New Brunswick implements unique program enabling hospital pharmacists to prescribe Paxlovid to COVID-19 patients

By Doug Doucette, Regional Director of Pharmacy and Dr. Susan Brien, VP of Medical, Academic and Research Affairs

When the federal government announced in January 2022 that Paxlovid, an antiviral medication, would be available for people experiencing mild or moderate symptoms of COVID-19, it was an exciting development for the treatment of COVID-19. This new prescription would prevent COVID-19 symptoms from worsening and reduce the need for hospitalization.

Each province was asked to develop a program to distribute the medication to people based on the criteria established by the federal government, which was for people age 60 + and for those that are immunocompromised.

Paxlovid treatment can only be prescribed for people who have a confirmed positive PCR test and who have not experienced symptoms for more than five days. Given these criteria, time was of the essence to ensure New Brunswickers who would be eligible for this new medication would be able to receive it in time. In addition to timing, significant medical and pharmacy oversight was needed as Paxlovid was known to interact with many other medications.

In New Brunswick we took a unique approach of establishing a system where hospital pharmacists from both Horizon Health Network and Vitalité Health Network would be the primary care provider and prescribe the medication directly to patients. We selected the most qualified prescribers given the short timeframe and significant risk of possible drug interactions.

For this to work, the hospital pharmacists were supported by the Department of Health, Public Health, physicians, and community pharmacists, as well as Service New Brunswick to establish IT infrastructure. We established a virtual clinic with 15 hospital pharmacists (eight from Horizon and seven from Vitalité) comprising the initial staffing complement for this special project with two or three pharmacists working each day shift.

Referrals would come from Public Health, Extra Mural Program and long-term care facilities once a positive PCR was confirmed and the patient agreed to be assessed further for the opportunity to be prescribed Paxlovid. A hospital pharmacist from the virtual clinic would connect with the patient to assess their COVID-19 symptoms, medical conditions and medications. If determined that Paxlovid was safe and appropriate, the patient would be offered a prescription from the hospital pharmacist.

The hospital pharmacists were supported by a group of on-call specialty physicians at both Vitalité and Horizon providing further consultation if required.  

For those patients who consented to Paxlovid, the hospital pharmacist would send the prescription to one of a number of designated community pharmacies located across the province to be dispensed to the patient.

Of the 950 referrals sent to the virtual clinic, only 320 (one-in-three) patients were issued a prescription following their assessment by a hospital pharmacist. Common reasons a prescription was not given included: significant potential for negative reaction if Paxlovid was to be given with another of the patient’s regular medications; patient had poor kidney function or could not swallow medication; patient’s symptoms were improving since COVID PCR test  or the patient refused to take the medication.

This unique program operates seven days per week and all referrals have been able to be processed within 24 hours.

New Brunswick was among first province to have Paxlovid prescribed to patients beginning in the last week of January. Until April, we were the only program to allow hospital pharmacists to consult and prescribe to patients outside a hospital setting.

The success of this program was built on the strong relationship that hospital pharmacists and physicians have when working together to ensure patients receive safe and quality care. In addition, it was a testament to full health care system, including the Department of Health, coordinating to ensure Paxlovid was able to be provided quickly to patients who needed it.

As of April 11, Department of Health extended the program to enable primary care providers to prescribe Paxlovid to their patients. The hospital pharmacist virtual clinic continues to provide its services to First Nations communities, Extra-Mural Program, nursing and special care homes, and for patients without access to a primary care provider.