Prescription of nirmatrelvir/ritonavir for Covid-19 by general practitioners in Italy: territorial ubiquity and differences

AURORA DI FILIPPO ^1* Simona Zito ¹ Benedetta Bellini ¹ Rosaria Simone ² Francesco Trotta ¹

• ¹ Italian Medicines Agency (AIFA), Rome, Italy
• ² Department of Political Science, University of Naples Federico II, Naples, Campania, Italy

The availability of nirmatrelvir/ritonavir as a therapeutic option in the management of COVID-19 disease has been important in the clinical management of outpatients. The need to take this drug within 5 days of symptom onset, as prescribed by a physician, has led to disparities, in access, particularly in some countries. Given the clinical and logistical challenges of drug access, the policy differences between countries, and evidence of inequalities, an analysis of nirmatrelvir/ritonavir prescribing in Italy was undertaken. The aim of this study is to assess whether prescribing by General Practitioners (GPs) and distribution by pharmacies actually ensured territorial homogeneity. An ecological study was carried out to assess whether there were subgroups of patients who did not use this drug or GPs who did not prescribe it and whether the therapeutic plan, which had to be reported by the GP, ensured adherence to guidelines. Additionally, we examined whether patient and GP characteristics influenced prescribing patterns through an analytical study. This is the first nationwide study of nirmatrelvir/ritonavir prescribing and its determinants in relation to patient and GP characteristics. The results show that the Italian drug prescribing and dispensing model ensured pharmacoequity, despite potential barriers such as social inequalities, the therapeutic window, the need for a doctor's visit, and potential Drug-Drug Interactions. Although the descriptive analysis and logistic model of GPs prescribing propensity analyse different outcomes, the results show that age is the main driver of prescribing, geographic area has an impact, and residence in a larger municipality results in more prescriptions.