Oral Antivirals

Overview

Oral antiviral treatment works by targeting specific proteins on the SARS-CoV-2 virus to prevent efficient virus replication within the host cell.

Paxlovid and molnupiravir reduce the risk of hospitalization and death by 88% and 30% respectively, in patients at high-risk for severe COVID-19 when started early after symptom onset.

Eligibility

The FDA authorized two oral antivirals, Pfizer's Paxlovid and Merck's molnupiravir, for the treatment of COVID-19 in certain patients who:

  • Have tested positive for COVID-19 and have had symptoms for 5 days or less.
  • Are at high risk for progression to severe COVID-19, including hospitalization or death.
  • Meet certain criteria depending on the antiviral.

Health care providers should discuss the risks and benefits of treatment with their patients.

Availability

New York State received a limited supply of both Paxlovid and molnupiravir from the federal government. New York State's distribution methodology for the new oral antiviral category of COVID-19 medications is to initially distribute on a pro rata population basis to every region in New York State.

New York City region has elected to receive its distribution to one pharmacy that will do home delivery to all boroughs in New York City. The rest of the state's nine regions are having their doses delivered to pharmacies in counties within their regions. Pharmacies were chosen based upon population density, as well as Medicaid population density.

During the initial weeks of allocation, when supplies remain scarce, only a few pharmacies in each county will receive the antivirals. Patients will require a prescription for Paxlovid and molnupiravir.

Supply Shortages

There are severe supply shortages for all COVID-19 treatments. While supplies remain low, providers should adhere to the New York State Department of Health prioritization guidance (PDF). Providers should prioritize therapies for people of any eligible age with moderate to severe immunocompromise regardless of vaccine status, or who are age 65 and older and not fully vaccinated with at least one risk factor for severe illness, or age 65 or older that is a resident of a long-term care facility environment.

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