NICE has updated its guidance to no longer recommend nirmatrelvir plus ritonavir for some risk groups including the over-70s.
The antiviral, also known as Paxlovid, is no longer cost effective in the over-70s as well as people with diabetes, obesity and heart failure, the new recommendations said.
It follows a partial review in March 2024 that extended access to the drug to a broader population than those who had already been eligible because they were most at risk from severe disease.
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At the time, it meant around 1.4 million more people could potentially access the antiviral treatment if they tested positive for Covid.
Those who were eligible could get free lateral flow tests from participating pharmacies and were encouraged to take a test as soon as they have symptoms before calling their GP, NHS 111 or a hospital specialist.
But a recent review found the treatment is no longer cost effective for the groups evaluated in the partial review and as such these have now been removed from the guidelines.
The drug remains cost effective for the highest-risk groups which also includes those with immune deficiencies, some people receiving treatment for cancer and those with serious respiratory problems such as individuals with COPD having long-term oxygen therapy, NICE said.
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A table in the guidance sets out the current list of those for whom Paxlovid will be funded.
A primary care update bulletin from NHS England noted that other groups that were no longer eligible for treatment as per the update include people aged 85 years and over, people with end-stage heart failure who have a long-term ventricular assistance device and people on the organ transplant waiting list.
Previous details of a price reached between the Pfizer who make Paxlovid and the NHS were confidential.
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In May 2025, the company set a new list price of £829 because NICE was considering if the recommendation needed to be reviewed ‘due to the evolving Covid-19 landscape and emerging data from NHS England’.
A version of this article was first published by our sister title, Pulse.
