Paxlovid
The individual lives, works, or studies in Ontario or is visiting Ontario from another province/territory or country; AND
• The individual has received a positive COVID-19 test result; AND
• The individual will be starting Paxlovid™ treatment within five days of symptom onset (symptom onset day is considered day zero); AND
• The individual is not on supplemental oxygen and is,
o 60 years of age and older,
o 18 years of age or older but less than 60 years of age, and is:
▪ immunocompromised ;
▪ at high risk of severe COVID-19 because the individual has comorbidities ; or
▪ at high risk of severe COVID-19 because they have inadequate immunity due to being unvaccinated, having an incomplete series of primary COVID-19 vaccination or not having had a COVID-19 vaccine dose or COVID-19 infection within the past six months.
“comorbidities” include, without being limited to,
(a) cancer,
(b) cerebrovascular disease,
(c) chronic kidney disease,
(d) chronic liver diseases, where the disease is cirrhosis, non-alcoholic fatty liver disease, alcoholic liver disease or autoimmune hepatitis,
(e) chronic lung diseases, where the disease is bronchiectasis, chronic obstructive pulmonary disease, interstitial lung disease, pulmonary hypertension or pulmonary embolism,
(f) cystic fibrosis,
(g) diabetes mellitus, type 1 or type 2,
(h) disabilities such as Down syndrome, learning, intellectual or developmental disabilities, ADHD, cerebral palsy, congenital disabilities or spinal cord injuries,
(i) heart conditions such as cardiomyopathies, coronary artery disease, heart failure and similar conditions,
(j) HIV infection,
(k) mental health disorders, where the disorder is a mood disorder, including depression, or a schizophrenia spectrum disorder,
(l) obesity,
(m) pregnancy or recent pregnancy,
(n) primary immunodeficiency diseases,
(o) smoking, current or former,
(p) solid organ or blood stem cell transplant,
(q) tuberculosis, and
(r) use of corticosteroids or other immunosuppressive medication; (“comorbodités”)
Billing
Please refer to the Executive Officer Notice:
Monograph
- please note information on renal impairment and drug interactions
Tamiflu (influenza)
Criteria
The individual has documented instructions to obtain oseltamivir for influenza prophylaxis as directed by the local Public Health Unit or institutional Infection Prevention and Control (IPAC) in response to an outbreak and requires a therapeutic assessment for a prescription; OR
• The individual:
– has a laboratory-confirmed influenza A or influenza B infection OR has suspicion of an influenza A or influenza B infection based on clinical judgment ( This may include a combination of: symptoms of influenza-like illness and a negative COVID-19 test result; and/or, influenza confirmed to be circulating in the Public Health Unit [see Public Health Ontario Respiratory Virus Tool]
); AND
– will be starting oseltamivir within two days of symptom onset (symptom onsetday is considered day zero)
Billing
– Oseltamivir is listed on the Ontario Drug Benefit (ODB) Formulary as a Limited Use benefit and is funded under the ODB program for eligible ODB program recipients who may be charged a co-payment, in accordance with ODB program rules. For non-ODB program recipients (e.g., individuals with private insurance or who pay out of pocket), regular dispensing fees and costs for oseltamivir apply