1.4 million more people at risk of severe COVID-19 to have access to antiviral Paxlovid

A further 1.4 million people who have an increased risk for progression to severe COVID-19 will be eligible for Paxlovid if they test positive following updated NICE final draft guidance published today (11 January 2024).

NICE already recommends Paxlovid (also called nirmatrelvir plus ritonavir and made by Pfizer) for an estimated 3.9 million people who do not need supplemental oxygen for COVID-19 and who have an increased risk for progression to severe COVID-19. This includes people with certain cancers, people who have had haematological stem cell transplant or who have a haematological disease and people with liver or kidney disease (2).  

Following a partial review NICE has published updated final draft guidance which increases the number of people eligible to access Paxlovid to an estimated 5.3 million. This means that within 3 months of NICE publishing final guidance, the following groups will also have access to Paxlovid if they test positive for Covid 19: 

  • People aged 85 years and over. 
  • People with end-stage heart failure who have a long-term ventricular assistance device.  
  • People on the organ transplant waiting list.  
  • People aged 70 years and over, or who have a BMI of 35 kg/m2 or more, diabetes or heart failure, and are resident in a care home, or are already hospitalised  

Paxlovid is an antiviral medicine, given as 2 separate tablets to people within 5 days of getting COVID-19 symptoms. It works by stopping the virus from growing and spreading in the body. It’s 2 separate medicines, nirmatrelvir and ritonavir. Nirmatrelvir stops the virus from growing and spreading, and ritonavir helps nirmatrelvir from being broken down in the body while it is working. 

People eligible for COVID-19 treatments can get free lateral flow tests from participating pharmacies and should take a test as soon as they have symptoms, even if mild. If positive, people should call their GP surgery, NHS 111 or hospital specialist as soon as possible. 

Helen knight, director of medicines evaluation said: Our review of the evidence on the use of Paxlovid has found it offers value for money for a wider group of patients. This is good news for people who may contract COVID-19 in the coming months and will help alleviate pressure on the health service. NICE is focused on getting the best care to patients while ensuring the NHS can continue to deliver maximum value to the taxpayer. 

Although we are no longer in a pandemic, COVID-19 is still circulating and we are pleased that more people at risk of severe disease can benefit from Paxlovid.” 

About the guidance 

  1. Link to guidance Final draft guidance: 2 | Project documents | Nirmatrelvir plus ritonavir for treating COVID-19 (Partial Rapid Review of TA878) [ID6262] | Guidance | NICE
  2. The information on risk factors for progression to severe covid can be found here - 5 Supporting information on risk factors for progression to severe COVID-19 | Casirivimab plus imdevimab, nirmatrelvir plus ritonavir, sotrovimab and tocilizumab for treating COVID-19 | Guidance | NICE 
  3. The full list of people identified as having severe risk outcomes can be found here - TCRP modelling group findings: risk of severe COVID-19 outcomes - GOV.UK (www.gov.uk).
  4. Figure 1: Estimated number of people who have been prescribed Paxlovid

A line chart showing the estimated number of people who have been prescribed Paxlovid in England up to June 2023, by financial quarter. 2021/22 Q4: 7628, 2022/23 Q1: 11786, 2022/23 Q2: 12622, 2022/23 Q3: 11560, 2022/23 Q4: 11974, 2023/24 Q1:7038

Data up to June 2023. Estimates based on the assumed daily dose and treatment duration.  

Source: NHS England, Innovation Scorecard. 

5. Eligible patients can pick up free rapid lateral flow tests from a local participating pharmacy. 

Nurse or Doctor holding hand of her senior patient and showing kindness while doing a checkup at a retirement, old age home or hospital

Our review of the evidence on the use of Paxlovid has found it offers value for money for a wider group of patients.

Helen knight, director of medicines evaluation

This is good news for people who may contract COVID-19 in the coming months and will help alleviate pressure on the health service

Helen knight, director of medicines evaluation

Although we are no longer in a pandemic, COVID-19 is still circulating and we are pleased that more people at risk of severe disease can benefit from Paxlovid

Helen knight, director of medicines evaluation