How do I get the COVID-19 medication Paxlovid?

Paxlovid, an antiviral drug for treatment of COVID-19 made by Pfizer, was approved in Canada on Jan. 17. Health Canada says as of March 31, it has shipped enough doses for 150,000 people to the provinces and territories, allocated on a per capita basis. 

But most of the provinces have only given a small percentage of their Paxlovid doses to patients so far, according to emailed responses to CBC News inquiries. In both Ontario and Alberta, for example, only about three per cent of their doses have actually reached patients. 

Despite provinces having so many doses on hand that haven't been used, people have told CBC News that the process of trying to get Paxlovid has been fraught with obstacles, ranging from availability of the drug to a lack of easily accessible places to get it.    

That's a problem, experts say, because to be effective, Paxlovid must be taken within five days of developing symptoms. 

"[There are] just so many delays along the way that patients are losing out here on a drug that really can change their prognosis if they're considered high risk," said Dr. Zain Chagla, an infectious diseases specialist at McMaster University. 

Here are some basics about Paxlovid, who should take it and where to start if you're trying to get it.  

Who is the drug for?

Paxlovid is for adults in the early days of infection who have mild to moderate symptoms of COVID-19 and who have a high risk of deteriorating into severe illness and requiring hospitalization. The risk criteria vary by province, but can include being immunocompromised, having serious underlying conditions (such as obesity or diabetes), being older and being unvaccinated.

Eligible patients take Paxlovid at home after testing positive for COVID-19. It is not approved for patients who are already hospitalized with severe or critical COVID-19 symptoms.   

How does it work and how do I take it?

Paxlovid is a combination of two antiviral medications: nirmatrelvir and 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. 

The medication is in pill form, taken twice a day for five days. The nirmatrelvir and ritonavir pills for each dose are packaged together in a blister pack, so you know how much to take.   

How do I get a prescription?

To get a prescription, you need a positive COVID-19 test.  

What you do after that depends on where you live, because the provinces and territories are in charge of distributing drugs.  

In most provinces, after you get a positive COVID-19 test, you need to get the prescription from a doctor or nurse practitioner.

If you don't have a primary health-care provider or can't get in touch with them, in some provinces you can consult with a health-care provider through telehealth services (e.g., Service BC in British Columbia, Health Links in Manitoba, Health Line 811 in Saskatchewan, Health Link in Alberta, or Telehealth in Ontario.) Nova Scotia asks patients to fill in an online screening form.  

A spokesperson for the Yukon government's department of health and social services told CBC North that it was planning to dispense Paxlovid through the emergency departments of the territory's three hospitals in Whitehorse, Dawson City and Watson Lake.

What about pharmacies?

Quebec is the only jurisdiction in Canada so far that has given pharmacists the authority to prescribe Paxlovid. In the April 1 news release making that announcement, the Quebec government also said that all 1,900 community pharmacies in the province would carry the medication.   

In most other provinces, once you get a prescription for Paxlovid, you can get it filled at specifically designated community pharmacies. Ontario is an exception, where the medication is only dispensed at COVID-19 assessment centres or hospitals. On Tuesday, Health Minister Christine Elliott said the province plans to add more distribution locations, and that plan may include pharmacies.

Conversations are happening with provincial governments to try to make Paxlovid more accessible through community pharmacies, said Danielle Paes, chief pharmacist officer at the Canadian Pharmacists Association.

"We know that pharmacies are in every jurisdiction," Paes said. "We're able to get it into the communities that need it."

In addition, following Quebec's lead and giving pharmacists prescribing authority for Paxlovid in other provinces would help streamline the process of getting COVID-19 treatment, she said. Pharmacists already administer COVID-19 tests, she said, so a patient could get their test, prescription and medication all in one place. 

Precautions need to be taken to reduce the risk of symptomatic patients infecting other people, Paes stressed, noting that Quebec pharmacies are offering delivery of rapid antigen tests to symptomatic patients, and doing consultations over the phone.  

It's important to have "multiple levels of access" to Paxlovid and to simplify the path to getting it, said Chagla, the infectious diseases specialist. 

It should be widely available at pharmacies, COVID assessment centres, primary care provider clinics and emergency departments, he said.   

I have mild COVID-19 and am at higher risk for hospitalization. Does that mean I should definitely take Paxlovid?

Not necessarily, because the drug interacts with a lot of other medications. It's critical you tell your doctor, nurse practitioner or pharmacist what other medications you're on. 

They'll help you weigh the risks versus benefits, or decide if you need a dose adjustment.

"Some of the highest-risk people [for severe COVID-19] tend to be people who are taking other medications," said Dr. Emily McDonald, an internal medicine and epidemiology specialist at McGill University Health Centre.

"They may have diabetes or heart disease or cancer. And so the highest-risk people tend to be taking the drugs that are at highest risk of interacting with Paxlovid." 

Why are there so many medications that interact with Paxlovid?

For Paxlovid to be effective, it slows how quickly the body metabolizes it. So it can have the same effect on other medications you're taking at the same time. 

Health Canada recommends people who are taking the medications on its list should not take Paxlovid. They include alfuzosin, which is used to treat high blood pressure; several medications for irregular heartbeat; certain cancer drugs; a few medications used to treat mental health issues, and the herbal product St. John's Wort.    

People with liver or kidney disease should talk to their health-care provider before taking Paxlovid, the product monograph and Health Canada say.   

Doctors and pharmacists emphasize that the availability of a COVID-19 treatment like Paxlovid is not a replacement for vaccination. Being fully vaccinated still provides the greatest level of protection against severe illness or hospitalization, they say.