NIH's Provider guidance on the use of outpatient therapeutics
Patients recommended for treatment:
- Recently diagnosed with COVID-19 AND
- Mild or moderate symptomatic disease NOT requiring hospitalization AND
- At risk for progression to severe COVID-19, due to any one of the following:
- Older age
- Having risk factors for severe disease
- Being immunocompromised
- Unvaccinated, not completely vaccinated, or longer time since the last vaccine dose.
- Pregnant
Treatment options for symptomatic individuals
- First Line:
- Nirmatrelvir/ Ritonavir (Paxlovid)
- Remdesivir (Veklury)
- Second Line:
- Molnupiravir (Lagevrio)
- No Long recommeded due to increased resistance against Omicron subvariants:
- Bebtelovimab
Pre-exposure prophylaxis
- Tixagevimab/cilgavimab (Evusheld)-- Although still recommended as the only available prophylactic medicine, providers should counsel patients that Evusheld may be less effective against newer Omicron subvariants.
Interim Health Advisory
CDC Health Advisory (May 24, 2022) - COVID-19 Rebound After Paxlovid Treatment
NIH Statement on Omicron's Subvariants (November 10, 2022) - The COVID-19 Treatment Guidelines Panel's Statement on Omicron Subvariants, Pre-Exposure Prophylaxis, and Therapeutic Management of Nonhospitalized Patients with COVID-19
FDA (11/30/2022)- Bebtelovimab is NO LONGER authorized for use
Additional Resources for Providers
FDA's Paxlovid Patient Eligibility Screening Checklist Tool for Prescribers
COVID-19 drug interaction checker
CDPH’s Treatment Information for Health Professionals
Test-to-treat therapeutics locator
Prescribing therapeutics for eligible patients in San Francisco
Prescriptions can now be sent to any Walgreens, CVS, and Safeway to reduce barriers. Medications will either be stocked or redistributed internally.
A full list of pharmacies and clinics can be found at covid.gov
Most prescriptions should be placed electronically through your EHR. However, if having difficulty, some pharmacies can accommodate phone prescriptions.
Your prescription must include the date of the patient's symptom onset, if relevant and their eligibility criteria.
If you are a provider who works at one of the following medical facilities (list below), you may access therapeutics within your own health system as well. Contact your department to determine which internal pharmacies have supplies.
- University of California San Francisco (UCSF)
- Kaiser Permanente
- California Pacific Medical Center (CPMC)
- Northeast Medical Services (NEMS)
- Zuckerberg San Francisco General (ZSFG)
- Skilled Nursing Facilities
Patients without insurance or a healthcare provider
Test to Treat sites can both test for SARS-CoV-2 and dispense COVID-19 treatments regardless of insurance status.
Sites providing test-to-treat in San Francisco can be found on: https://sf.gov/get-treated-covid-19
Current sites participating in the federal program can be found on the Department of Health and Human Services’ Test to Treat Locator, which can be found here: https://covid-19-test-to-treat-locator-dhhs.hub.arcgis.com.
Congregate settings & Skilled Nursing Facilities
Congregate settings can access Test to Treat sites listed above
Skilled nursing facility prescribers should order through their internal pharmacy.
Delivery options & cost
See table below for more information on delivery options and costs.
