Selling Covid antivirals over the counter could compromise patient safety, Australian doctors say

Doctors have warned that a push for Covid antiviral treatments to be sold over the counter at pharmacies may compromise patient safety due to their complex prescription process.

As GP wait times continue to grow significantly across the country and with some GPs ditching bulk billing, the Pharmacy Guild has called on the government to allow antiviral medication to be sold at pharmacies without a prescription.

The Pharmacy Guild president, Prof Trent Twomey, said current wait times for GPs were “unacceptable” and were making it difficult for patients to access this medication in a timely manner.

New South Wales residents have to wait an average of 4.17 days to see their GP. In Victoria, the wait time has risen from an average 1.98 days in 2019 to an average 3.33 days now.

“Given the treatment program of these life-saving antiviral medicines needs to commence within five days of the initial onset of Covid-19 symptoms, it’s vital that patients … receive treatment without long delays due to the lack of GP appointments,” Twomey said.

“Community pharmacists in Australia have the skills, expertise and knowledge to assist patients so there is no reason for delaying treatment to eligible patients.”

But the vice-president of the Royal Australian College of General Practitioners (RACGP), Dr Bruce Willett, said while he can “understand” the push, prescribing antivirals is a complex process best suited to GPs.

“If medications are complicated they do need to know all the medications that a patient is taking and also their blood results, liver function and kidney function,” Willett said.

“It would be compromising safety to go to a pharmacy over-the-counter model.”

There are two forms of antiviral Covid treatments approved for use in Australia, Lagevrio and Paxlovid, which are taken as capsules or tablets to help prevent Covid infections from becoming severe.

Last month the Pharmaceutical Benefits Advisory Committee updated the eligibility criteria for the medication to include Covid-positive people who are:

• 70 years and older, regardless of risk factors and with or without symptoms;

• 50 years or older with two additional risk factors; or

• Aboriginal or Torres Strait Islander, 30 years or older with two additional risk factors.

The Pharmacy Guild has put its proposal to the health minister, Mark Butler.

Willett said there are three main barriers for patients when accessing antiviral Covid medication early: knowing that the medication exists, accessing a GP to get the script, and getting the script filled.

Instead of pivoting to a pharmacy over-the-counter model, Willett would instead like to see the antiviral medication provided directly to GPs who can provide them directly to patients after hours.

He said the aged care sector is in dire need of a stockpile of the medication, and that addressing this should be a priority.

New Zealand was the latest country to make antiviral medication available over the counter at pharmacies, following similar decisions in Canada and the UK.

The RACGP president, Dr Karen Price, warned against comparisons between Australia and other countries, saying this doesn’t account for differences in primary care models, pharmaceutical training and safety classification of medicines.

“These treatments can make the difference between someone suffering relatively minor effects or ending up in hospital,” Price said. “However, we must proceed with caution because the last thing we want to do is potentially endanger patients.”