COVID-19 Medications - Minnesota Dept. of Health

COVID-19 Medications

Information for the public on who can get medications to prevent or treat COVID-19 and how to access them. Health care providers should refer to Therapeutic Options for COVID-19 Patients for more information on treatment options and prescribing.

On this page:
Who should get COVID-19 medication
Antiviral therapy
    Oral antivirals
    Remdesivir (intravenous)
Monoclonal antibodies
    Evusheld (tixagevimab/cilgavimab)
Pregnant or breastfeeding
Cost and insurance
COVID-19 convalescent plasma (CCP)
More information

People who test positive for COVID-19 and are at higher risk of becoming very sick may benefit from available COVID-19 medications. These treatments can help prevent severe illness, hospitalization, and death from COVID-19. Talk to your health care provider right away if you test positive and are at higher risk as treatments need to be started early to work best. Your health care provider will help determine which COVID-19 medication option is best for you.

COVID-19 medications are not a substitute for prevention. It is still recommended that everyone who is eligible get vaccinated and take other steps to prevent the spread of COVID-19.

Who should get COVID-19 medication

Not everyone who tests positive for COVID-19 needs to get treated. Antiviral treatments for COVID-19 are available for patients with mild to moderate symptoms, who are not in the hospital, who have had symptoms for seven days or less, and who are at high risk for severe illness.

People can be high risk for many reasons. Some of the most common are being older than 65 years, obesity, having chronic medical conditions such as heart, lung or kidney disease, being on treatment that suppresses your immune system, or pregnancy. To find a full list of factors that may put someone at high risk, visit CDC: People with Certain Medical Conditions.

If you are high risk and develop symptoms that could be COVID-19, get tested right away. If you are positive, contact your health care provider right away, even if your symptoms are mild right now. Don't delay, treatment must be started early to work.

Antiviral therapy

Oral antivirals

Oral antivirals are a pill taken by mouth for the treatment of COVID-19 in certain people.

  • FDA authorization for the oral antivirals Paxlovid (nirmatrelvir/ritonavir) and molnupiravir provide another tool for treating COVID-19 in patients at highest risk for severe illness.
  • Treatment is no substitute for prevention, so getting vaccinated, getting your booster when eligible, masking when recommended, and taking other steps to protect yourself and others is still very important.
  • Oral antivirals may not be right for everyone. Your health care provider can help determine what type of treatment is right for you.

Patients can contact health systems and clinics listed to ask about availability of oral antiviral medications or access the federal Test-to-Treat program:

Where to access
Oral Antivirals

On Dec. 22, 2021, the FDA issued an EUA for Paxlovid to be used in the treatment of COVID-19. Paxlovid is an oral antiviral medication that works by blocking the virus from making copies of itself (replicating). It has been authorized for use in people ages 12 years and older with mild to moderate COVID-19, and at high risk for severe disease. In a clinical trial, Paxlovid reduced the risk of being hospitalized with severe COVID-19 or death by 88% compared to a placebo.

Paxlovid is to be taken within five days of symptoms starting, so it's important for people at high risk to connect with their health care provider if they have symptoms and test positive for COVID-19.

Also be sure to inform your health care provider of your current prescriptions, supplements, and over-the-counter medicines, as Paxlovid may interact with certain medications. Do not start any new medication while on Paxlovid without informing your health care provider.

On Dec. 23, 2021, the FDA issued an EUA for molnupiravir to be used in the treatment of COVID-19. Molnupiravir is an oral antiviral medication that works by blocking the virus from making copies of itself (replicating). It has been authorized for use in adults ages 18 and older with mild to moderate COVID-19, and at high risk for severe disease. In a clinical trial, molnupiravir reduced the risk of being hospitalized with severe COVID-19 or death by 30% compared to a placebo.

Molnupiravir is to be started within five days of symptoms starting, so it's important for people at high risk to connect with their health care provider if they have symptoms and test positive for COVID-19.

This medication is not recommended for use while pregnant or breastfeeding. Talk to your health care provider about other treatment options if you are pregnant or breastfeeding, and people of childbearing age should talk to their provider about preventing pregnancy if using this treatment.

COVID-19 Medications: Oral Antivirals (PDF)
Handout summary of when oral antivirals are used to treat COVID-19.

Remdesivir (intravenous)

Remdesivir is an established antiviral drug. It works by blocking the virus from making copies of itself (replicating). Remdesivir is given through a needle in the vein (intravenously) over time, which is called an IV infusion.

