Related Materials:
Background
Lagevrio (molnupiravir) and Paxlovid (nirmatrelvir/ritonavir) remain primary oral antiviral defenses for preventing hospitalization and death in patients at higher risk for severe disease. As of January 1, 2026, these medications are fully integrated into standard pharmacy procurement; however, ensuring timely access remains a priority.
This guide provides updated recommendations to clarify dispensing requirements and financial assistance programs to ensure no patient faces a delay in care. The following information is intended to clarify topics that pharmacies and pharmacy staff may need to prevent delayed access to critical COVID-19 treatment.
While treatments are vital, staying up to date with the latest 2025-2026 respiratory virus vaccinations remains the most effective way to mitigate severe impact. Learn more about vaccines at the
CDPH COVID-19 Information site.
Treatment Resources for Healthcare Providers
- All Facility Letter (AFL) for Skilled Nursing facility (SNF) residents AFL 23-29 that provides guidance and resources for evaluating, prescribing, and obtaining COVID-19 therapeutics for SNF residents. AFL 23-29 supersedes AFL 22-20.
- CDPH health advisories related to respiratory viruses including COVID-19, can be found in the CDPH California Health Alert Network (CAHAN) page.
- Most insurance plans still cover COVID-19 treatment. Persons who do not have a healthcare provider should use the COVID-19 Test-to-Treat-Locator or call CDPH (916) 558-1784 for assistance.
Insured patients may still have access to free, low-cost, and/or reimbursable over-the-counter COVID-19 tests. Check with your insurance providers for specific details.
- Ensure all staff are knowledgeable about patients' benefits for COVID-19 tests.
- Pharmacists should order and/or dispense allotted test kits for Medi-Cal beneficiaries at the point-of-sale in accordance with the following information: DMHC COVID-19 Fact Sheet (ca.gov) (PDF).
- Insurance plans may still cover COVID-19 at-home tests. Refer to the DMHC COVID-19 Fact Sheet or contact your insurance carrier directly for information on commercial plans.
- Medicare no longer covers or pays for OTC COVID-19 tests for those with Medicare Part B benefits. Some Medicare Advantage (MA) plans may cover and pay for OTC COVID-19 tests as an added benefit. MA plan enrollees should check with their MA plan to see if it covers and pays for these tests. Medicare patients with Part B benefits still have access to laboratory-conducted COVID-19 tests (like PCR tests). Refer to the CMS webpage for Medicare recipients.
- For insurance plans that allow patients to pick up tests at pharmacies within their network free of charge, including Medi-Cal, pharmacists should write an order for the COVID-19 tests and submit the claim as a pharmacy benefit.
- If tests are not covered by insurance at point of sale in the pharmacy, patients may elect to pay at the counter and submit a claim for possible reimbursement from their insurance company directly. Patients should contact the insurance carrier for specific details.
Pharmacies and pharmacy staff should be aware that patient assistance are available to ensure COVID-19 treatment remain free or low-cost.
Provide patients with the best option based on
programs below so that patients are not
charged or are provided the lowest possible cost for COVID-19 oral antivirals.
- Organizations must not sell or
seek reimbursement for publicly funded COVID-19 therapeutics that the federal
government provides at no cost to an organization.
- For Medi-Cal
patients, both Paxlovid and Lagevrio are on the Medi-Cal Contract Drug List.
Patients should not be charged a co-pay.
- Manufacturers are offering
programs to assist patients. Eligibility may be subject to approval according to insurance status:
- Paxlovid:
- The US Government Patient Assistance Program (USG PAP) is operated by Pfizer to help eligible patients without commercial insurance get Paxlovid for free.
- Patients may be able to get a prescription at a local pharmacy or via overnigh mail order. To find a pharmacy participating in the USG PAP or to arrange overnight shipping, call 877-219-7225. For more information, see:
- PAXCESS Patient Support Program
- Lagevrio:
Pharmacies should maintain an adequate supply of COVID-19 oral antivirals during seasonal surges.
CDPH has learned of several pharmacies that have notified patients that they are out of stock of COVID-19 oral antivirals and have not replenished their supply. This puts the public at risk for not receiving treatment quickly.
- Even pharmacies that have not dispensed many oral COVID-19 antivirals in the past are recommended to be prepared for potential incoming patients and ensure on-shelf availability during seasonal surges. Seasonal COVID-19 surges can be tracked at the CDPH Respiratory Virus Dashboard.
- Supplies of these medications are available from drug wholesalers with no concerns of shortages.
- Pharmacies that are temporarily out of stock are strongly encouraged to aid patients in finding COVID-19 therapeutics using the COVID-19 HHS Treatments Locator.
There are several ways patients can be evaluated for COVID-19 treatment.
- Clinicians should consider COVID-19 treatment in patients with mild or moderate COVID-19 who have one or more risk factors for severe COVID-19 to reduce progression to hospitalization and death.
- The California Business and Professions Code (BPC) 4052.04 states a pharmacist may furnish COVID-19 oral therapeutics following a positive test for SARS-CoV-2. Pharmacy staff may also find additional assessment and treatment information at COVID-19 Treatments and COVID-19 Treatment Clinical Care for Outpatients. Note: Paxlovid is the only FDA approved COVID-19 oral therapeutic allowed to be furnished under this statute.
- If a pharmacy has any additional methods for access to treatment, those should also be shared with patients.
Pharmacists should NOT reject COVID-19 prescriptions solely due to the absence of patient renal function and liver function test results.
- Licensed physicians and advanced practice providers are not required to perform additional laboratory testing when prescribing Paxlovid. Providers should use clinical judgement to determine if labs are necessary.
- In making a reasonable attempt to clarify any concerns with the provider and/or patient, pharmacists should use clinical judgement and consider the impact of delayed COVID-19 treatment. Treatment must be started within 5 days of symptom onset.
Pharmacists should NOT reject COVID-19 prescriptions due to the absence of a "positive test" date or "symptom onsent" date written on the prescription.
These items are not required to be written on a prescription, and patients can self-attest to the symptom onsent dates.
- The FDA revised its emergency use authorizations and FDA approvals on Paxlovid and Lagevrio to no longer require positive results of direct SARS-CoV-2 viral testing before a provider can prescribe them.
- Paxlovid received full FDA approval for adults, for the treatment of mild to moderate COVID-19 in adults who are at risk for progression to severe COVID-19, including hospitalization or death. There is no mention of a requirement for a positive test.
- Pharmacists only require a positive test when furnishing Paxlovid to a patient without a prescription. Business and Professions Code 4052.04 states a pharmacist may furnish COVID-19 oral therapeutics following a positive test for SARS-CoV-2.