COVID-19 Medication Options - Minnesota Dept. of Health
As we learn more about COVID-19, recommendations and guidance are updated frequently. Please check back often.

COVID-19 Medication Options

Monoclonal antibodies

Monoclonal antibody treatment can be used in people 12 years of age and older who weigh at least 88 pounds (40 kg) who are at high risk for severe COVID-19, including hospitalization or death for:

  • Treatment of mild to moderate symptoms of COVID-19.
    To be eligible, patients must:
    • Test positive for SARS-CoV-2.
    • Be within 10 days of the start of their symptoms.
    • Not be hospitalized.

  • Prevention of COVID-19 in people who have had close contact or are at high risk of being in close contact with someone with COVID-19, such as people in the same institutional setting (for example, nursing homes or prisons) where COVID-19 is circulating.
    To be eligible, people:
    • Must not be fully vaccinated against COVID-19
      or
    • Are not expected to build up enough of an immune response to the complete COVID-19 vaccination (for example, someone with immunocompromising conditions, including someone who is taking immunosuppressive medications).

Note: When demand for monoclonal antibody (mAb) treatments increases, the Minnesota health care system works to prioritize access to the treatments to those who are most at risk of severe illness.

  • The Minnesota Department of Health has worked closely with the Mayo Clinic and the University of Minnesota to look at who benefits from monoclonal antibody treatment. When there is a lot of COVID-19 in the community and high demand for the treatments, priority will be given first to treating patients who are ill and who have the highest risk of developing severe illness and requiring hospital admission. This means that some lower-risk patients, who are eligible for treatment, will be notified that an appointment is not immediately available. If more appointments become available after higher risk patients have been treated, those lower risk patients will be contacted, likely within 2-3 days of their submission. Patients should remain in contact with their provider and closely monitor their symptoms.
  • Also, during times of high demand, those who have been exposed but do not have symptoms likely will not have access to monoclonal antibodies for prevention of COVID-19 unless they are immunocompromised or until case counts and demand for monoclonal antibody treatment decreases. People who have been exposed should be in contact with their provider and closely monitor for symptoms. If symptoms develop and they have a positive COVID-19 test, they may then seek treatment.
  • This prioritization framework applies to patients age 18 years and older. Children who are eligible for mAb treatment under the current FDA guidance should continue to be assessed and treated as they have been. Refer to Suggested Criteria for the Use of Monoclonal Antibody Therapy for COVID-19 in Children (PDF).
  • Aged 65 years or older
  • Obesity (BMI of 35 kg/m2 or greater)
  • Diabetes
  • Chronic kidney disease
  • Cardiovascular disease in patients aged 55 years or older
  • Chronic lung disease in patients aged 55 years or older
  • Hypertension in patients aged 55 years or older
  • Immunocompromised
  • Pregnancy
  • Member of BIPOC community (Black/African American, Hispanic/Latino, Asian, Native Hawaiian or Pacific Islander, or American Indian or Alaskan Native)
  • Hematologic and solid tumors on active therapy
  • Hematopoietic stem cell or solid organ transplant on immunosuppressants
  • Moderate or severe primary immunodeficiency (such as DiGeorge syndrome, Wiskott-Aldrich syndrome)
  • HIV/AIDS with CD4<200

*Congregate living setting such as long-term care centers, correctional facilities and shelters for people experiencing homelessness with supplies of mAbs on hand will still be permitted to provide mAb preventive treatment to all eligible patients if they have staff available to provide this therapy on-site without requiring an appointment through MNRAP.

This approach was developed by MDH in consultation with the Minnesota COVID-19 Ethics Collaborative, similar to previous guidance on scarce therapeutics. Full details are available at Ethical Framework for Allocation of Monoclonal Antibodies during the COVID-19 Pandemic (PDF).

Talk to your doctor or other health care provider about treatments that are right for you, including if you have other medical conditions that are not listed above.

COVID-19 Medication (PDF)
Handout summary of when monoclonal antibodies are used to prevent and treat 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 treatment with bamlanivimab and etesevimab, REGEN-COV™ (casirivimab and imdevimab), or sotrovimab are for people who have tested positive for COVID-19 and have mild to moderate symptoms. Additionally, monoclonal antibody treatment with bamlanivimab and etesevimab or REGEN-COV™ (casirivimab and imdevimab) can be given to people who have had close contact or are at high risk of being in close contact with someone with COVID-19. These treatments are allowed by the U.S. Food and Drug Administration (FDA) under an Emergency Use Authorization (EUA) while clinical studies continue to look at their usefulness and safety.