Remdesivir is approved for the treatment of non-hospitalized adults and children who are at high risk for severe COVID-19. In a clinical trial, three days of IV remdesivir reduced the risk of hospitalization with severe COVID-19 or death by 87% compared to a placebo. On April 25, 2022, the FDA expanded this approval to include children at least 28 days old who weigh at least 3 kg (about 6.6 pounds) and who are at risk for developing severe disease, making remdesivir the first FDA-approved treatment for children under age 12.

Remdesivir should be started as soon as possible, and within seven days of when symptoms began, so it's important for people at high risk to connect with their health care provider if they have symptoms and test positive for COVID-19. The treatment is given as a series of three IV infusions, given once a day for three consecutive days.

Not all health care facilities can offer outpatient remdesivir treatment – patients should speak to their health care provider to see if it may be a potential treatment option.

Remdesivir is also used to treat patients who are hospitalized with more severe illness due to COVID-19. If you are hospitalized due to COVID-19, your health care providers will decide if remdesivir or other treatments are needed.

Monoclonal antibodies

Currently authorized monoclonal antibody medications for COVID-19 include bebtelovimab and tixagevimab/cilgavimab. These medications are used at different times, including for the prevention and treatment of illness due to COVID-19. They are authorized for the treatment of outpatients only, not patients who have been admitted to the hospital with COVID-19.

Antibodies are proteins that people's bodies make to fight viruses, such as the virus that causes COVID-19. Antibodies made in a laboratory act a lot like natural antibodies to limit the amount of virus in your body. They are called monoclonal antibodies.

Antibodies can be given into a vein by intravenous (IV) infusion or into the skin by subcutaneous (SQ) injection. Antibodies may be administered only in settings where health care providers have immediate access to medications to treat any reactions and where emergency medical systems are available, if needed.

Monoclonal antibody treatments are allowed by the FDA under an EUA while clinical studies continue to look at their usefulness and safety.

Minnesota Resource Allocation Platform (MNRAP)
As of April 4, 2022, the public or their caregivers are not able to submit their information directly to MNRAP. As new COVID-19 treatments have become available, and as the pandemic has evolved, there is now a need for providers to do a more detailed assessment before choosing a treatment option, such as reviewing medications or lab work. Talk to your health care provider if you have questions about COVID-19 treatments.

Variants and effectiveness of monoclonal antibodies

Some monoclonal antibodies are not as effective against certain variants of COVID-19. This means that when a particular variant is the dominant type of virus spreading in a community, your provider might recommend one type of monoclonal antibody over another. It is generally not possible to know with certainty which virus variant a person has.

As of Jan. 24, 2022, bamlanivimab/etesevimab and casirivimab/imdevimab are no longer authorized for use due to the high prevalence of the Omicron variant.

As of March 30, 2022, sotrovimab is no longer authorized for use in Minnesota due to the high prevalence of the BA.2 variant.

Overview

Products Bebtelovimab EVUSHELD
(Tixagevimab/ Cilgavimab)
Authorized use(s) Treatment of mild to moderate symptoms. Prevention: before exposure
Age eligibility Ages 12 years and older Ages 12 years and older
Weight eligibility 88 pounds or more 88 pounds or more
Other criteria for treatment Test positive for SARS-CoV-2

Be within 7 days of the start of symptoms

Not be hospitalized

Alternative treatment options are unavailable or not appropriate
Not applicable
Other criteria for prevention Not applicable Weakened immune system and not expected to respond to COVID vaccine
OR
Unable to get a COVID-19 vaccine for medical reasons
EUA Fact sheet for patients, parents, caregivers (English) EUA of Bebtelovimab (PDF) EUA of Evusheld™ (tixagevimab co-packaged with cilgavimab) (PDF)
Fact sheets for patients, parents, caregivers (Spanish) EUA de Bebtelovimab (PDF) Not available

COVID-19 Medications: Monocolonal Antibodies (PDF)
Handout summary of when monoclonal antibodies are used to prevent and treat COVID-19.

It is important to know that if you have already received a vaccine for COVID-19, you are still eligible for antibody treatment if you develop a COVID-19 infection. You may be treated with monoclonal antibodies regardless of how many doses of vaccine you have received.

You may also be vaccinated after receiving monoclonal antibodies. According to updated guidance from CDC, there is no need to delay vaccination after monoclonal antibody treatment.

For patients receiving Evusheld, this treatment should be administered at least two weeks after receiving a COVID-19 vaccine. It is still unclear how long someone should wait after receiving Evusheld to get additional doses of COVID-19 vaccine.

