Medical experts tout value of Paxlovid, but say usage remains low

A summer COVID-19 surge has killed thousands of Americans and sent many more to hospitals, yet experts say some of those people would still be alive if they had taken a medication that studies show dramatically reduces the chances of severe disease.

Paxlovid, available since December 2021, reduced the COVID-19 death rate in high-risk patients by 73%, according to a study National Institutes of Health researchers released last year.

Yet uptake has been low. Only 9.7% of those eligible for Paxlovid took it, the study found. Researchers estimated that if half of people with COVID-19 who had been eligible for Paxlovid had taken it, 48,000 lives would have been saved between December 2021 and February 2023.

That study also found that Paxlovid reduced hospitalizations by 26% — with other studies finding even greater hospitalization declines, such as 51% and 65%.

Experts say misperceptions and misunderstandings about Paxlovid among patients and health care providers are among the reasons so few people have taken the medication.

In addition, many are repelled by drugmaker Pfizer's list price of $1,390 for 30 pills to be taken over five days, but are unaware that many people can get the drug for free or at a deep discount. 

There’s also the clock that begins ticking when people get sick: Treatment with Paxlovid must begin within five days of symptom onset, before the virus can potentially cause severe damage, according to the Centers for Disease Control and Prevention guidelines. During that time, a patient must get an appointment with a provider and then pick up a prescription.

"It's very hard for people to get the drug in hand within five days of symptom onset, because of all of these hoops and hurdles," said Denis Nash, a professor of epidemiology at CUNY School of Public Health in Manhattan. "By the time you get through all these steps, you’re beyond the window of where it could potentially help you."

Although the number of COVID-19 deaths has plummeted since the early years of the pandemic, thousands still die of the disease — more than 76,000 in 2023, according to a CDC report released this month. About 30,000 Americans have died of COVID-19 so far this year, incomplete and provisional CDC data shows.

Up to 234 people a day were hospitalized with COVID-19 on Long Island this month, three times May's peak, although lower than in the early winter, state data shows. More than 300 people have died of the disease on Long Island this year, according to state Department of Health statistics that do not include deaths outside health care facilities. 

Dr. Kawsar Talaat, an associate professor of international health at the Johns Hopkins Bloomberg School of Public Health in Baltimore, bemoans that much of the suffering and dying could have been prevented by 30 small pink and white tablets. 

"Some of those people did not have education [about Paxlovid] or access to lifesaving treatment," she said.

Treatment must begin right away

Doctors and other providers should consider Paxlovid for any adult — or child 12 and older weighing at least 88 pounds — with at least one risk factor for severe COVID-19, the CDC advises.

That includes anyone 50 and older, and those with certain medical conditions, including obesity, asthma, cancer or diabetes, and behaviors such as smoking.

A study released in June that Nash co-authored found only 18.5% of people who fit the CDC criteria believe they are at risk for severe COVID-19.

"There’s a big disconnect between what people perceive as their risk and what their actual risk is," Nash said.

Even when people want Paxlovid, their doctors may not always prescribe it, he said.

“People call me all the time asking, ‘How can I get Paxlovid? My father's physician won’t prescribe it because he doesn't think his symptoms are severe enough,’ ” Nash said. "These are 80- and 90-year-old people."

Yet treatment must begin when symptoms are mild or moderate, the CDC says.

"If you wait until they get sicker, then it’s too late to give it, and it’s not going to work," Talaat said.

Doctors worry about potentially dangerous interactions with other medications — although in some cases, use of other drugs can be suspended while using Paxlovid, she said. In other cases, the patient cannot take Paxlovid, but there are alternative treatments. 

A small percentage of people who took Paxlovid had a "rebound" of symptoms within a few days of initially improving, but the same thing can happen in people who don’t take the medication, multiple studies show.

Delainne Bond, a Florida nurse who founded the 112,000-member COVID-19 Long Haulers Support Facebook page and a long-COVID support and education group, said that even when physicians recommend Paxlovid, some patients balk. They’ve read online misinformation that Paxlovid is "poison" and are afraid to take it, she said.

Risk of losing money on drug

The federal government had provided Paxlovid for free until December 2023. 

Nidhin Mohan, owner of New Island Pharmacy in Deer Park, said the current $1,390 list price and poor insurance reimbursement rates means he loses money on each Paxlovid prescription for about half of insurance plans. Other pharmacists don’t stock the drug for that reason, he said.

Customers, in turn, sometimes get sticker shock when they see a charge of more than $1,000 and they leave without the pills.

Mohan said he tells customers they typically can obtain a big discount or free medication if they fill out a form, but some say, “I’m too sick. Forget it. I don’t want to deal with this.”

The federal government will provide Paxlovid for free for Medicare and Medicaid recipients until the end of the year, and for uninsured people through 2028, with Pfizer paying administrative costs, the Department of Health and Human Services said in a statement. Pfizer also administers a program offering free or deeply discounted Paxlovid for those with private insurance. Enrollment forms for both programs are at paxlovid.com/paxcess.

But a huge bill could result if the online forms are not filled out. Even if Paxlovid is free, patients may get charged for an office visit, said Jennifer Kates, a senior vice president at KFF, a San Francisco-based health policy, research and news group.

Many are unaware of the online forms and worry about paying hundreds of dollars, she said.

"You might hear that it might cost you something, or there might be other charges, and you say, ‘You know what, I'm just going to forgo this.’ And in some cases, that could actually have real medical consequences, since Paxlovid is so effective," Kates said.

Nash said the extra steps to obtain free or low-cost Paxlovid are "totally unnecessary."

Pfizer said in a statement that 93% of health insurers cover Paxlovid. Yet some policyholders may face pricey copays.

Sen. Brad Hoylman-Sigal (D-Manhattan) introduced a bill requiring companies to provide COVID-19 antiviral medications such as Paxlovid for free after he heard from people who paid up to $140 even after joining Pfizer’s copay assistance program, his spokesman said. The bill passed the Senate unanimously in June but has not been voted on in the Assembly.

Many uninsured people don't seek Paxlovid because they are unaware it can be free, said Dr. Grace Ting, interim chief medical officer of Nassau University Medical Center in East Meadow. Ting didn't know the drug was free for uninsured people until she spoke with Newsday.

"They haven’t publicized it," she said of Pfizer and the federal government.

By David Olson

david.olson@newsday.com@DavidOlson11

David Olson covers health care. He has worked at Newsday since 2015 and previously covered immigration, multicultural issues and religion at The Press-Enterprise in Southern California.