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Biden administration boosts access to antivirals as covid cases rise

Many have struggled to find Paxlovid pills amid the latest wave of infections driven by the highly transmissible omicron subvariant BA.2

Consumers have reported difficulty finding doctors who will prescribe the antiviral medication Paxlovid. (Jennifer Lorenzini/Reuters)

The Biden administration announced plans Tuesday to double the number of locations that carry antiviral pills to combat covid-19 as many consumers report difficulty finding a doctor to prescribe the medication, or a pharmacy that carries it, when they get sick.

The administration is also taking other steps to boost availability of the drug, a pill from Pfizer called Paxlovid, including an effort to stand up more “test-to-treat” programs in pharmacies and clinics, where many people will be able to get a five-day regimen of pills after testing positive for the coronavirus.

The drug has been in increased demand in recent weeks as coronavirus cases once again rise, driven by the highly transmissible omicron subvariant BA.2. The seven-day average of new coronavirus cases was about 50,000 on Tuesday, up from about 41,000 one week prior, even as many new infections go unreported as more people rely on home test kits.

“Paxlovid is a really important step in our ability to fight this pandemic,” Ashish Jha, the White House coronavirus response coordinator, said at a briefing Tuesday. “Our job is to make sure those doses are getting out there and into the hands of patients that would benefit.”

The actions are designed to surmount hurdles that have emerged as people try to get Paxlovid, which studies have shown can reduce the risk of hospitalization or death by about 90 percent when taken within three to five days of the start of symptoms. Those challenges include difficulty finding a doctor who will quickly prescribe the medication or a nearby pharmacy that carries it, lack of knowledge about the drug and who might be eligible for it, and inequities in who can get it based on access to medical care.

Some experts commended the steps the administration is taking but said those measures will not ameliorate some of the issues that have made it difficult for many people to access Paxlovid, leaving much of the national supply unused. More than 600,000 courses of the drug remain available, and states have not ordered the full supply made available by the federal government. The United States has committed to buying 20 million treatment courses.

“It really speaks to this huge problem of implementation and all the hurdles of bringing in something new to our very messy health-care system,” said Abraar Karan, an infectious-disease physician at Stanford University. “It has to be orchestrated quite well, and we’re seeing in real time all the things that can go wrong with this. There are so many parts that need to be improved for this to have the kind of effect we’re looking for.”

Confusion and inconsistency among doctors on how to prescribe the drug, and for whom, have stymied efforts to more widely distribute the pill, since Paxlovid was originally authorized for people at high risk of severe disease and was in short supply during the omicron surge.

Jha addressed the confusion among doctors and nurse practitioners, who are able to prescribe the drug, noting that some still believe they need to restrict it to high-risk patients because of limited supplies when authorization was granted late last year.

“Too many physicians still have that mind-set. What we need to do is help American physicians and nurse practitioners understand that we now have plenty available,” Jha said.

The administration said it would aim to provide clearer guidance for doctors about a host of covid treatments, including their benefits, interactions with other drugs, side effects and underlying medical conditions that may restrict their use, according to a White House fact sheet. Those efforts should help put doctors “in a position to quickly prescribe one of these treatments where appropriate,” the fact sheet states, particularly because Paxlovid must be prescribed within five days of symptoms beginning.

Other experts welcomed the administration’s efforts, especially as cases rise, but said simply boosting the supply wasn’t enough, noting that inequities persist in who has access to Paxlovid. People without health insurance and those who live far away from medical providers or pharmacies are among those at highest risk from covid and face some of the highest hurdles to receiving effective treatment, said Julie Morita, executive vice president of the Robert Wood Johnson Foundation.

“It is essential that we collect and report data on who is receiving Paxlovid and other antiviral medications to swiftly pinpoint and address any disparities that emerge,” Morita said. “If done right, this can be a real turning point — but it is essential that all populations and communities have the opportunity to reap the benefits.”

The medication is available in about 20,000 locations across the country, including pharmacies, hospitals, community health clinics and urgent-care centers. In some areas, however, residents may live hundreds of miles from the nearest pharmacy or provider that carries the drug. The administration said it expects Paxlovid to soon be available in about 30,000 locations, with a goal of 40,000 in coming weeks.

It will also allow certain pharmacies to order the antivirals directly from the government free of charge.

In recent weeks, some patients have reported calling multiple pharmacies and visiting numerous health clinics and emergency rooms in sometimes unsuccessful efforts to get Paxlovid. Even doctors have shared stories of herculean efforts to get the drug for their older, high-risk relatives after they became infected.

Jha also addressed the challenges the administration faces if Congress does not authorize more money for the pandemic. Unless Congress approves a $10 billion deal for more covid aid, which has been stalled for weeks, the government would not be able to develop and distribute next-generation vaccines if needed or purchase new, more effective treatments that may emerge, Jha said. The government would also be inhibited from purchasing additional treatment courses of existing drugs, including Paxlovid, when the current supply runs out.

“So far, Congress has not stepped up to provide the funds that are needed for our most urgent needs,” Jha said.

On Monday, the Centers for Disease Control and Prevention put out a national health advisory to physicians, instructing them to not use certain treatments, including antibiotics, in patients with covid.

And in an acknowledgment of the information gap that has made it difficult for many Americans to know about Paxlovid and how to access it, administration officials said they would work to boost public awareness. They also said they wanted to ensure that people knew that the drug must be taken within five days of the onset of symptoms.

Coronavirus: What you need to know

Vaccines: The CDC recommends that everyone age 5 and older get an updated covid booster shot. New federal data shows adults who received the updated shots cut their risk of being hospitalized with covid-19 by 50 percent. Here’s guidance on when you should get the omicron booster and how vaccine efficacy could be affected by your prior infections.

New covid variant: The XBB.1.5 variant is a highly transmissible descendant of omicron that is now estimated to cause about half of new infections in the country. We answered some frequently asked questions about the bivalent booster shots.

Guidance: CDC guidelines have been confusing — if you get covid, here’s how to tell when you’re no longer contagious. We’ve also created a guide to help you decide when to keep wearing face coverings.

Where do things stand? See the latest coronavirus numbers in the U.S. and across the world. In the U.S., pandemic trends have shifted and now White people are more likely to die from covid than Black people. Nearly nine out of 10 covid deaths are people over the age 65.

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