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COVID-19 Treatments: Information for Long Term Care Facilities

Long-Term Care Information Sheet PDF

COVID-19 cases are increasing. Staying up to date with COVID-19 vaccines and accessing treatments in a timely manner are the best ways to reduce the risk of hospitalization and death due to the illness.

COVID-19 Treatments are safe, effective, and widely available.

There is strong scientific evidence that using antiviral treatments reduces the risk of hospitalization and death for those at risk of severe COVID-19. Authorized and approved COVID-19 treatments are widely available. There are no supply constraints limiting providers’ ability to prescribe treatment.

Based on current analysis, these treatments are expected to be active against all currently circulating variants.

Treatments should be considered for any patient over the age of 50 or with a high-risk health condition, regardless of vaccination status.

Patients are more likely than others to get very sick from COVID-19 if:

  • They are 50 years of age or older.
  • They have a compromised or weakened immune system OR they have one or more health issues, heart, lung, or kidney disease; are overweight; have diabetes; severe asthma; or some types of disabilities.
  • They are unvaccinated.

Anyone over the age of 50 and anyone with a high-risk health condition should be prescribed COVID-19 treatment as clinically appropriate.

COVID-19 Treatments must be started early, even if symptoms are mild.

Treatments must be started within 5 days of symptom onset for oral medications (Paxlovid and Lagevrio) and 7 days of symptom onset for IV medication (Veklury).

Providers should discuss a COVID-19 Action Plan in advance with patients in case of infection, including the optimal medication choice and how to access the medication.

The oral antiviral pill Paxlovid (nirmatrelvir co-packaged with ritonavir) and the IV administered drug Veklury (remdesivir) are the preferred treatments for eligible patients.

Paxlovid is the preferred oral antiviral and is taken twice daily for 5 days.

  • Paxlovid is not recommended in patients with severe renal (eGFR < 30) or hepatic impairment. Dose reduction for patients with moderate renal impairment (eGFR >30-<60) is recommended.
  • For all other eligible patients, drug interactions need to be assessed and certain medications may need dose adjustments. (Helpful resources include the FDA checklist for Paxlovid Prescribing and the Liverpool drug interaction checker).
  • Preliminary evaluation of drug-drug interactions can be done in advance of a positive test but should be rechecked at the time of treatment initiation.

For patients for whom Paxlovid is not appropriate, Veklury (remdesivir) IV infused once a day for 3 days is also a preferred treatment option.

Veklury is not recommended for use in patients with severe renal (eGFR < 30) or hepatic impairment.

See the FDA’s Fact Sheet for Healthcare Providers for detailed information about Paxlovid and the U.S. Prescribing Information for Veklury.

Lagevrio (molnupiravir) is an alternative oral antiviral for patients for whom neither Paxlovid nor Veklury are clinically appropriate or feasible.

  • Lagevrio is taken twice daily for 5 days.
  • Lagevrio is not recommended in patients who may be pregnant.
  • There are no known drug interactions with Lagevrio based on limited available data.
  • See the FDA’s Fact Sheet for Healthcare Providers for detailed information about Lagevrio.

Long-term care facilities should ensure timely access to effective COVID-19 treatments for all eligible patients, including through pre-positioning the medications directly at facilities:

  • The oral antivirals Paxlovid and Lagevrio are currently being distributed for free by the US Government; contact your long-term care facility’s serving pharmacy or for access.
  • The oral antivirals can be positioned within a long-term care or skilled nursing facility, following local regulations, so long as they are only dispensed to patients once a prescription is entered and verified.
  • Veklury is available commercially for outpatient use through the distributors Cardinal [1-855-855-0708 /] and Amerisource Bergen [1-800-746-6273 /]. LTC and SNF providers can access this product directly from the distributor or through their servicing pharmacy.