In December 2021, the FDA issued an Emergency Use Authorization (EUA) for two oral antivirals for the treatment of COVID-19: Paxlovid and Molnupiravir. TRICARE now covers these treatments at military pharmacies, in-network pharmacies, and non-network pharmacies, and beneficiaries will have a $0 charge.
Beginning Jan. 14, 2022, TRICARE’s coverage will expand to include the Paxlovid and Molnupiravir oral antivirals to military pharmacies, in-network pharmacies, as well as at out-of-network pharmacies. Oral antivirals dispensed at pharmacies are at no cost to beneficiaries with an order from an authorized provider. Beneficiaries are encouraged to contact their pharmacy of choice to ensure that there is an adequate supply of the antiviral treatment.
Beneficiaries should be aware that with each treatment, there is a limited quantity restriction. With either antiviral medication, the beneficiaries are limited to one course of treatment per 180 days.
Key Messages
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Messages for Communicators
- Two oral antiviral treatments for COVID-19 received EUA by the FDA in Dec. 2021:
- Paxlovid – approved for EUA on Dec. 22, 2021
- Molnupiravir – approved for EUA on Dec. 23, 2021
- With the EUA approval on the two antivirals, TRICARE will expand to cover Paxlovid and Molnupiravir at military pharmacies, in-network pharmacies, and out-of-network pharmacies on beginning Jan. 14, 2022.
- Dispensing of medications will require beneficiaries to have an authorized prescription and will be dispensed at no cost.
- Beneficiaries are limited to one course of treatment per 180 days.
- Beneficiaries should contact their pharmacy of choice to ensure that there is an adequate supply of the medications.
- Other treatment available to beneficiaries for mild to moderate COVID-19 include Sotrovimab and Remdesivir.
- Though Sotrovimab and Remdesivir are treatment options, they not part of the pharmacy benefit, but are covered by the TRICARE health plan when ordered by a TRICARE authorized provider.
- Beneficiaries should consult with their providers to determine the best course of treatment for them.
Talking Points
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Talking Points for Communicators
- With the recent approval of two oral antiviral treatments for COVID-19, TRICARE will expand its coverage to include Paxlovid and Molnupiravir at military pharmacies, in-network pharmacies, and out-of-network pharmacies beginning Jan. 14, 2022.
- These treatments are for those who test positive for COVID-19 and are at high-risk for progression to severe COVID-19 symptoms
- Paxlovid – treatment for mild-moderate COVID-19 for those over the age of 12 (and weighing at least 40kg)
- Molnupiravir – treatment for mild-moderate COVID-19 for those over age of 18, and for whom alternative COVID-19 treatment options authorized by the FDA are not accessible or clinically appropriate.
- Paxlovid and Molnupiravir are not for those who require hospitalization due to severe COVID-19.
- Paxlovid and Molnupiravir are not pre-exposures/post-exposures prevention of COVID-19.
- With the antiviral medications, the beneficiaries are limited to one course of treatment per 180 days.
- Beneficiaries must obtain an order from a provider in order to have these prescriptions dispensed at pharmacies.
- Starting Jan. 14, 2022, there will be no cost to beneficiaries picking up Paxlovid and Molnupiravir at military pharmacies, in-network pharmacies, and out-of-network pharmacies. Beneficiaries should consult with their providers and/or pharmacist to determine if they’re eligible to receive these treatments, and to address any questions they may have regarding either antiviral treatment.
- Beneficiaries should also contact their pharmacy of choice to ensure that there is an adequate supply of the medications.
- Beneficiaries also have the option of being prescribed Strovimab or Remdesivir for treatment, depending on the individual’s risk factors.
- Though Sotrovimab and Remdesivir are treatment options, they not part of the pharmacy benefit, but are covered by the TRICARE health plan when ordered by a TRICARE authorized provider. Beneficiaries should consult with their doctors regarding these treatment options.
- If the beneficiary tests positive for COVID-19, they should consult with their providers about which treatment plan is right for them.
Graphics
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If your military hospital or clinic offers these antiviral treatments as part of the COVID-19 Test to Treat Initiative, use these graphics to promote your services to your beneficiaries.
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