May 2023 update: Ontario Health is advising that Paxlovid™ can cause severe interactions with some transplant medications and solid organ transplant recipients should not take Paxlovid™ without first speaking to their transplant care team. Solid organ transplant recipients who test positive for COVID-19 should be directed to contact their transplant care team to receive the appropriate COVID-19 therapeutics and follow-up care.
As announced by the Ontario government, as of December 12, 2022, O. Reg.107/96 – Controlled Acts, under the Regulated Health Professions Act (RHPA), was amended to authorize a Part A pharmacist to prescribe Paxlovid™ (nirmatrelvir/ritonavir) antiviral treatment for COVID-19 in accordance with section 16 of the regulation and the eligibility criteria set out by the Ministry of Health.
On December 12, 2023, the authority for Part A pharmacists to prescribe Paxlovid™ (nirmatrelvir/ ritonavir) transitioned from the Regulated Health Professions Act (RHPA), Controlled Acts Regulation (107/96) to O. Reg 202/94 (General) of the Pharmacy Act. This did not represent a change to practice.
Pharmacists must possess the required clinical knowledge, skills and competency to prescribe and/or dispense Paxlovid™ for eligible individuals. A comprehensive patient assessment is required to identify and manage potential drug therapy problems (such as drug interactions, contraindications, the need for dosage adjustments, etc.) or to determine whether a referral to a primary care provider is necessary. Pharmacists offering this service must follow expectations outlined in the Pharmacist Prescribing: Initiating, Adapting and Renewing Prescriptions Guideline.
Additional resources to support pharmacists with clinical decision-making and links to the Ministry of Health Executive Officer notices can be found below. Resources related to screening protocols and IPAC measures can be found under Pharmacy Operations – Infection Prevention and Control Measures.
No other registrant (i.e., Part B pharmacist, registered pharmacy student, intern, pharmacy technician, pharmacist (emergency assignment), or pharmacy technician (emergency assignment)) is authorized to prescribe Paxlovid™.
For more information, please reference the resources below:
- Ministry of Health
- Ontario Health
- Ontario COVID-19 Science Advisory Table
- University of Waterloo School of Pharmacy / University of Toronto Leslie Dan Faculty of Pharmacy
- Canadian Pharmacists Association
- ISMP Canada Safety Bulletin:
- Centre for Effective Practice (CEP)
- Government of Canada
- Renal function (eGFR) calculators (examples):
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