White House is pushing to make Paxlovid available to more Covid patients

WASHINGTON — White House officials said Thursday they are rolling out new models for distributing Paxlovid, the oral Covid-19 drug made by Pfizer, to get more people with treatment and reduce coronavirus death rates even as cases increase to be kept relatively low.

The federal government will begin compensating a Providence, RI clinic for evaluating patients who test positive and immediately prescribing Paxlovid to those who qualify — the first of what the White House said, would be a number of state-supported locations, others are ready to open in New York and Illinois. Federal employees are also being sent to state testing sites in Minnesota to convert them to “test-to-treat” sites, the White House said.

“Basically, we’re trying to get to a point where Covid deaths are largely preventable, and I think we’re pretty close to that point,” said Dr. Ashish K. Jha, the White House Covid-19 operations coordinator, said in an interview Wednesday night. “Deaths from this disease really should be decreasing.”

Significant barriers remain to making Paxlovid available to all who might benefit; More than a million courses of Paxlovid bought by the government are still available, according to the Department of Health and Human Services. Because of the vague approval guidelines, which are open to wide interpretation – the drug is approved for people aged 12 and over with “mild to moderate” Covid-19 who are at risk of serious illness – some doctors are reluctant to prescribe the pill, or require detailed advice.

The United States was averaging more than 110,000 new coronavirus cases per day as of Wednesday, up about 30 percent over the past two weeks, according to a New York Times database. But that’s believed to be a significant undercount as Americans increasingly rely on at-home testing and their cases often go unreported. New deaths have averaged less than 400 per day for the past two weeks.

dr Jha attributed the more modest death rate to a combination of immunity, conferred in part by vaccines, and the success of Paxlovid, which has been found to significantly reduce the likelihood of severe forms of Covid-19 in those at high risk if it does the case started early in the course of the infection.

Federal health officials have continued to warn of the risks to high-risk individuals and urged older Americans to keep up to date on immunizations. Last week, the CDC cited increasing cases and hospitalizations to reinforce its second booster recommendation for people age 50 and older. But dr Jha said the current gap between infection and death rates across the country is a promising moment in the pandemic where Covid-19 may be less deadly.

dr Jha said the Northeastern states, places with already higher vaccination rates, are using more Paxlovid and acknowledged that other places in the country might have different results. Conditions appear to be stabilizing in some northeastern states, which were among the first to experience a spring surge in cases. Although still high, case numbers in New Jersey, New York, and Rhode Island have begun to stabilize or fall.

“What worries me is that this virus is spreading to other parts of the country, both of which are less amplified and have used less Paxlovid to date – whether this phenomenon that we’re seeing is of infections not leading to many hospitalizations and deaths, whether that will hold up or not,” said Dr. yeah

Pharmacists still cannot prescribe the drug themselves, a move that would reduce the time it takes patients to receive the drug.

The Food and Drug Administration “is looking at this and thinking about it,” said Dr. yeah “Whether they make a change, when and how, etc. is entirely up to their wheelhouse.”

Many patients still go through the sometimes cumbersome steps themselves: locating a virus test, then getting a Paxlovid prescription from a healthcare provider, and then finding a pharmacy that stocks the pill, all within days of the first onset of symptoms.

dr Jha described his frustration with fellow doctors who told him they still restrict Paxlovid to patients over the age of 65.

Many locations in the government’s test-to-treat program are CVS MinuteClinics, with on-site nurses and physician assistants who can prescribe the drug, a service that requires appointments and can be prohibitively expensive for those without health insurance.

Michael Ganio, senior director of pharmaceutical practice and quality at the American Society of Health-System Pharmacists, said the test-to-treat system is suffering from a lack of federal funding for Covid-19 care for the uninsured. He said that while the test-to-treat idea supported by the federal government is limited in scope, it could serve as an important example for state and local officials to implement similar programs.

“I don’t think it’s possible for the federal government to raise enough of this to ensure equal access nationwide,” he said.

However, given the increase in confirmed cases and increasing awareness and availability of Paxlovid, prescriptions have exploded in recent weeks, with 25,000 to 30,000 being prescribed daily, said Dr. yeah More than 182,000 prescriptions for oral antiviral drugs were filled last week, the White House said in a news release Thursday. Three hundred more locations now qualify as test-to-treat locations than a month ago, and nearly 40,000 pharmacies and other locations now carry the antiviral pills.

Pharmacies can now also order Paxlovid directly from the federal government.

Without strict reporting requirements, the federal government struggles to understand who is receiving Paxlovid, data that could be key to knowing whether Americans most at risk, such as those in nursing homes, are receiving the drug.

dr Jha said federal officials should get a more detailed picture in the coming weeks of some of the groups tracking who received the drug, from the Department of Veterans Affairs, Kaiser Permanente and certain hospital systems. The researchers are also studying cases of symptoms that appear to recover after taking Paxlovid, he said.

“I hope that over the next few weeks we will see a lot of data from a number of these organizations,” he said.

MitchSmith and Chloe Reynolds contributed reporting.

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