Fact sheets for patients, parents, and caregivers

Bamlanivimab and etesevimab

REGEN-COV™ (casirivimab and imdevimab)

Sotrovimab

Clinical trials for monoclonal antibodies against COVID-19 have shown a decrease in hospitalizations and emergency room visits and a decrease in the amount of virus carried by an infected person. Studies are still ongoing, but so far clinical trials have shown that these treatments can reduce the risk of hospitalization with severe COVID-19 or death by 70-85%.

Monoclonal antibody treatment may have side effects. The most common reported side effects include:

  • For bamlanivimab/etesevimab: nausea, dizziness, itching, and rash.
  • For casirivimab/imdevimab: nausea, vomiting, hyperglycemia, and pneumonia.
  • For sotrovimab: itching, fever, rash, and diarrhea.

The side effects of getting any medicine by vein may include brief pain, bleeding, bruising of the skin, soreness, swelling, and possible infection at the infusion site. Additionally, because bamlanivimab/etesevimab, casirivimab/imdevimab, and sotrovimab are antibody treatments, they could affect your body's own immune response to future infections with SARS-CoV-2, the virus that causes COVID-19, or they could affect your immune response to a vaccine for COVID-19.

Allergic reactions including hypersensitivity reactions (such as itching or flushing) and anaphylaxis have been reported in clinical trials of casirivimab/imdevimab, bamlanivimab/etesevimab, and sotrovimab. These allergic reactions are very rare and in all cases were successfully treated and resolved. Clinical studies are ongoing to evaluate the usefulness and safety of antibody treatment. It is possible that not all risks are known yet.

Pregnant women and their babies are at high risk for serious illness from COVID-19. Women who are pregnant should talk with their doctor or other health care provider. There is no specific safety data on the use of monoclonal antibodies for COVID-19 in pregnancy. However, pregnant women have been successfully receiving these treatments since November 2020. Monoclonal antibody treatment for pregnant women with COVID-19 is recommended by the National Institutes of Health and the American College of Obstetricians and Gynecologists (ACOG).

There is no available data on the presence of lab-made antibodies in human or animal milk, the effects on breastfed infants, or the effects on milk production. However, ACOG recommends that breastfeeding is not a contraindication for the use of monoclonal antibodies. There is no need to temporarily stop breastfeeding when receiving monoclonal antibodies.

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

CDC: Considerations for Newborns and Breastfeeding

We do not yet know how effective vaccines are in someone who has previously received an antibody treatment for a COVID-19 infection, or whether the antibody treatment could interfere with your body's own immune response to a vaccine. Once you have had COVID-19, you are very unlikely to be reinfected for three months afterward. So, if you receive an antibody treatment, you should delay receiving a vaccine for three months as a precaution.

It is important to know that if you have already received a vaccine for COVID-19, you are still eligible for antibody treatment. You may be treated with monoclonal antibodies whether you have received one or two doses of vaccine. If you have only received one dose of vaccine, you should delay receiving the second dose for three months after treatment, but you do not have to start the vaccine series over again.

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

The federal government distributed antibody supplies at no cost to patients. However, some hospitals may have billed insurance companies to administer the drug. The state of Minnesota is working to ensure that any location that gives antibody treatments is considered in network and covered by insurance. However, if you are treated at a health care facility outside of your usual network, it is possible that you may have additional out-of-pocket charges (for example, if an E-Health visit is necessary to confirm eligibility).

How can I get monoclonal antibody treatment?

The Minnesota Resource Allocation Platform (MNRAP) is an online tool that connects people and health care providers with COVID-19 medications. People, their caregivers, or their health care providers can use MNRAP to find out which medications are available, whether they will help the person, and whether the person is able to get medication.

If someone can get a COVID-19 medication, MNRAP passes along information on their behalf to a health care facility that can give it. A final decision about whether someone can get a medication is up to the health care provider at that facility.

