National Antiviral Service (NAVS) – Healthcare Professionals site

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National Antiviral Service Cymru (NAVS)

The National Antiviral Service Cymru (NAVS) is co-ordinating the supply of treatments for COVID‑19 for the most vulnerable individuals across Wales who have not been admitted to hospital. 

Information for Healthcare Professionals

The following information and resources are aimed at healthcare professionals. Members of public can access information about the National Antiviral Service (NAVS) from this site.

NICE guidance [TA878] published on COVID-19 treatments

On 29 March 2023, NICE published evidence-based recommendations on casirivimab plus imdevimab (Ronapreve▼®), nirmatrelvir plus ritonavir (Paxlovid▼®), sotrovimab (Xevudy▼®) and tocilizumab (RoActemra®) for treating COVID-19 [TA878].

This evaluation reviews the clinical and cost effectiveness of treatment options for mild COVID-19 and for severe COVID-19. The recommendations can be accessed via the NICE website.

National Antiviral Service Pathway

The NHS Wales National Antiviral Service Referral Pathway provides a consistent way of triaging and assessing individuals for either an oral antiviral preparation, or referral to the local health board within which they reside for an infusion of a neutralising monoclonal antibody (nMAB).

Interim Clinical Commissioning Policy Treatments

Update The published UK-wide policy has been updated, effective with immediate effect, to provide access to antiviral treatment options for eligible individuals, based on a review of the latest available evidence.

Rapid Policy Statement Interim Clinical Commissioning Policy: Treatments for non-hospitalised patients with COVID-19. Effective from 28 November 2022

A decision aid (only accessible from an NHS Wales networked computer) has been developed to help maximise Paxlovid▼® use.

Eligibility Criteria

The eligibility criteria are specified in the UK-wide Clinical Commissioning Policy and are available in this NAVS table.

Referral Portal

Healthcare professionals should use the information in the UK-wide Clinical Commissioning Policy to decide whether a patient is likely to be eligible for treatment. Where a healthcare professional considers a patient may be eligible for treatment, they can refer them for review by NAVS via an online portal. Patients can self-refer via the Self-Referral Portal or can call NHS 111 Wales.

Extended use of antivirals beyond labelled expiry dates

The Department of Health and Social Care (DHSC) and pharmaceutical company Pfizer have extended the shelf life of specified batches of Paxlovid▼® (nirmatrelvir 150mg and ritonavir 100mg) film-coated tablets.

The DHSC and pharmaceutical company MSD have extended the shelf life of specified batches of Lagevrio▼® (molnupiravir) 200mg hard capsules.

Some expiry dates have been extended following assessment by the Medicines and Healthcare products Regulatory Agency (MHRA). The list of specified batches can be found on the GOV.UK website:

The following Direct Healthcare Professional Communications have also been circulated regarding these changes:

Patient Group Directions (PGDs)

The national COVID-19 treatment PGD templates are available below. The sotrovimab PGD template is for adaptation by local health boards.

(Xevudy▼®) sotrovimab 500mg in 8mL (62.5mg in 1mL) concentrate for solution for infusion for the treatment of mild to moderate COVID‑19 infection in adults at high risk for severe disease

The national COVID-19 treatment PGD for oral antivirals is being run centrally for the whole of Wales within Cardiff and Vale University Health Board by the National Antiviral Service (NAVS Cymru). Copies of the PGDs are provided for information.

(Paxlovid▼®) nirmatrelvir 150mg film-coated tablets and ritonavir 100mg film-coated tablets for the treatment of mild to moderate coronavirus disease in high risk individuals for severe disease

(Lagevrio▼®) molnupiravir 200mg capsules for the treatment of mild to moderate coronavirus disease in high risk individuals for severe disease

UK-wide Clinical Commissioning Policy Documents

The latest clinical commissioning policy documents can be accessed via the All Wales Therapeutics and Toxicology Centre (AWTTC ) COVID-19 therapies – alerts and advice page; under the ‘Neutralising monoclonal antibodies or antivirals’ section 

COVID-19 “Rebound” associated with Paxlovid▼® treatment

Cases of COVID-19 rebound following treatment with nirmatrelvir/ritonavir have been noted. The NAVS team have been involved in highlighting case reports, which you can read more about in this Journal of Infection letter.

NAVS webinar

This recorded webinar focuses on the NHS Wales community deployment of neutralising monoclonal antibodies (nMABs) or antivirals for non-hospitalised patients with COVID-19.

Other useful resources

Change history

29 Mar 23

NICE guidance [TA878] added.

22 Dec 22

Expiry date extension information added.

26 Oct 22

Paxlovid PGD updated. Decision aid link added.

25 Oct 22

Paxlovid PGD updated. Treatment options evidence review added.

07 Sep 22

NAVS Referral Pathway added, eligibility criteria and PGDs updated.

11 Jul 22

Webinar link added.

01 Jul 22

Eligibility criteria and PGDs updated.

22 Jun 22

COVID-19 “Rebound” article added.

06 Apr 22