Dear Colleagues,

This email is to provide update on the current state of outpatient therapies for COVID-19. Providers, please read the following information so that we are all providing consistent messaging to our patients and employees around access to outpatient treatments for COVID-19. For those of you in a position to prescribe treatment, please review this algorithm and the FAQ below.

Outpatient Therapeutic FAQ:

What treatments are available for non-hospitalized patients with COVID?

There are 2 outpatient treatments currently available for treating individuals at risk for complications from COVID-19:

  • PREFERRED: Paxlovid (nirmatrelvir/ritonavir) is an antiviral oral medication that must be started within 5 days of symptom onset. Paxlovid appears to be effective against all COVID-19 variants at this point. There are many drug interactions with this medication and some health conditions (severe liver or kidney problems) that may be contraindications. If you have questions about medication interactions or contraindications to Paxlovid’s use for your patient, you can use this FDA-approved website (Liverpool COVID-19 Interactions https://www.covid19-druginteractions.org/).

  • ALTERNATIVE: If Paxlovid is contraindicated: Bebtelovimab is an IV monoclonal antibody that must be started within 7 days of symptom. There are no drug interactions or adjustments needed for liver or kidney problems, but it is an IV infusion that is currently being administered at the Pena Urgent Care via referral and the Adult Urgent Care Clinic for patients tested there. The monoclonal antibody Denver Health offers is based on the current dominant variant and could change in the future.

Who qualifies for treatment?

Outpatients with mild to moderate COVID-19 (not hospitalized or on oxygen due to COVID-19) who are at least 12 years of age, have symptom onset within 5-7 days (see above), and have at least one risk factor for severe disease. Conditions include, but are not limited to (see CDC website for updated lists):

  • Age ≥65 years

  • Overweight and obesity (BMI > 25)

  • Pregnancy

  • Chronic kidney disease including patients receiving dialysis

  • Diabetes

  • Immunosuppressive disease or immunosuppressive Rx

  • Cardiovascular disease

  • Hypertension

  • Chronic lung diseases

  • Sickle cell disease

  • Mental health conditions

  • Neurodevelopmental disorders

  • Medical-related technological dependence (tracheostomy, feeding tube, ventilator dependence)

• Other medical conditions or social factors that are associated with progression to severe COVID-19. E.g., racial and ethnic minority groups; housing insecurity; living in crowded conditions)

How does a patient or employee access treatment?

  • Current Denver Health patients can access Paxlovid or a referral for Bebtelovimab through their Denver Health primary care provider or seek care through one of our urgent care locations.

  • Patients new to Denver Health (including employees who may not have a PCP at Denver Health) can be evaluated for these therapies through our urgent care clinics:

    • *Peña Urgent Care Clinic—patients 12 years and older, in person (walk in) or telehealth. Call (303)-602-0999 to schedule. 1339 S. Federal Blvd, Denver CO 80219

    • Virtual Urgent Care Clinic—patients 18 years and older, telehealth only. Schedule online: https://www.denverhealth.org/services/emergency-medicine/urgent-care/adult-virtual-urgent-care

    • *Adult Urgent Care Clinic—patients 18 years and older, in person (walk in). 660 Bannock St, Denver CO 80204

    • Downtown Urgent Care Clinic—patients 18 years and older, in person (walk in). 1545 California St, Denver CO 80202

*Peña Urgent Care and the Adult Urgent Care Clinic can provide onsite testing and treatment (prescription for Paxlovid or administration of Bebtelovimab infusion)

Is a laboratory confirmed test required for treatment?

No, a lab confirmed or PCR test is not required to be eligible for treatment. We are able to accept a home test (self-test) being positive as sufficient to prescribe either of these therapies.

How do I know if my patient has a Drug-Drug Interaction (DDI) with Nirmatrelvir-Ritonavir (Paxlovid)?

Use this FDA-approved website: Liverpool COVID-19 Interactions (covid19-druginteractions.org) and/or consult with your local clinical pharmacist.

Who has stock of Paxlovid?

For inventory management and regulatory purposes, this medication can only be dispensed from a couple locations (prescribers please review the attachment for details).

Who needs baseline labs (kidney or liver function) before prescribing Paxlovid?

Getting baseline labs is not necessary unless there is something in the patient’s medical history or their medication list which would prompt concern for renal insufficiency or severe hepatic disease. As always though, be conservative – if there are any concerns then get labs.

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