Provider Briefing: Paxlovid Availability in 2026

As a prescriber, you know that Paxlovid (Nirmatrelvir/Ritonavir) remains one of the most effective outpatient treatments for mild-to-moderate COVID-19 in high-risk adults. You also know that prescribing it and having your patient actually fill it are two very different things.

This article provides a concise update on the current Paxlovid landscape — availability, prescribing considerations, cost barriers, and practical tools to help your patients access treatment within the critical 5-day window.

Timeline: How We Got Here

A brief review of the key milestones:

• December 2021: FDA issues Emergency Use Authorization (EUA) for Paxlovid in adults
• 2022-2023: U.S. government purchases and distributes Paxlovid at no cost through the pandemic response
• May 2023: Public health emergency ends; Paxlovid transitions to commercial market
• May 2023: FDA grants full approval (NDA) for Paxlovid in adults at high risk
• March 2024: EUA-labeled packaging discontinued; NDA-approved single-dose packaging becomes standard
• January 2025: Adult EUA authorization removed (full approval covers adults); pediatric EUA maintained for ages 12+ weighing ≥40 kg
• 2026: No generic available in the US; commercial distribution continues through Pfizer

Prescribing Implications

Indications and Dosing

Paxlovid is FDA-approved for treatment of mild-to-moderate COVID-19 in adults at high risk for progression to severe disease. Treatment should be initiated as soon as possible after diagnosis and within 5 days of symptom onset.

Standard dosing:

• Normal renal function: Nirmatrelvir 300 mg (two 150 mg tablets) + Ritonavir 100 mg (one tablet), twice daily for 5 days
• Moderate renal impairment (eGFR 30-59 mL/min): Nirmatrelvir 150 mg (one tablet) + Ritonavir 100 mg (one tablet), twice daily for 5 days
• Severe renal impairment (eGFR <30 mL/min): Not recommended
• Severe hepatic impairment (Child-Pugh C): Not recommended

Drug Interaction Screening Is Essential

The ritonavir component is a potent CYP3A4 inhibitor, making drug interaction screening a critical step before prescribing. Key contraindicated co-medications include:

• Statins: Lovastatin and simvastatin (contraindicated); atorvastatin and rosuvastatin require dose reduction or temporary hold
• Antiarrhythmics: Amiodarone, flecainide, propafenone
• Immunosuppressants: Tacrolimus, cyclosporine, sirolimus, everolimus (dramatically increased levels — if used, requires close monitoring and significant dose adjustment)
• Sedatives: Oral midazolam, triazolam (contraindicated)
• Anticoagulants: Rivaroxaban, apixaban (increased bleeding risk); warfarin (monitor INR closely)
• CYP3A inducers: Rifampin, carbamazepine, phenytoin, St. John's Wort (reduce Paxlovid efficacy, contraindicated)
• Colchicine: Contraindicated in patients with renal or hepatic impairment

The NIH COVID-19 Treatment Guidelines and the Liverpool COVID-19 Drug Interaction Checker remain valuable resources for rapid screening. For many patients on complex regimens, Lagevrio (Molnupiravir) may be a more practical choice due to its significantly fewer interaction concerns.

The Availability Picture

Paxlovid is not on the FDA drug shortage list as of early 2026. National supply exists. However, provider teams should be aware of the following ground-level realities:

• Pharmacy stocking is inconsistent. Many retail pharmacies don't carry Paxlovid routinely due to its high wholesale cost ($1,400-$1,600) and expiration risk.
• Seasonal surges strain supply. During winter COVID waves, pharmacies that normally stock it can deplete their inventory within days.
• Geographic disparities persist. Rural and underserved communities have fewer pharmacies and less inventory overall.
• No generic competition. Without a US-approved generic, supply remains limited to Pfizer's production and distribution.

Cost and Access Barriers

Cost remains a significant barrier to patient adherence, particularly for uninsured and underinsured populations:

• Commercial insurance: Most plans cover Paxlovid with $0-$75 copays
• Medicare Part D: Covered, copays vary by plan
• Medicaid: Generally covered, minimal cost-sharing
• Uninsured: $1,400-$1,600 cash price per course

Pfizer's PAXCESS Program is the primary patient assistance resource:

• Commercially insured patients: Co-pay assistance up to $1,500 per prescription
• Uninsured/underinsured patients: May qualify for free medication
• Enrollment: paxlovid.com/paxcess or 1-877-219-7225

Proactively informing patients about PAXCESS at the point of prescribing can prevent fill abandonment due to cost surprise at the pharmacy counter.

Tools and Resources for Your Practice

Medfinder for Providers

Medfinder for Providers offers real-time pharmacy inventory data that your care team can use to direct patients to pharmacies that actually have Paxlovid in stock. This is particularly valuable during surge periods when stock is unpredictable.

Workflow Recommendations

1. Screen for drug interactions before prescribing — use the NIH interaction checker or Liverpool tool
2. Check availability using Medfinder for Providers before sending the prescription
3. Send the prescription to a pharmacy with confirmed stock to avoid delays
4. Inform patients about PAXCESS at the point of prescribing, especially uninsured patients
5. Have alternative treatment plans ready — know which local infusion centers offer Remdesivir and whether Lagevrio is available

Alternative Treatment Considerations

When Paxlovid is not appropriate or available:

• Lagevrio (Molnupiravir): Oral, 5-day course, fewer drug interactions, EUA status, lower efficacy (~30% vs ~89% risk reduction)
• Remdesivir (Veklury): FDA-approved, 3-day IV infusion, requires infusion center access, strong evidence base
• Monoclonal antibodies: Availability depends on circulating variants; check current FDA authorizations

For detailed alternative comparisons to share with patients: Alternatives to Paxlovid 5-Day.

Looking Ahead

Several developments may improve the Paxlovid access landscape in the coming years:

• Generic competition: While no US generic is available in early 2026, Pfizer has licensing agreements that allow generic production in certain low- and middle-income countries. US generic approval timelines remain uncertain.
• Next-generation antivirals: Multiple novel COVID-19 antivirals are in late-stage clinical trials, which could expand treatment options and reduce pressure on Paxlovid supply.
• Improved distribution models: Some health systems are piloting direct-to-patient dispensing and test-to-treat programs that bypass retail pharmacy bottlenecks.

Final Thoughts

Paxlovid remains the preferred first-line outpatient treatment for high-risk COVID-19 in 2026, but real-world access challenges persist. Providers who proactively screen for interactions, verify pharmacy stock, and connect patients with cost assistance are best positioned to ensure their patients actually receive treatment within the critical window.

Bookmark Medfinder for Providers for real-time inventory checks, and consider sharing our patient-facing resources with your team: How to Find Paxlovid 5-Day in Stock Near You.