COVID-19 Outpatient Treatments

March 18, 2022

Outpatient COVID-19 Treatment Updates

There are several therapies meant to prevent COVID-19 patients with high-risk medical conditions from becoming hospitalized, as follows:

Pfizer’s Paxlovid antiviral pill: A limited supply of Pfizer’s Paxlovid antiviral pills are being distributed by L.A. County to select clinics and pharmacies, including those operated by UCLA Health. Paxlovid is only prescribed if patient is within 5 days of symptom onset. Click to view the FDA fact sheet in English.

Monoclonal antibody therapies: Effective monoclonal antibody therapies to treat symptomatic, high-risk COVID-19 patients are available. UCLA Health receives a limited weekly supply of sotrovimab and bebtelovimab, the only monoclonal antibody therapies that work against the omicron variant, from L.A. County. Given the limited data, bebtelovimab is not considered a first line agent to treat COVID-19. However, it may have improved efficacy against the omicron subvariant, BA.2, over sotrovimab. Casirivimab/imdevimab (manufactured by Regeneron) and bamlanivimab/etesevimab (manufactured by Eli Lilly), are not effective against the omicron variant.

Remdesivir: If we cannot offer sotrovimab due to supply limitations, a process is in place to offer high-risk patients a three-day course of remdesivir via IV. While sotrovimab is easier to administer, as it only requires a one-day infusion, the National Institutes of Health (NIH) lists three days of remdesivir as an option for patients at risk of COVID-19 disease progression.

Merck’s molnupiravir antiviral pill: Merck developed a second oral antiviral pill that’s meant to reduce the risk of hospitalization in high-risk patients. This is considered the least effective outpatient therapy, and only offered if Paxlovid, monoclonal antibody therapy and remdesivir are not available.

Watch video: outpatient COVID-19 therapies

Cost information for COVID outpatient treatments: COVID-19 medications are currently being provided to patients at no cost. We are also not charging for the administration of monoclonal antibody therapies and remdesivir.

Want more information? Please reach out to your primary care physician if you have questions about outpatient COVID-19 therapies. Please see the COVID-19 vaccine info hub for information about the available vaccines.

Guidelines for who to treat with outpatient therapies:

UCLA Health is following the recommendations put forth by the NIH regarding whom to treat with the available outpatient therapies. The NIH panel organized patients into four tiers, and prioritized them based on age, vaccination status, immune status and clinical risk factors. Currently, we are offering therapies to those patients who meet all tiers, but this may be subject to change pending supply. 

Tiers 1 and 2 include immunocompromised individuals not expected to mount an adequate immune response to COVID-19 vaccination and unvaccinated individuals with additional risk factors. Patients with these conditions remain at the highest risk of hospitalization. 

Tier 1 and 2 conditions are as follows:

Tier 1:

  • Patients who are within one year of receiving B-cell depleting therapies (e.g., rituximab, ocrelizumab, ofatumumab, alemtuzumab)
  • Patients receiving Bruton tyrosine kinase inhibitors (e.g. ibrutinib, acalabrutinib, zanubrutinib)
  • Chimeric antigen receptor T cell recipients (CAR-T)
  • Post-hematopoietic cell transplant recipients who have chronic graft versus host disease or who are taking immunosuppressive medications for another indication
  • Patients with hematologic malignancies who are on or within 3 months of active therapy
  • Lung transplant recipients
  • Patients who are within one year of receiving a solid-organ transplant (other than lung transplant)
  • Solid-organ transplant recipients with recent treatment for acute rejection with T or B cell depleting agents
  • Patients with severe combined immunodeficiencies
  • Patients with untreated HIV who have a CD4 T lymphocyte cell count <50 cells/mm3
  • Unvaccinated patients who are 75 or older — or 65 and older with additional risk factors

Tier 2:

  • Unvaccinated patients who are 65 or older, or under 65 with additional clinical risk factors
  • Patients in active cancer treatment for non-hematologic malignancies (e.g. myelosuppressive chemotherapy)
  • Patients who received a solid-organ transplant more than one year ago and are on immunosuppressive drugs
  • Post-hematopoietic cell transplant recipients who received treatment within two years without GVHD / not taking immunosuppressive medications for another indication
  • Patients receiving treatment for moderate primary immunodeficiency
  • Patients with untreated/advanced HIV who have a CD4 T lymphocyte cell count <200 but >50 cells/mm3
  • Patients actively being treated with high-dose corticosteroids in less than or equal to 20 mg daily for at least two weeks, or actively taking other drugs (within one month) that may suppress their immune response

Tier 3 and Tier 4:

Tier 3 includes vaccinated individuals at high risk of severe disease, such as anyone 75 or older, or 65 or older with clinical risk factors other than immunosuppression.

Tier 4 includes vaccinated individuals at risk of severe disease, such as anyone aged 65 or older or anyone younger than 65 with clinical risk factors.

Monoclonal antibody therapy for pre-exposure prophylaxis

Evusheld (tixagevimab/cilgavimab), manufactured by AstraZeneca, is FDA authorized for pre-exposure prevention of COVID-19 in select high-risk individuals, such as those who are immunosuppressed and have not had an adequate response to vaccination, or those who are unvaccinated and have a contraindication to vaccination. Please note that this drug is not meant to replace vaccination.

UCLA Health will offer this therapy to select high-risk patients. Please contact your primary care clinician to obtain a referral for this program.   

Cost information: There is no cost for Evusheld.