COVID-19 Antivirals for Adults 65+, 2023–2025: Prescribed Less When Cases Were Low

Adults 65 and older have the highest rates of COVID-19 hospitalization, and the risk rises with age. Antiviral treatment is proven to prevent severe outcomes — outpatient treatment with nirmatrelvir/ritonavir reduces the risk of severe disease in real-world studies — yet earlier studies found it is used little, especially by older adults.

This CDC study looked at how often older outpatients with COVID-19 were prescribed an antiviral, and who was more likely to get one, from June 1, 2023 to September 30, 2025.

The background

SARS-CoV-2 circulates all year and usually surges in summer, fall and winter. From 2020 to 2024 the fall–winter surges (October–February) were consistently worse than the summer ones (June–September) — but the 2024 summer surge caused more hospitalizations than the 2024–25 fall–winter surge. Besides age, people with several chronic conditions or weakened immune systems, and people not vaccinated for the season, are at highest risk.

How the study worked

• Data: Truveta, a real-time collection of deidentified electronic health records from more than 30 U.S. health systems — about 120 million patients at about 20,000 clinics and 900 hospitals. Data were extracted in January 2026.
• Who: outpatients 65 and older in primary care with a positive molecular or antigen test or a COVID-19 diagnosis code, and no hospital stay in the month before. One encounter per person per period; people with COVID-19 in the previous 6 months were left out.
• Treatment: a prescription for nirmatrelvir/ritonavir, remdesivir or molnupiravir within 7 days.
• Vaccinated: a COVID-19 vaccine dose in the previous 6 months.
• Periods: seven seasons, sorted into surge and nonsurge periods.

How often an antiviral was prescribed

Of 482,456 patient encounters, 147,715 (31%) included an antiviral prescription and 334,741 (69%) did not.

Share of patients 65 and older with COVID-19 who received an antiviral prescription as outpatients, by period, June 2023–September 2025. Figure from CDC's report.

• 99% of prescriptions came within 7 days of the positive test or diagnosis.
• Of those treated, 80% got nirmatrelvir/ritonavir, 13% molnupiravir and 7% remdesivir.

Who was more — and less — likely to get one

Adjusted odds of a prescription, after accounting for age, sex, race and ethnicity, chronic conditions, vaccination, rural or urban home and period:

What it means

• Antivirals appear to be underprescribed to older adults, as a 2023 analysis also found — but unlike that study, this one found prescribing rose with age, which suggests providers are recommending them more to the oldest patients, whose risk is highest.
• People with chronic conditions were less likely to get one, perhaps because of complicated medication lists and worry about drug interactions — although these patients are at higher risk, and studies suggest the interactions, a known barrier to nirmatrelvir/ritonavir, can be safely managed.
• Vaccinated people were more likely to be treated, suggesting that people who seek preventive care also seek treatment. COVID-19 vaccination rates are lower than in earlier years.
• Prescribing tracked the virus's circulation: providers may be weighing how much COVID-19 is going around rather than the patient's own risk — which stays even when circulation is low.

Recommendations: encourage annual vaccination for older adults; consider early outpatient treatment for older adults with mild to moderate COVID-19; teach providers and patients the benefits and risks of antivirals; and raise awareness of patient access programs for antivirals.

Limits

• The data cover only people who sought care, and miss cases never recorded as a positive test or diagnosis.
• There were no symptom data to judge who was eligible for treatment.
• Some information, such as vaccination, is likely incomplete.
• Reasons not to treat (contraindications) could not be examined.

Sources

Based on Raykin J, Rochin I, Wiegand R, et al., "COVID-19 Antiviral Prescription Receipt Among Outpatients Aged ≥65 Years — United States, June 1, 2023–September 30, 2025," MMWR Morbidity and Mortality Weekly Report, volume 75, Centers for Disease Control and Prevention; a work of the United States government in the public domain. The source gives the fall–winter 2024–25 prescribing share as 23.4% in its text and 23.7% in its table, so it is left out; and its abstract compares summer 2024 with "other analytic periods" where its results and table compare it with summer 2023, which is followed here.