COVID-19 Antiviral Prescription Receipt Among Outpatients Aged ≥65 Years — United States, June 1, 2023–September 30, 2025

Adults aged ≥65 years have the highest rates of COVID-19-related hospitalization. Despite the proven benefit of COVID-19 antivirals in preventing severe outcomes, data suggest that their use is low among older adults. To assess factors associated with receipt of an antiviral prescription among adults aged ≥65 years examined in outpatient settings who received a positive SARS-CoV-2 test result or COVID-19 diagnosis during June 1, 2023-September 30, 2025, multivariate logistic regression analysis of Truveta real-time deidentified electronic health record data was performed. The percentage of COVID-19 outpatients aged ≥65 years who received an antiviral prescription was lower in spring 2024 (21%), fall-winter 2024-25 (23%), spring 2025 (16%), and summer 2025 (19%) than during other seasons (range = 37%-38%). Among those persons who received a prescription, 99% received it within 7 days of a positive SARS-CoV-2 test result or COVID-19 diagnosis, and 80% were prescribed nirmatrelvir/ritonavir. Among adults aged ≥65 years, the odds of receiving an antiviral prescription were higher among those aged 75-84 and ≥85 years (adjusted odds ratio [aOR] = 1.09 and 1.11, respectively), Asian (aOR = 1.42) or Hispanic or Latino persons (aOR = 1.24), and those who had received ≥1 COVID-19 vaccine dose (aOR = 1.73) than among adults in other age, racial, ethnic, and vaccination status groups. Persons with at least one comorbidity and rural residents had lower odds of receiving an antiviral prescription. Persons with COVID-19 had higher odds of receiving a COVID-19 antiviral prescription in summer 2024 (aOR = 1.05) compared with other analytic periods. Odds of prescribing were lower during periods of lower COVID-19 incidence. Antivirals might be underprescribed among adults aged ≥65 years, and prescribing rates vary temporally. Encouraging annual COVID-19 vaccination and increased prescribing of antivirals among adults aged ≥65 years with COVID-19 could reduce the risk for severe illness and hospitalization in this population.