Dispensing Paxlovid and Monitoring Adverse Drug Events 
                                     A Guide for B.C. Community Pharmacists 
              Table of Contents 
              Background ............................................................................................................................................... 3 
              Dispensing and Clinical Assessment Fee (PAX-A) *NEW June 13, 2022* ..................................... 3 
                 Clinical Assessment (PAX-A) ............................................................................................................... 4 
                 Counselling ............................................................................................................................................ 5 
                 Patient requiring renal dose adjustments (renal) ........................................................................ 5 
                 Patient with drug-drug interactions (DDI) ..................................................................................... 5 
                   Direct oral anticoagulant (DOAC) drug-drug interaction ....................................................... 6 
              Follow-up (PAX-F) ...................................................................................................................................... 6 
                 Claiming the PAX-F Fee *NEW June 13, 2022* ............................................................................... 6 
                 Recording moderate and severe ADEs to the Adverse Reaction field in PharmaNet .......... 7 
                 Required documentation ................................................................................................................... 7 
              Suggested follow-up questions ............................................................................................................ 7 
              Classification of ADE severity ................................................................................................................ 8 
              Appendix A: Coding table ....................................................................................................................... 9 
                 Format................................................................................................................................................... 10 
                   Format examples ............................................................................................................................ 10 
                 Important notes ................................................................................................................................. 10 
                   Days taken ....................................................................................................................................... 10 
                   Treatment stopped early and reason ........................................................................................ 10 
                   ADE # ................................................................................................................................................. 11 
                   ADE - severity .................................................................................................................................. 11 
                   ADE - management ........................................................................................................................ 11 
              Appendix B: Sample form .................................................................................................................... 12 
              Appendix C – Optional Prescriber Communication Form ............................................................. 13 
              Appendix D: Resources ......................................................................................................................... 14 
                 COVID-19 Antiviral Support Line for Clinicians ........................................................................... 14 
                 Prescription form and coverage criteria ....................................................................................... 14 
                 BCCDC Clinical Practice Guide and Practice Tools ...................................................................... 14 
                                                                                                                      
              BC Ministry of Health – Pharmaceutical, Laboratory and Blood Services Division                       1 
              Appendix E: FAQs ................................................................................................................................... 15 
               
                                                                                                                      
              BC Ministry of Health – Pharmaceutical, Laboratory and Blood Services Division                       2 
              Background 
              Nirmatrelvir/ritonavir (Paxlovid™) is an oral antiviral drug used to treat mild-to-moderate 
              COVID-19 in adults who do not require hospitalization and are at high risk of progressing to 
              serious illness. It is new to the market, and information about its safety and effectiveness is 
              limited. The use of Paxlovid is further complicated by the large number of clinically important 
              drug-drug interactions.  
              Given their close relationship with patients, community pharmacists are well-positioned to 
              provide follow-up and monitor patients for potential adverse drug events (ADEs). 
              Documentation, follow-up, and entering the correct information in the SIG in PharmaNet are 
              important. Documentation ensures that the information shared with other members of the 
              patient’s healthcare team is accurate. Follow-up and appropriate coding contribute valuable 
              information for evaluation purposes. 
               
              Dispensing and Clinical Assessment Fee (PAX-A) *NEW June 13, 2022* 
              Like other prescription drugs, nirmatrelvir/ritonavir (Paxlovid™) must be dispensed in 
              accordance with the College of Pharmacists of BC’s Community Standards of Practice, 
              including but not limited to patient identification, review of PharmaNet, documentation and 
              counselling. When dispensing Paxlovid, pharmacists should ensure they have the knowledge, 
              skills and abilities to do so. Pharmacists are reminded that every prescription must be 
              reviewed for completeness and appropriateness, and to review patient personal health 
              information for drug therapy problems, therapeutic duplications and any other potential 
              problems. 
              As of March 1, 2022, all pharmacies will be able to order publicly funded Paxlovid from their 
              regular distributor. Consider carrying adequate Paxlovid courses in order to reduce 
              treatment delays, as patients need to start treatment within 5 days of symptom onset.  
                 •   Publicly funded Paxlovid is available free of charge 
                                                                                                             ®
                 •   Prescribers are encouraged to use the standardized Nirmatrelvir/ritonavir (Paxlovid ) 
                     5-day treatment pack prescription form 
              Exceptional Plan Z coverage of Paxlovid is available for any patient receiving treatment in 
              B.C., regardless of their MSP or residency status. 
              In PharmaNet, enter: 
                 •   Drug cost: $0.01 per pack 
                 •   Dispensing fee: $10 maximum 
                 •   Quantity: 1 pack (containing 30 tablets) 
              Some local systems may not yet be correctly configured for these claims. Please double-
              check your local system settings when first entering a claim for Paxlovid, and before 
                                                              . 
              reporting issues to the PharmaNet Help Desk
                                                                                                                 
              BC Ministry of Health – Pharmaceutical, Laboratory and Blood Services Division                   3 
                The Full Payment Policy applies to Paxlovid since it is under Plan Z (Assurance Plan), which 
                provides 100% paid coverage. Providers may not charge patients any costs associated with 
                the dispense of Plan Z products. 
                Clinical Assessment (PAX-A)  
                As of June 13, 2022, pharmacists dispensing Paxlovid are eligible to claim a temporary $30 
                clinical assessment fee (PAX-A), in addition to the standard dispensing fee. Pharmacists are 
                eligible to claim a PAX-A fee after assessment of the Paxlovid prescription, including 
                completion of a drug-drug interaction (DDI) check with two independent sources, even if no 
                drug therapy problem is identified.  
                Document and communicate with the prescriber, as needed, following usual pharmacy 
                procedures or systems already in place. No additional documentation is required to claim the 
                PAX-A fee, however an optional prescriber communication form
                                                                                                    is available in Appendix C.  
                The PAX-A fee must be submitted the same day as the Paxlovid claim from the same 
                pharmacy. Only one fee can be claimed per treatment course.  
                Required Activities: 
                     •   Assess the Paxlovid prescription for completeness and appropriateness  
                     •   Include *DDI* or *Renal* in the SIG for the Paxlovid dispense as needed 
                     •   Communicate with the prescriber as needed to resolve drug therapy problems, 
                         including any DDIs, recommended management plans  
                              o  An optional form
                                                         in Appendix C may be used to document DDIs and associated 
                                  management plans but is not required. 
                     •   Submit the PAX-A claim the same day as the Paxlovid claim using PIN 66128340 
                Procedure: 
                     1.  Enter the PAX-A PIN 66128340 in the DIN/PIN field 
                     2.  If necessary, enter $0 for drug cost, mark-up and fee 
                     3.  Enter 1 in the QTY field 
                     4.  In the PRACT ID Ref field, enter P1 – College of Pharmacists of BC 
                     5.  In the PRACT ID field, enter your College ID 
                     6.  At start of SIG, type the 10-digit phone number of the pharmacy where the service 
                         took place  
                Refusal to Fill: 
                It is recommended to ask the prescriber for a Paxlovid prescription so that a Refusal to Fill 
                fee can be claimed if a Pharmacist determines it is inappropriate or unsafe to dispense 
                Paxlovid after the clinical assessment. When submitting a Refusal to Fill claim, document with 
                the appropriate intervention code (such as ‘CI- Significant Drug Interaction (Drug-to-Drug)’) 
                to communicate to others in the patients circle of care that an assessment has been done but 
                the drug has not been dispensed. Patients who are not dispensed Paxlovid are not eligible 
                for a PAX-A fee.   
                                                                                                                                         
                BC Ministry of Health – Pharmaceutical, Laboratory and Blood Services Division                                        4