For Outpatient Patient Care – Current Medications for Outpatient Treatment of COVID-19

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Date: July 12, 2021
To: Health Plan of San Joaquin (HPSJ) All Contracted and Non-Contracted Providers
From: Health Plan of San Joaquin
Subject: For Outpatient Patient Care – Current Medications for Outpatient Treatment of COVID-19
Business: Medi-Cal Managed Care

Management of COVID-19 is rapidly evolving. There are only a few medications that have obtained Emergency Use Authorization (EUA) from the FDA to treat this disease in the ambulatory population. Many trials are still ongoing, and therapies will continue to change as data is collected.

It is crucial for providers to stay in the forefront of information, to appropriately advocate for and treat patients. To assist providers, HPSJ’s Pharmacy Department has brought together in this single piece all the FDA-authorized treatment options for outpatient management for COVID-19.

Key Points

  • Among ambulatory patients with mild-to-moderate COVID-19 at high risk for progression to severe disease, EUAs have been approved for bamlanivimab + etesevimab, casirivimab + imdevimab, and sotrovimab
  • Patients who require carisivimab + imdevimab infusion:
    • Must be referred to San Joaquin General Hospital Infusion Center
    • Review the eligibility criteria and complete the attached referral form, also posted here: www.hpsj.com/pharmacy-announcements/.
  • There is limited or no evidence supporting hydroxychloroquine, dexamethasone or other corticosteroids, ivermectin, or convalescent plasma in outpatient COVID-19 treatment.
  • Consider casirivimab + imdevimab or sotrovimab in patients with mild-to moderate COVID-19:
    • Who are ≥12 years of age, weigh at least 40 kg (88.1849 pounds), and are at high risk of progressing to severe COVID-19 and/or hospitalization
    • With treatment to be started as soon as possible after a positive result is received and within 10 days of symptom onset

Background1
Early in the pathogenesis of COVID-19, the disease is mostly driven by replication of SARS-CoV-2. Later in the course of infection, the disease causes an exaggerated immune and inflammatory response to the virus which leads to tissue damage.

With this understanding, it is reasonable that: antiretrovirals exhibit the greatest effect during the early stages of disease progression, and immunosuppressive and anti-inflammatory therapies are more useful in the later stages.

Attachments:

  1. Summary of Current Medications for Outpatient Treatment of COVID-19,
    Recommended and Non-Recommended – following pages 2 – 3
  2. Eligibility/Referral Form – San Joaquin General Hospital Infusion Center (carisivimab + imdevimab) – 3 additional pages
  3. Download Attachments here:

Posted on July 12th, 2021 and last modified on July 26th, 2021.

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