Experts: Underuse of COVID-19 drug Paxlovid shortchanging patients

ATLANTA — Ira Katz bustles at his pharmacy in Atlanta’s Little Five Points neighborhood this cough season, serving patients who need medicine for respiratory viruses like COVID-19. He dispenses occasional packages of Paxlovid, a drug designed to nip COVID in the bud. But there aren’t as many of those Paxlovid prescriptions as there might be.

In fact, the drug is “vastly” underprescribed, national data suggest. And with a winter surge underway, that is likely costing patients unnecessary hospitalizations and even deaths.

Some likely culprits: Time and confusion. Screening everyone who qualifies for Paxlovid would take too much time and effort. And without study, many medical workers still aren’t sure who qualifies.

“I think we’re seeing a lot of physicians just pause, even though there’s very clear indication that this drug not only saves lives, but it saves hospital days, it reduces long COVID risk,” said Dr. Bronwen Garner, an infectious disease specialist at Piedmont Atlanta Hospital.

Katz can empathize: Under a special federal pandemic rule, he could register to prescribe and dispense Paxlovid as a pharmacist, letting customers bypass a trip to their doctor. But when he considers the complexities of the drug’s potential interactions for some patients, he gives that a pass.

“It surprises me a little bit; this is not hard to figure out,” said Dr. Davey Smith, a virologist and professor of medicine at the University of California at San Diego who frequently prescribes Paxlovid. “There’s pretty clear guidance … but in a busy practice, people oftentimes will just shrug their shoulders and go, ‘Is it really worth my time to have to go through that?’”

Most primary care doctors are overburdened and don’t get rewarded with higher pay for studying up, Smith said, but for seeing a lot of patients quickly.

When Paxlovid first hit the market just one year ago, U.S. officials thought it was such an advance that they feared a rush on supplies. The COVID antiviral was the first that could be taken at home in a pill. Studies found it provided an 89% reduction in the risk of hospitalization and death for unvaccinated people. FDA also authorized a second antiviral pill, Molnupiravir, estimated to be 30% effective against hospitalization and death. Authorities strictly limited the drugs’ initial prescriptions to the oldest and most vulnerable patients.

But production has ramped up and supplies are now plentiful, yet still the drugs are reaching just a small fraction of those who are eligible, studies show.

An August study by the Covid States Project of Northeastern, Harvard, Rutgers and Northwestern universities found that only 11% of COVID patients reported taking an antiviral pill. The study called that rate of prescribing, “a tremendous lost opportunity.”

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