PBAC wants COVID-19 antiviral prescribing rules tightened as cost reaches $1 billion

Press/Media: Expert Comment


The PBAC has warned that the $981 million annual cost of subsiding COVID-19 antivirals must be curbed with stricter PBS criteria or price cuts for the manufacturers...

f the government did adopt stricter criteria, GP Professor Mark Morgan said it would lead to some patients falling through the cracks. 

“You can have a patient with one serious risk factor who has a higher risk of severe outcomes than someone with two milder risk factors,” said the chair of the RACGP Expert Committee — Quality Care.

But he stressed that the PBAC “did not have a bottomless pit of expenditure” and that the prescribing criteria would “never be perfect”. 

“It is always going to be a simplification of something more complex.” 

Similarly, the PBAC suggested changes to the prescribing restrictions for molnupiravir, as well as a reduction in the price, following a cost-effectiveness evaluation. 

The market share for molnupiravir “did not reflect clinical guidelines”, it added.

PBS expenditure data showed that molnupiravir cost taxpayers nearly $650 million in 2022/23 — more than any other drug. 

In contrast, nirmatrelvir–ritonavir ranked seventh for cost at $330 million, even though clinical guidelines recommended it ahead of molnupiravir unless contraindicated or otherwise unsuitable.

Professor Morgan said there were several reasons why doctors were prescribing more molnupiravir than nirmatrelvir–ritonavir.

“When the drugs came out, doctors were encouraged to use either one,” he told AusDoc

“However, now, the WHO is quite clear that Paxlovid is preferred based on effectiveness in reducing hospitalisations and some uncertainty with Lagevrio’s long-term safety profile. 

“There is also heavy marketing of Lagevrio — nothing wrong, illegal or against guidelines — but still heavy marketing.” 

He added that Paxlovid required additional time and effort to prescribe because of the “complex list” of contraindications and drug–drug interactions.

“But of course, if Paxlovid is safe for the patient, you are not doing anybody any favours by choosing to prescribe a less effective drug.



General practice


Health policy

Period11 Jan 2024

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