How to use MNRAP

  • The online screening form will ask about your age, medical history, symptoms, location, and your contact information. The questions will determine whether you may have a qualifying high-risk condition and if you are within the treatment window.
  • You may complete the screening form yourself or ask your provider, caregiver, or trusted friend or family member to complete it for you. Providers should select the button "For Health Care Providers."
  • When you finish filling out the screening form, you will be notified whether you meet the basic criteria for a monoclonal antibody treatment and whether there is an appointment available. If an appointment is available, a provider at the facility site after you are referred for treatment must confirm that you are clinically eligible. They may require additional information for this, such as medical or prescription records if you are not a patient at that facility. A decision on eligibility is up to the provider at the facility, and their decision is final.
  • The system will match you to the closest available appointment to you, based on your ZIP code. You will also be given the option to select an alternative location if there are other appointments available.
  • Once you hit "submit," MNRAP will send your information to the facility you have selected. Duplicate entries are not allowed, so you will not be able to submit a second time unless it is for a different reason (for example, treatment instead of prevention).
  • You will receive an email confirming your MNRAP submission and the contact information of the treatment facility where your referral has been sent. If you do not have an email address, please provide a phone number. You can also ask a friend, family member or your provider to fill out the form for you. If your provider, caregiver, friend or family member has completed the form for you, they can provide their email address or yours. If you cannot provide an email address for the confirmation email, your referral will still be sent to the treatment facility.
  • A provider should then contact you from that facility by the next business day to confirm your eligibility and schedule your appointment. If your provider, caregiver or friend or family member has completed the form for you, they will be given the option to provide their contact information and schedule the appointment on your behalf.

PLEASE NOTE:

  • Appointments are limited, especially on Fridays, Saturdays, and Sundays. If you do not accept an appointment when offered, you may not be able to get another one.
  • Please ensure you have selected the right treatment facility before you hit submit. Write down the name and address for that site.
  • MDH and MNRAP do not make the final decision about who can get a medication. The final decision is up to the health care provider at the treating facility. MNRAP screens patients for initial eligibility and sends patient information to treatment facilities for consideration. Individual treatment decisions are up to health care providers.
  • MDH and MNRAP do not control the number or location of available appointments. The platform is designed to connect patients and providers to the appointments that are currently available from health care facilities. MNRAP will match you to the closest available appointment, but if demand is high, treatment facilities closer to you may not have open slots.
  • After submitting your form and receiving an email if you do not hear from your selected facility by the next business day of submitting your MNRAP request, please contact them directly. The contact information for the facility will be in your confirmation email. Your appointment is not confirmed until you are contacted by the treating facility and scheduled. Please answer your phone for unknown numbers – it may be the facility trying to contact you.
  • When there is a lot of COVID-19 in the community and high demand for the treatments, priority will be given first to treating patients who are ill and who have the highest risk of developing severe illness and requiring hospital admission. This means that some lower-risk patients, who are eligible for treatment, will be notified that an appointment is not immediately available.
  • If more appointments become available after higher risk patients have been treated, you will be contacted. Please stay in contact with your health care provider and closely monitor your symptoms.
  • While the system will be prioritizing higher risk patients as of Dec. 1, this is NOT the same as a lottery. A lottery for monoclonal antibody treatment has not been implemented in Minnesota. MDH is encouraging all health care systems and providers to increase the number of available appointments as they are able.
  • MDH and MNRAP do not make the final decision about who can get a medication. The final decision is up to the health care provider at the treating facility.

For patients or
caregivers

For health care
providers

Oral antivirals

There are new treatments under development for COVID-19 that are administered orally (by mouth). They have not yet received emergency use authorization from the FDA. Once an authorization is issued, the U.S. government plans to begin allocating supplies to states for distribution. MDH is in the process of planning this distribution. Further details will be available once an emergency use authorization has been issued and Minnesota has received details of the allocation.

New monoclonal antibody for prevention

A new monoclonal antibody for the prevention of COVID-19 is under development that may be used in immunocompromised patients and patients who have a medical contraindication to receiving a vaccine for COVID-19. It has not yet received emergency use authorization from the FDA. Once an authorization is issued, the U.S. government plans to begin allocating supplies to states for distribution. MDH is in the process of planning this distribution. Further details will be available once an emergency use authorization has been issued and Minnesota has received details of the allocation.

Remdesivir and convalescent plasma

These medication options are typically for people with severe COVID-19 who require hospitalization.

More information

For more information on COVID-19 treatments and vaccines, please visit Combat COVID provided by the U.S. Department of Health and Human Services (HHS).

  • Combat COVID Monoclonal Antibodies Call Center is a helpline to assist you with determining whether you may be eligible for a COVID-19 treatment. Note: this is not an MDH helpline.
    • English: 1-877-332-6585
    • Spanish: 1-877-366-0310

Updated Wednesday, 01-Dec-2021 10:23:02 CST