How to prescribe molnupiravir and nirmatrelvir/ritonavir (PaxlovidTM)
for treatment of high-risk COVID-19 patients
through Tufts Medical Center Atrium 3 Outpatient Pharmacy
 Visit our all-new COVID-19 website for updated resources for ambulatory practices.
January 14, 2022

A Message for the Wellforce Clinically Integrated Network, including primary and specialty care physicians, practice administrators, Network leaders (Presidents, Administrators, and Medical Directors) and Network staff

Dear Wellforce Clinicians and Leaders:

The purpose of this update is to provide guidance about how to prescribe two oral COVID-19 treatments – molnupiravir and nirmatrelvir/ritonavir (Paxlovid) – through Tufts Medical Center’s Atrium 3 Outpatient Pharmacy in Boston.


The Massachusetts Department of Public Health (DPH) has designated Tufts Medical Center’s Atrium 3 Outpatient Pharmacy in Boston as one of several dispensing pharmacies for oral COVID-19 agents molnupiravir and nirmatrelvir/ritonavir (Paxlovid).

The agents may be dispensed to any eligible patient, not just those receiving care through Tufts MC/Wellforce. The medications are provided to patients at no cost to them.
Supplies of both oral COVID-19 antiviral agents are extremely limited and may only be prescribed to patients with documented COVID-19 who meet certain risk factors as summarized on this form

As of January 11, 2022, Tufts MC has been allotted 320 courses of molnupiravir and 0 courses of nirmatrelvir/ritonavir (Paxlovid).

The following guidelines have been developed for the equitable distribution of the agents.

Prescribing Guidance

All prescribers should:
·       Review the HHS treatment algorithm for determining the most appropriate outpatient COVID-19 therapy for their high-risk patients (monoclonal antibodies, remdesivir or oral therapy).
·       Review the oral COVID-19 treatment guidance document
·       Molnupiravir is contraindicated in pregnancy and requires effective contraception for both males and females. Counseling on contraception is required prior to dispensing. Prescribers must assess whether individuals who are able to become pregnant are pregnant, if clinically indicated.
·       Nirmatrelvir/ritonavir (Paxlovid) has a number of clinically significant CYP450 drug interactions. It is essential to carefully review all of a patient’s current medications prior to dispensing. Contact Atrium 3 Outpatient Pharmacy at 617-636-5381 with questions regarding drug-drug interactions.

Steps To Prescribe Medications
1.     All prescribers must review the Patient Emergency Use Authorization (EUA) factsheets with the patient when prescribing oral COVID-19 antiviral prescriptions and document it in the patient’s medical record. The Atrium 3 Outpatient Pharmacy will provide printed EUAs with the dispensed medication.

Paxlovid factsheet
Molnupiravir factsheet

2.     All prescribers must complete the required risk factor form, which includes the date of symptom onset and indication for therapy. Please review the Tier 1 and Tier 2 risk factors listed on the form.  Prescribers should fax the completed form to the Atrium 3 Outpatient Pharmacy at (617) 636-1612. The Pharmacy is open Mondays-Fridays, 8 a.m. to 7 p.m. and Saturdays-Sundays, 10 a.m. to 3 p.m.

3.     All prescribers who are not employed by Tufts MC must also complete and fax a standard paper prescription to Atrium 3 Outpatient Pharmacy at (617) 636-1612.

Tufts MC physicians with the capability to e-prescribe to the Atrium 3 Outpatient Pharmacy can order the medications electronically. Please note: A risk factor form must still be completed and faxed to the Pharmacy.

On the prescription form, the prescriber must: (1) include the patient’s phone number and (2) specify whether the medication will be:
-       Delivered to a Boston-based Tufts MC clinic (please specify location)
-       Delivered to Tufts MC emergency department (exclusively for patients who have been evaluated in the ED)
-       Picked up by patient, curbside, near the taxi-stand at the Tufts MC Main Entrance, 800 Washington Street, Boston
-       Shipped to patient at an address to be confirmed with Pharmacy at time of dispensing. Patients will not be billed for shipping.

4.     The Atrium 3 Outpatient Pharmacy will review the prescription to assure it meets eligibility guidelines, will call the patient for counseling, and verify the prescription pick-up process.

5.     Patients should NOT be sent to the Tufts MC emergency department for the explicit purpose of picking up or seeking a prescription for an oral COVID-19 antiviral agent.

Important note: Due to limited supply and EUA recommendation to start therapy within 5 days of symptoms, prescriptions will only be valid for the day prescribed. If the Atrium 3 Outpatient Pharmacy is unable to dispense a prescription on the day received due to inadequate supply, the prescriber will be notified by fax or call. Prescribers should check this website for updated information about medication availability.

For More Information and Updates on Medication Availability

  • Call our hotline at 617-636-5252 for a recorded greeting about current availability of oral COVID-19 therapies
  • Visit this website for up-to-date information on availability and necessary forms.

I would like to extend my sincere appreciation to the Tufts MC Division of Geographic Medicine and Infectious Disease and the Tufts MC Pharmacy for putting this equitable system in place to benefit our patients and community.

Thank you,
Michael Wagner, MD, FACP
Chief Physician Executive