PAXLOVID Reimbursement
date: 19/12/2023
JSIS reimbursement of PAXLOVID requires introducing a request for prior authorisation* with a prescription from either a general practitioner or a specialist, for patients who:
· Are Covid-19 positive
· have an increased risk of severe COVID with risk of hospitalisation: the criteria for increased risk are:
o Age > 65 years and at least one of the following comorbidities: Body Mass Index >30 – diabetes mellitus – chronic kidney disease with glomerular filtration rate (eGFR) >29ml/min/1.73m² - chronic neurological pathology – liver disease or cirrhosis (except severe liver failure)
o the existence of heart failure
o the existence of chronic obstructive pulmonary disease (COPD)
o being an Immunocompromised Patient** (due to a medical disease or treatment that has a significant impact on immunity)
Caution: CONTRAINDICATIONS TO PAXLOVID:
o If your condition requires supplemental oxygen treatment
o being treated with medications with contraindications for concomitant use with PAXLOVID
o Be on hemodialysis – peritoneal dialysis
o Be in severe hepatic impairment (CHILD-PUGH classification: class C)
* Given the indication of starting treatment within the 5 days of initial symptoms, if the member meets the criteria for reimbursement, JSIS may accept prior authorisations submitted a posteriori.
**immunocompromised patients = patient with at least one underlying characteristic or pathology:
• Malignant haemopathy;
• Solid cancer actively treated with cytotoxic chemotherapy;
• Solid organ or hematopoietic stem cell transplantation;
• B-cell depletion therapies for less than one year (e.g., rituximab, ocrelizumab, alemtuzumab);
• Primary immune deficiency
• HIV with CD4 count <200/mm3 and/or detectable viral load;
• Chimeric antigen receptor T cell therapy (CAR-T therapy);
• Immunosuppressive drugs such as antiproliferative agents (azathioprine, cyclophosphamide, mycophenolate mofetil), calcineurin inhibitors (tacrolimus, cyclosporine, etc.), CTLA-4 agonists (abatacept), JAK inhibitors (baricitinib, ruloxitinib, tofacitinib, etc.);
• Chronic treatment with high doses of corticosteroids (> 20mg prednisolone or equivalent per day) or Methotrexate (> 20mg per week)