Outpatient COVID-19 Treatments: Information for Health Professionals

Updated December 5, 2022

The U.S. Food and Drug Administration (FDA) has authorized several widely-available therapeutics to treat mild-to-moderate COVID-19 in people who are at high-risk for progressing to severe COVID-19. Treatment, which requires a prescription, must start within days after symptom onset to be effective. This webpage will help assist you in understanding which treatments might be beneficial for your patients.

On this page:

Who's eligible?

Outpatients should be prioritized for early treatment of COVID-19 if they meet one or more of the following criteria:

  • Age 50 or older
  • Not up to date on COVID-19 vaccinations
  • One or more underlying medical conditions, including chronic lung disease, heart disease, or a weakened immune system. See the CDC list of underlying medical conditions.

Therapeutics overview

Oral antivirals Paxlovid and Lagevrio (molnupiravir) are widely available. Intravenous antiviral Veklury (remdesivir) can be used in some outpatient situations. Monoclonal antibody therapy bebtelovimab is only available commercially.

Find the latest important updates on COVID-19 therapeutics from ASPR, including shelf life extensions.

Paxlovid (nirmatrelvir and ritonavir)

Lagevrio (molnupiravir)

  • FDA EUA Fact Sheet
  • Eligibility: At least 18 years old, weighing at least 88 pounds. Must start within 5 days of symptom onset.
  • Administration: Oral. Patient takes 4 capsules every 12 hours for 5 days.
  • How it works: Molnupiravir introduces mistakes into the virus's genetic code, preventing the virus from replicating properly.
  • Special considerations: Not recommended for pregnant or breastfeeding patients.

Veklury (remdesivir) Gilead

  • Fact Sheet (PDF)
  • Eligibility: At least 28 days old, weighing at least 7.7 pounds. Must start within 7 days of symptom onset.
  • Administration: Intravenous infusion. One dose given per day for 3 days. Observe patient for at least 1 hour after injection.
  • How it works: Remdesivir interferes with one of the key enzymes the virus needs to replicate.
  • Special considerations: FDA-approved for treating hospitalized patients.

Bebtelovimab

IMPORTANT UPDATE [11/30/2022]: The U.S. Food and Drug Administration today announced bebtelovimab is not currently authorized (and cannot be used) for emergency use in the U.S. because it is not expected to neutralize Omicron subvariants BQ.1 and BQ.1.1., according to data included in the Health Care Provider Fact Sheet. Paxlovid, remdisivir, and molnupiravir are expected to retain activity against currently circulating variants, including Omicron subvariants BQ.1 and BQ.1.1

Resources for health professionals

Order form 

Decision aids 

Locator tools 

Toolkit for pharmacists

Treatment guidelines 

Webinars 

Flyer 

Pre-exposure protection: Evusheld

Update [10/3/2022] FDA added important information to the authorized Fact Sheets for Evusheld (tixagevimab co-packaged with cilgavimab) to inform health care providers and individuals receiving Evusheld of the increased risk for developing COVID-19 when exposed to variants of SARS-CoV-2 that are not neutralized by Evusheld. Detailed neutralization data can be found in the revised authorized Fact Sheet for Healthcare Providers. Health care professionals should inform patients of this risk and advise patients who develop signs or symptoms of COVID-19 to test for SARS-CoV-2 infection and promptly seek medical attention, including starting treatment for COVID-19, as appropriate if they test positive.

Evusheld (tixagevimab/cilgavimab) is a long-acting monoclonal antibody therapy that has been authorized by the FDA under EUA for pre-exposure prophylaxis for COVID-19. In Alaska, Evusheld is available through nearly all infusions centers and clinics that care for the eligible patient populations.

  • Eligibility: At least 12 years old, weighing at least 88 pounds; and are moderately to severely immunocompromised, or cannot be fully vaccinated with any available COVID-19 vaccines.
  • Administration: Intramuscular injection. Administered once every 6 months. Patient is given 2 injections during the same session (one 300 mg injection of tixagevimab and one 300 mg injection of cilgavimab). Observe patient for at least 1 hour after injection.
  • How it works: Tixagevimab and cilgavimab are two types of monoclonal antibodies that are designed to stay in the body for long periods of time. They can prevent an infection by blocking the virus from attaching to the body's cells.
  • Special considerations: Cannot be used to treat an active COVID-19 infection. Cannot be given after a known COVID-19 exposure. Not a substitute for vaccination in individuals for whom COVID-19 vaccination is recommended. Patient should wait at least 2 weeks after COVID-19 vaccination to receive Evusheld.

More information 

Bebtelovimab replacement initiative

On Sept. 23, 2022, the U.S. Department of Health and Human Services (HHS) launched a bebtelovimab product replacement initiative to help uninsured and underinsured patients access bebtelovimab. Under this program, HHS replaces bebtelovimab doses for free when health care providers use a commercially procured dose to treat an uninsured or underinsured patient. To qualify for a free replacement dose under this initiative, the provider site should meet following criteria:

  • Have used all their federal supply acquired through the HHS distribution program;
  • Have purchased commercial bebtelovimab and attest to using a purchased dose to treat an uninsured (has no insurance coverage and cannot afford treatment) or underinsured patient; and
  • Consider waiving or reducing the administration fee for bebtelovimab to be reasonable for that patient.

Health care providers now have three avenues for obtaining bebtelovimab:

  • For patients with Medicare, Medicaid or with private insurance who are not underinsured, or for patients who can afford the treatment without insurance: Health care providers should use commercially purchased product ordered directly from AmerisourceBergen.
  • For patients who are uninsured or underinsured, where a provider has already depleted their federal supply distributed through the state/jurisdiction and attests in HHS Health Partner Ordering Portal (HPOP) that they have administered a purchased dose to treat an uninsured or underinsured patient with consideration of administration fees waived or reduced: Health care providers should use HPOP to request a bebtelovimab replacement dose.
  • For patients who are uninsured or underinsured, where the product replacement initiative is not used (including sites that are not able to purchase commercial bebtelovimab): Health care providers should request doses from the supply that the federal government distributed to state/jurisdiction health departments.

Treating Long COVID

Post-COVID conditions, or "Long COVID," can be considered a lack of return to a usual state of health following acute COVID-19 illness. There is no test to diagnose Long COVID, and people may have a wide variety of symptoms that could come from other health problems. Consider a diagnosis of Long COVID based on a patient’s health history, including if they had a diagnosis of COVID-19, as well as a health examination.

Health care providers and patients are encouraged to set achievable goals through shared decisions, focusing on specific symptoms or conditions. A plan focusing on improving physical, mental, and social wellbeing may be helpful for some patients.

Our understanding of Long COVID remains incomplete, and treatment guidance will likely change over time as the evidence evolves.