CDC: Interim Clinical Considerations for Use of COVID-19 Vaccines Currently Approved or Authorized in the United States

Evusheld (tixagevimab/cilgavimab)

On Dec. 8, 2021, the FDA issued an emergency use authorization (EUA) for a new monoclonal antibody therapy named Evusheld (tixagevimab/cilgavimab). Unlike other currently available monoclonal antibodies, Evusheld is a long-acting antibody that has been authorized for use only to prevent or protect someone before they are exposed to COVID-19. Evusheld is not for the treatment of symptoms due to COVID-19 and is not given following an exposure to someone with COVID-19; it is given to prevent infection before an exposure.

Evusheld is NOT a substitute for COVID-19 vaccination. All patients for whom COVID-19 vaccination is recommended, including those with compromised immune systems, should receive COVID-19 vaccination.

COVID-19 Medications: Evusheld (PDF)
Handout summary of when Evusheld is used to prevent COVID-19.

The U.S. government has purchased supplies of this antibody therapy and will be allocating it to states. MDH has issued guidance for providers and patients on how supplies will be allocated to facilities and which patients should be prioritized when supplies are scarce. This guidance can be found at Therapeutic Options for COVID-19 Patients: Ethical guidance and eligibility. Patients who may be eligible for treatment should discuss their eligibility and the availability of Evusheld with their provider.

Pregnant or breastfeeding

Pregnant people and their babies are at high risk for serious illness from COVID-19. People who are pregnant should talk with their doctor or other health care provider.

Antivirals

There is limited specific safety data on the use of antiviral treatment for COVID-19 in people who are pregnant or breastfeeding, and patients should discuss potential treatment options and their risks and benefits with their providers. The use of antiviral treatments for COVID-19 in pregnant or breastfeeding patients is supported by the National Institutes of Health (NIH), the American College of Obstetricians and Gynecologists (ACOG), and the Society for Maternal Fetal Medicine (SMFM).

  • Paxlovid may be considered for use in people who are pregnant or breastfeeding.
  • Molnupiravir is not recommended for people who are pregnant or breastfeeding due to potential concerns from animal studies on its effect on the developing baby. However, it may be used as a treatment option if no other therapies are available.

Monoclonal antibodies

  • Monoclonal antibodies may be considered for use in people who are pregnant or breastfeeding.

ACOG: COVID-19 FAQs for Obstetrician-Gynecologists, Obstetrics

CDC: Considerations for Newborns and Breastfeeding

Cost and insurance

The federal government has purchased supplies of certain COVID-19 medications and is distributing them free of charge. These include:

  • Paxlovid
  • Molnupiravir
  • Bebtelovimab
  • Evusheld

This means patients do not have to pay for the medication itself, but there may be other fees associated with getting the treatment that a person or an insurance company would need to pay. For example, a clinic may charge for services associated with administering a treatment, or a pharmacy may charge insurance a dispensing fee for filling a prescription. Patients may have a copay for these services, depending on their insurance type. Talk to your health care provider or pharmacist if you have any questions about costs associated with receiving a particular treatment.

There are a couple of other COVID-19 medications are not being distributed for free by the government and are available commercially similar to other types of medication. These include:

  • Remdesivir
  • COVID-19 convalescent plasma (CCP)

This means there may be a cost for the medication itself, like other prescription medications you might get, as well as possible other fees associated with getting the treatment. Talk to your health care provider or pharmacist if you have any questions about costs associated with receiving a particular treatment.

Health insurance may cover most of these costs. Patients who do not have insurance may be able to find low- or no-cost treatment in their communities at a U.S. Health Resources & Services Administration (HRSA) health center or community health center. Refer to HRSA Health Center COVID-19 Therapeutics Program Participants for a list of centers. Additional information on Minnesota community health centers/federally qualified health centers that provide services to medically underserved and disadvantaged populations, as well as a health center locator, are available at Minnesota Association of Community Health Centers: Find a Health Center.

COVID-19 convalescent plasma (CCP)

On Dec. 28, 2021, the FDA updated the emergency use authorization (EUA) for COVID-19 convalescent plasma (CCP). COVID-19 convalescent plasma is the liquid portion of blood from donors who have recovered from COVID-19. The blood from people who recover from COVID-19 contains substances called antibodies, which are capable of fighting the virus that causes COVID-19.

CCP may benefit people with compromised immune systems, in which the body is unable to make its own antibodies to the virus or the patient may be taking medications that weaken their immune system.

CCP is given through an IV. Your health care provider can let you know if CCP is an appropriate treatment for you.

More information

For more information on COVID-19 testing, treatments, and vaccines, please visit COVID.gov, provided by the U.S. government.

  • The COVID.gov website offers a helpline for more information, including help with navigating the federal locator website to find treatment locations. Note: this is not an MDH helpline.
    • English or Spanish: 1-800-232-0233
    • TTY (Text Telephone for hearing impaired): 888-720-7489

Updated Monday, 16-May-2022 08:18:08 CDT