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Pfizer Oral COVID-19 Drug, Paxlovid, Added to Formulary

Last updated on 1/4/2022

On December 22, 2021, the U.S. Food and Drug Administration issued an emergency use authorization (EUA) for the Pfizer oral COVID-19 drug Paxlovid. The medication treats mild to moderate COVID-19 in adults and children 12 years of age or older who are at high risk for progression to severe COVID-19. Paxlovid requires a prescription and should be started within 5 days of symptom onset after diagnosis of COVID-19. This medication is not authorized for the prevention of COVID-19. 

The Health and Human Services Commission (HHSC) will add Paxlovid to the Medicaid and Children’s Health Insurance Program (CHIP) formulary as a payable pharmacy benefit.

On December 27, 2021, HHSC added the following national drug codes (NDC) to the formulary:

Drug name

Dosage

Package size

NDC

Paxlovid EUA

300-100mg

6 tablets

00069-1085-06

Paxlovid EUA

300-100mg

30 tablets

00069-1085-30

Paxlovid is nirmatrelvir tablets co-packaged with ritonavir tablets. The dosage for Paxlovid is 300mg of nirmatrelvir (two 150mg tablets) with 100mg of ritonavir (one 100mg tablet), with all three tablets taken together orally twice daily for 5 days. 

There is no ingredient cost associated with the medication because the federal government has purchased treatment courses. The Texas Department of State Health Services (DSHS) will distribute the medication to pharmacies.

Providers can find more information at the DSHS Therapeutics website, which includes a map of pharmacies where DSHS distributed Paxlovid for the week of December 27, 2021, and an update on the recently authorized therapeutics for COVID-19. DSHS will revise the site when they distribute additional allocations of Paxlovid in the coming weeks.

Email VDP-Formulary@hhsc.state.tx.us with questions or comments. spray