In this real-world study using EHR data from over 310,000 treatment-eligible patients with SARS-CoV-2 receiving care from an integrated healthcare system, several important patterns in nirmatrelvir–ritonavir were identified. In general, treatment allocation aligned with NIH tiered guidelines, with the majority of dispenses concentrated among older adults and those with other clinical conditions that increase the risk for severe COVID-19. This demonstrates a need to enhance patient and