it has to be administered within five days of onset of symptoms," Maseh said.

"Most patients that I know can't get a hold of their physician in five days," he added, and that's if they even have a family doctor to begin with. 

If we end up getting another wave due to waning immunity or a new variant, we can't be left scrambling like the last waves. We have to have an established path to deliver antivirals in a timely fashion moving forward.- Kyro Maseh, pharmacy owner

Maseh said adjustments for a test-to-treat program should be put in place as soon as possible. 

"If we end up getting another wave due to waning immunity or a new variant, we can't be left scrambling like the last waves. We have to have an established path to deliver antivirals in a timely fashion moving forward," he said. 

Dr. Peter Juni, scientific director of the science advisory table, agrees. He said there could be a summer wave or an autumn wave if there is a new variant, and the province should be ready to have a mass vaccination again, if needed, as well as a test-to-treat program in the community

Juni said it's important that the province uses all "tools that we have in our toolbox," including antivirals, to fight COVID-19.

He said that as part of a test-to-treat program, the province would need to make "rapid molecular tests" widely available.

"Testing needs to happen fast and the turnaround time, if it's a conventional PCR test, would need to be really fast," Juni said. 

Pharmacies and community health centres would also need to be equipped to do rapid molecular tests with a turnaround time of 15 to 30 minutes, Juni said.

The Ministry of Health did not provide a comment by CBC's deadline.