Pfizer Oral COVID-19 Drug, Paxlovid, Added to Formulary

Date: January 5, 2022 Attention: All Providers Effective Date: December 27, 2021Providers should monitor the Texas Children’s Health Plan (TCHP) Provider Portal regularly for alerts and updates associated to the COVID-19 event.  TCHP reserves the right to update and/or change this information without prior notice due to the evolving nature of the COVID-19 event. Call to action: Health and Human Services Commission (HHSC) added Paxlovid to the Medicaid and Children’s Health Insurance Program (CHIP) formulary as a payable pharmacy benefit on December 27, 2021. The medication treats mild-to-moderate COVID-19 in adults and children 12 years of age and older, who are at high risk for progression to severe COVID-19. HHSC added the following national drug codes (NDC) for Paxlovid:

Drug name	Dosage	Package size	NDC
Paxlovid EUA	300-100mg	6 tablets	00069-1085-06
Paxlovid EUA	300-100mg	30 tablets	00069-1085-30

Paxlovid is nirmatrelvir tablets co-packaged with ritonavir tablets. The dosage for Paxlovid is 300mg of nirmatrelvir (two 150mg tablets) with 100mg of ritonavir (one 100mg tablet), with all three tablets taken together orally twice daily for 5 days. How this impacts providers: Paxlovid requires a prescription and should be initiated after diagnosis of COVID-19 within 5 days of symptom onset. This medication is not authorized for the prevention of COVID-19. Providers can find more information at the DSHS Therapeutics website, which includes a map of pharmacies where DSHS has distributed Paxlovid for the week of December 27, 2021, and an update on the recently authorized therapeutics for COVID-19. DSHS will revise the site when they distribute additional allocations of Paxlovid in the coming weeks. Next steps for providers: Providers should share this update with their staff. If you have any questions, please email Provider Network Management at: providerrelations@texaschildrens.org