Access to Paxlovid, the first oral antiviral treatment for COVID-19, has expanded since the FDA issued an emergency use authorization (EUA) for the Pfizer-made medication in December. However, physicians and pharmacists say there is still more that can be done to make sure the potentially life-saving drug reaches the right people at the right time.
Paxlovid is currently authorized for adults and children ages 12 and older who have tested positive for COVID and are at high risk for severe outcomes, including hospitalization and death. A clinical trial supporting the EUA showed that the drug reduced hospitalizations and death by 88%.
Of note, Paxlovid must be initiated within 5 days of symptom onset, meaning that not only do patients and providers need to be aware of the drug’s availability, they also need to know how to quickly and conveniently get it.
Rebecca Wang, MD, of Dartmouth Hitchcock Medical Center in Lebanon, New Hampshire, told MedPage Today that access to Paxlovid has increased compared to when it was first made available at the beginning of the year.
For instance, one night last week, Wang searched an online tool from HHS that’s designed to help providers locate COVID treatments in their area, and found that CVS and Walgreens locations nearby had more than 10 courses each.
So, if it’s not a supply issue, what is impeding access in some cases?
“A lot of it boils down to a lack of patient and provider familiarity with the medication,” Wang said. Patients may not realize the drug is available to them, or they may feel well enough that they don’t want to burden their providers.
However, if they eventually reach out to their providers, they may be outside the window for benefit, she noted.
On the physician side, there are nuances that can make Paxlovid intimidating to prescribe. There are a number of drug interactions, and patients who are most likely to benefit from the medication, such as the elderly or those with underlying conditions, are often taking other drugs. “That might be a limitation that gives providers pause,” Wang said.
Another challenge is that patients with reduced kidney function may need to have their Paxlovid dose adjusted, and that can bring up questions of whether there may be additional lab work needed before prescribing the drug, she explained.
At Dartmouth, a centralized system that integrated its pharmacists was set up early on, with the goal of supporting providers in their decision making. In speaking with the pharmacists involved, Wang said that about half of the patients prescribed Paxlovid required special recommendations or a change of treatments, including a switch to monoclonal antibodies.
Additionally, some patients may have more than one doctor, and may not be sure which one to turn to if they believe they are in need of Paxlovid, Wang pointed out. Whether an oncologist, primary care physician, or another provider, there should be more efforts to empower any provider to feel comfortable prescribing the drug to eligible patients, she said.
Paul Sax, MD, of Brigham and Women’s Hospital and Harvard Medical School in Boston, noted that one of the biggest hurdles to improving access is a lack of healthcare providers.
Imagine an overweight man in his 40s who meets the criteria for Paxlovid, Sax said. He may have high blood pressure, but other than that, may not have had much medical care recently. Without a doctor, or access to a healthcare provider, he wouldn’t be able to access the drug.
Currently, physicians, physician associates, and advanced practice registered nurses are able to prescribe Paxlovid. But allowing pharmacists to also do so “would really help,” Sax suggested. People with positive COVID tests could call the pharmacy and get a prescription. “I would have no hesitation giving them the authority,” he added.
He also agreed with Wang that greater education about Paxlovid and its availability would help. Unless people are keeping up with specific developments on a regular basis, they may not know about the drug, he pointed out.
Lauren Lam, PharmD, a pharmacist at UVA Health in Charlottesville, Virginia, told MedPage Today that her pharmacy has seen a steady outflow of Paxlovid and that local supply is stable, though she heard from a patient in another state that they had to travel for access to the drug.
Lam noted that UVA Health’s Department of Population Health has been working with the Latino population in Charlottesville to improve access to testing, vaccines, and now COVID therapies. “These are patients who maybe don’t have insurance or who have never been seen by a provider before,” she said.
She also stressed the importance of communicating to providers which pharmacies have the medication, adding that she still fields that question on a regular basis.
Early on at UVA Health, a special ordering system was built into electronic health records to account for any drug interactions or organ assessment tests that were needed, Lam explained. Ongoing communication between providers, pharmacists, and patients continues to be critical to get the right dose to a patient at the right time, and documenting as much as possible up front for specific orders can reduce the need for tedious back-and-forth discussions, she added.
Kathy Yang, PharmD, a clinical pharmacist at the University of California San Francisco, told MedPage Today that while general supply of Paxlovid has improved, “that doesn’t necessarily translate to better access.”
Access can be especially problematic for certain patients, such as the elderly or more resource-limited populations who may not be computer savvy or have access to a computer to search for testing and treating sites, she noted.
Yang also urged providers to talk to patients about reaching out if they’re feeling sick. “It’s just really important to get the word out that we have a lot more tools in the toolkit now,” she said.
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