Updated: Outpatient COVID-19 treatments available in Ohio and Florida

Updated on April 19, 2022 to include additional availabilty in Florida.

Updated on April 5, 2022 with new monoclonal antibody formulary, Bebtelovimab.

Updated on March 30, 2022 to include expanded criteria for prescribing Evusheld.

A Cleveland Clinic enterprise team is working on strategies for the equitable distribution and delivery of COVID-19 treatments.

Please see below for current treatments as well as Emergency Use Authorizations (EUA) and U.S. Food and Drug Administration (FDA) approval status for COVID-19 anti-viral and preventative therapies.

Long-acting monoclonal antibodies for pre-exposure prevention of COVID-19: Evusheld

The FDA issued an EUA for AstraZeneca’s Evusheld (tixagevimab co-packaged with cilgavimab and administered together by intramuscular injection) for the prevention of COVID-19 in certain high-risk adults and children 12 years of age and older, weighing at least 88 pounds.

Cleveland Clinic is administering Evusheld in certain locations in Ohio and Florida through scheduled appointments to patients with immunocompromising conditions or medications, and those unable to receive a COVID-19 vaccine due to severe adverse reaction.

All Cleveland Clinic providers are now able to order Evusheld for eligible patients. We encourage providers to consider ordering if their patient meets the expanded eligibility criteria outlined below. Please review the training materials for ordering details.

Expanded Cleveland Clinic eligibility for Evusheld includes:

  • Patients who have moderate to severe immune compromise due to a medical condition or receipt of immunosuppressive medication or treatment and may not mount an adequate immune response to COVID-19 vaccination OR
  • Patients for whom vaccination with any available COVID-19 vaccine is not recommended due to a history of severe adverse or severe allergic reaction to a COVID-19 vaccine(s)

Additionally, the product is only authorized for patients who meet both of the following requirements:

  • Patients who are not currently infected with COVID-19 AND
  • Patients who have not recently been exposed to an individual infected with COVID-19

Patients will require documentation of a negative COVID-19 test at least 72 hours before their scheduled injection.

Oral antiviral agents for COVID-19: Paxlovid and Molnupiravir  

Paxlovid (nirmatrelvir and ritonavir) and Molnupiravir received EUA approvals last December. These oral antivirals treat mild to moderate COVID-19 infection in high-risk outpatients. 

Paxlovid can be used for adults and children at least 12 years of age and at least 88 pounds.

Molnupiravir is only approved for adults 18 years and older and should not be used in pregnant or lactating women.  

Ordering criteria

The oral antivirals are EUA-approved for outpatients who meet all three of the following requirements: 

  1. Test positive for COVID-19  
  2. Are within five days of symptom onset  
  3. Are at high risk for progression to severe COVID-19, which includes hospitalization   

Ohio

Cleveland Clinic began distribution of Paxlovid and Molnupiravir in January.

  • Patients: Patients should contact their primary care providers to review the EUA fact sheet and determine eligibility.
  • Prescribers: Prescribers can find details on the therapies and patient eligibility criteria at this link.

How to order

Prescribers must use the SmartSet in Epic called COVID-19 Oral Therapies.  This SmartSet is the only way to order COVID oral antivirals at Cleveland Clinic. It includes product availability details and ordering instructions.  

Cleveland Clinic Emergency Departments in Northeast Ohio do not provide outpatient COVID therapies including monoclonal antibody infusions and prescriptions for oral therapies. These therapeutics cannot be ordered by emergency department providers.

Florida

Cleveland Clinic outpatient pharmacy locations in Florida have received allocations of Paxlovid and are dispensing at Weston and Tradition. Molnupiravir is currently unavailable at our Florida locations. 

Monoclonal antibody infusions for treatment of mild to moderate COVID-19: Bebtelovimab

Cleveland Clinic provides monoclonal antibody infusions to treat mild to moderate COVID-19 infection in certain patients who have a high risk for severe illness.  Effective April 5, 2022, our COVID-19 monoclonal antibody formulary in Ohio and Florida will be changed to Bebtelovimab which is shown to work against current COVID-19 variants.

In Northeast Ohio, we offer outpatient COVID-19 monoclonal antibody infusions at four locations:

  • Marymount and Euclid Hospital, adults
  • Akron General Health and Wellness Center located at Green, the preferred location for adults with immunocompromising disorders and therapies
  • Main campus R building, pediatrics only

In Florida, we offer outpatient COVID-19 monoclonal antibody infusions at the following locations:

  • Outpatient infusion sites: Martin North, Weston
  • ED infusion sites: Indian River 

Cleveland Clinic’s monoclonal antibody appointments are for patients who are under the care of a Cleveland Clinic primary care provider or select sub specialty provider. Patients should contact their primary care provider or subspecialty provider to determine if they are a candidate for an infusion.

There are additional locations throughout Ohio and Florida that offer COVID-19 monoclonal antibody infusions. Click here using Google Chrome to view an interactive map.

For the latest information on COVID-19 monoclonal antibody therapeutics, click here.

New ACIP guidance on COVID-19 vaccine timing after treatment

COVID-19 vaccines may now be administered without regard to the timing of monoclonal antibody infusions for treatment of COVID-19 infection. The Advisory Committee on Immunization Practices (ACIP) updated its guidance and no longer recommends a deferral period for patients to receive a COVID-19 vaccine after monoclonal antibody infusion (Sotrivimab).

Please note: use of tixagevimab/cilgavimab (EVUSHELD™) taken in advance of COVID-19 exposure should be deferred for at least two weeks after vaccination. 

The COVID-19 vaccines are the best way to protect yourself and others from severe illness and death from COVID-19.  We encourage everyone who is eligible to receive a COVID-19 vaccine.