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You’re reading The Checkup With Dr. Wen, a newsletter on how to navigate covid-19 and other public health challenges. <a href="https://www.washingtonpost.com/newsletters/the-checkup-with-dr-wen/?method=SURL&location=ART&auto=true&itid=lk_inline_manual_2" target=_blank>Click here to get the full newsletter in your inbox</a>, including answers to reader questions and a summary of new scientific research.

In response to <a href="https://www.washingtonpost.com/opinions/2024/01/16/paxlovid-covid-under-prescribed/" target=_blank>last week’s column</a> on how the antiviral pill Paxlovid is dramatically underutilized in treating covid-19, readers shared their challenges with accessing the medication. One of the most frustrating: unexpected financial barriers.

Karen from Virginia, for example, contracted covid last week and was prescribed Paxlovid. But her pharmacy told her she had to pay the list price of $1,400.

Fortunately, she had just read an <a href="https://www.aarp.org/health/drugs-supplements/info-2023/are-paxlovid-covid-treatments-still-free.html#:~:text=Paxlovid%2C%20the%20most%20commonly%20used,by%20the%20drug%27s%20maker%2C%20Pfizer." target=_blank>article from AARP</a> explaining that patients on Medicare should be able to get Paxlovid for free. “You have to fill out information through the <a href="https://paxlovid.iassist.com/" target=_blank>Pfizer Patient Support Program</a>,” she told me. “I didn’t know this, and I think many of your readers may not either.”

Indeed, I was not aware of this program, so I spoke with a senior official in the Department of Health and Human Services for clarification. Last November, Paxlovid transitioned to the commercial market. Previously, the federal government purchased the medication and provided it free of charge. Now, it is dispensed like other drugs and billed through insurance.

The Biden administration has been <a href="https://www.hhs.gov/about/news/2023/10/13/hhs-and-pfizer-reach-agreement-to-increase-patient-access-to-paxlovid.html" target=_blank>working closely</a> with the drug’s manufacturer, Pfizer, to ensure that patients aren’t being priced out from accessing this lifesaving treatment. The senior official was clear with me that “everyone on Medicare, Medicaid or without insurance should be able to get Paxlovid for free.”

People should go to <a href="https://paxlovid.iassist.com/" target=_blank>paxlovid.iassist.com</a> and enroll in the patient assistance program. They can also call 877-219-7225 to sign up. Those on Medicare, Medicaid or who are uninsured should then be able to get Paxlovid free either from pharmacies or through the mail. Those with private insurance might be charged a co-pay, but the patient access program can also help to reduce that amount.

David from Maryland also recently had covid. But when he called his local Harris Teeter pharmacy to check that his prescription had been filled, he said he was told that Paxlovid wasn’t covered and that he would have to pay $1,400 for the five-day supply. He called another pharmacy, a CVS, and this time he was told there was no charge. “I got it filled in two hours,” he wrote.

I posed this scenario to the senior federal health official, who provided a couple of explanations. To begin, there are millions of doses of Paxlovid that the federal government had purchased that are still in various pharmacies around the United States. It’s possible that the second pharmacy David went to had that supply and gave it to him free of charge.

In addition, some pharmacies are out of network on certain insurance plans. If you are quoted the list price of the medication from one pharmacy, it’s worth calling other pharmacies to see whether it’s available free or at a significantly discounted price.

“There’s no one in America that should have to pay $1,400 for this product,” the official told me.

That’s just one barrier to accessing Paxlovid. Other readers had trouble convincing their doctors that they needed it.

Ben from Massachusetts wrote that his mother is in a nursing home and “has every possible risk factor (I think literally) for severe covid.” She developed a cough and lost her sense of taste. She asked for Paxlovid if she tested positive but was told “they don’t use it due to all the side effects.”

Similarly, when Mark from Washington and his wife (both 65 or older) had covid last June, she got Paxlovid, but he did not. “Our doctor would not prescribe Paxlovid, as I also took a low-dose statin drug. No option was given to temporarily stop [taking] simvastatin. My wife tested negative for covid after finishing her five-day treatment. She felt much better, just a little tired. I had 103-degree fever for days, terrible joint pain, cough and headache. This went on for more than two weeks, and I did not test negative for covid until Day 18.”

Mark spoke with his doctor after, who said that he was “just playing it safe.” But, in his view, “it was not safe not to prescribe Paxlovid.”

Mark is right. There needs to be far more education of doctors, nurses, pharmacists and other health-care professionals about the benefit-risk trade-off of Paxlovid. Side effects are minor compared with the prospect of severe disease from covid, and most drug interactions can be managed.

Readers were also frustrated that their providers have resisted giving them “just in case” medications. One of these readers is <a href="https://www.vumc.org/ccm/person/paul-newhouse-md" target=_blank>Paul Newhouse</a>, a psychiatrist and director of the Vanderbilt Center for Cognitive Medicine in Nashville.

“I am a physician-scientist and have survived a hematologic malignancy,” he wrote. “Yet I could not get my geriatrician to give me prophylactic prescription for Paxlovid when I traveled to Poland last summer for a scientific meeting, to take in case I developed covid. She told me that their ‘policy’ forbids this kind of medication. But I can recall years ago that I was provided antibiotics when I traveled to Thailand. (I did get ill that time and was glad to have the antibiotics.) It is very irritating that physicians seem very reluctant to prescribe Paxlovid, even for high-risk patients such as myself.”

I agree. It’s routine for physicians to prescribe an albuterol inhaler in case someone’s asthma suddenly worsens. And when people visit certain international locations, they often carry an antibiotic prescription in the event that they develop severe traveler’s diarrhea. Paxlovid should be no different. The drug is fully approved by the Food and Drug Administration, just like albuterol and antibiotics. There is no shortage of Paxlovid, and there is no legal or ethical reason to deny someone this “just in case” prescription.

It is a travesty that only <a href="https://www.medrxiv.org/content/10.1101/2023.05.26.23290602v1.full.pdf" target=_blank>1 in 6 people</a> at high risk for severe covid are being prescribed this lifesaving drug. This must change, and I appreciate the work of readers who are helping to educate one another and their providers.

Have you used the new Paxlovid Patient Access Program? Are there other issues you’ve encountered in trying to obtain antiviral treatment for covid-19? <a href="https://docs.google.com/forms/d/1G-8i5LYOq2MAOyvrI0Yn2jNkJINYsz7d1tdo0oru5Wg/edit?ts=63936263" target=_blank>Please write to me</a>, and I will try to include your comments in a future edition of The Checkup.

Lifelines: A Doctor’s Journey in the Fight for Public Health

When Doctors Don't Listen

California State University, Los Angeles, BS

Washington University School of Medicine, MD

University of Oxford, MSc

Leana S. Wen, a Washington Post contributing columnist who writes the newsletter The Checkup with Dr. Wen, is a professor at George Washington University's Milken Institute School of Public Health and author of the book "Lifelines: A Doctor's Journey in the Fight for Public Health." Previously, she served as Baltimore’s health commissioner.

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