On December 22, 2021, the FDA issued an emergency use authorization (EUA) for Pfizer’s COVID-19 treatment, Paxlovid. Paxlovid is indicated for the treatment of mild-to-moderate coronavirus disease (COVID-19) in adults and pediatric patients (12 years of age and older weighing at least 40 kilograms) with positive results of direct SARS-CoV-2 testing and who are at high risk for progression to severe COVID-19, including hospitalization or death. Paxlovid is available by prescription only and should be initiated as soon as possible after a diagnosis of COVID-19 and within five days of symptom onset.
On December 23, 2021, the FDA issued an EUA for Merck’s molnupiravir for the treatment of mild-to-moderate coronavirus disease (COVID-19) in adults with positive results of direct SARS-CoV-2 viral testing, and who are at high risk for progression to severe COVID-19, including hospitalization or death, and for whom alternative COVID-19 treatment options authorized by the FDA are not accessible or clinically appropriate. Molnupiravir is available by prescription only and should be initiated as soon as possible after a diagnosis of COVID-19 and within five days of symptom onset.
While the federal government pays for the product, the product cost cannot be billed to MO HealthNet. Pharmacy providers filling prescriptions for Paxlovid or molnupiravir will be reimbursed the current professional dispensing fee, at the time the prescription is dispensed. For pharmacies to receive the full dispensing fee, the Usual & Customary charge submitted to MO HealthNet must be in excess of the current professional dispensing fee. Non-pharmacy providers (clinics, hospitals, ERs, etc.) do not receive a professional dispensing fee.
Information about Missouri’s distribution of COVID-19 oral antivirals is available here: https://health.mo.gov/living/healthcondiseases/communicable/novel-coronavirus/covid-therapeutics.php
For more information about Paxlovid: https://www.fda.gov/media/155052/download
For more information about molnupiravir: https://www.fda.gov/media/155053/download