Facilitating oral COVID-19 therapy utilization through a pharmacy consult service

BACKGROUND: Two oral therapies, nirmatrelvir/ritonavir (Paxlovid) and molnupiravir (Lagevrio), are now available for the treatment of coronavirus disease 2019 (COVID-19). Treatment guidelines recommend using these agents for nonhospitalized adults with mild to moderate COVID-19 who are at high risk of disease progression. Despite guideline recommendations, therapy is frequently underutilized, resulting in lost opportunity to prevent severe outcomes including death. OBJECTIVE: This study aimed to describe the implementation of a pharmacy consult service for oral COVID-19 therapy within the ambulatory care setting. PRACTICE DESCRIPTION: Upon receipt of a positive COVID-19 test result, providers were encouraged to place a pharmacy consult for review. Information required within the consult submission served as a simple guide for determining eligibility for therapy. Once submitted, the pharmacist would identify which oral COVID-19 medication and dosage was most appropriate. In addition, for nirmatrelvir/ritonavir, the pharmacist would provide clear and concise instructions on how to manage any significant drug-drug interactions identified. Upon consult completion, the provider would order the appropriate therapy. PRACTICE INNOVATION: We depict an interdisciplinary approach to facilitate oral COVID-19 therapy utilization at a health care system level. EVALUATION: Veterans with a positive COVID-19 test from January 10, 2022, to July 10, 2022, were identified. A chart review was then used to collect relevant patient demographics and outcomes. The primary outcome was the eligibility for and subsequent prescribing of oral COVID-19 therapy. RESULTS: Of the 245 positive COVID-19 cases, 172 (70%) were eligible for oral COVID-19 therapy. Of those eligible, 118 (68.6%) were offered therapy and 95 (80.5%) accepted. Nirmatrelvir/ritonavir was the predominant agent used with 16% requiring renal dosage adjustment. Pharmacists identified 167 significant drug-drug interactions with nirmatrelvir/ritonavir encompassing 42 unique medications. Fourteen of the interactions warranted the utilization of molnupiravir. CONCLUSION: The utilization of a pharmacy consult service has facilitated interdisciplinary team collaboration and ultimately empowered the utilization of oral COVID-19 therapy.