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Ira Katz is busy at her pharmacy in the Little Five Points neighborhood of Atlanta this cough season, serving patients who need medication for respiratory viruses like COVID-19. He occasionally distributes packets of Paxlovid, a drug designed to kill COVID in its infancy. But there are not so many prescriptions for Paxlovid.
In fact medicine National data show “a lot” of not being prescribed. And with a winter surge underway, that could result in unnecessary hospitalizations and even death.
Some possible culprits are: Time and confusion. Screening all those eligible for Paxlovid would take too much time and effort. And without education, many healthcare workers are still unsure who qualifies.
“I think we are seeing a lot of doctors pause, even though there are very clear indications that this drug not only saves lives but also saves days in hospital,” said Dr. , reducing the risk of long-term COVID”. specialist at Piedmont Atlanta Hospital.
Katz can empathize: Under a special federal pandemic rule, he can register to prescribe and dispense Paxlovid as a pharmacist, allowing customers to avoid seeing a doctor. But when he considered the complexity of potential drug interactions for some patients, he flopped.
Dr Davey Smith, a virologist and professor of medicine at the University of California at San Diego, who regularly prescribes Paxlovid, said: “I was a bit surprised; This is not hard to find. “There are pretty clear instructions… but in a hectic practice, people often just shrug and say, ‘Is it really worth my time to go through that?'”
Most primary care doctors are overburdened and don’t get better pay in higher education, Smith said, but because they see many patients quickly.
When Paxlovid first hit the market just a year ago, US officials thought it was such a huge step forward that they feared supplies would skyrocket. The COVID antiviral is the first drug that can be taken at home in pill form. Studies show it reduces the risk of hospitalization and death by 89% for unvaccinated people. The FDA also authorized a second antiviral drug, Molnupiravir, which is estimated to be 30 percent effective on hospitalizations and deaths. Authorities severely restricted initial prescribing of the drug to the oldest and most vulnerable patients.
However, production has increased and supplies are now plentiful, but the drugs still reach only a fraction of those who qualify, studies show.
An August study by the COVID States Project by Northeastern, Harvard, Rutgers and Northwestern universities found that only 11% of COVID patients reported taking antiviral medication. The study calls that prescribing rate “a huge lost opportunity.”
Even among people 65 and older, the odds of getting antiretroviral medication are only 20%. The patient performed higher income or men are more likely to get the disease. The study cited confusion and unclear instructions. A more recent study found that Black and Hispanic patients were about one-third less likely to have Paxlovid than white patients.
Contrary to popular assumptions, there are now many young patients eligible for Paxlovid as well as children over 12 years of age weighing at least 80 kg.
It took some action to figure out the prescribing instructions. The FDA’s authorization for Paxlovid states that the drug is only for COVID patients at “high risk” of progressing to severe COVID, including hospitalization or death. For specifics, the FDA refers readers to a CDC list of conditions that patients may have that put them at “higher risk” of the disease. serious disease.
People run the gamut from obvious, like asthma, to common, like “physical inactivity”. The list contains dozens of conditions, including depression, “disability”—linked to another list—and obesity (190 pounds or more for people 5′ 6″ tall).
An even greater bureaucratic hurdle could be factors that keep patients ineligible for Paxlovid.
There is a long list of drugs that patients should avoid mixing with Paxlovid. And there are conditions, such as severe kidney disease, that mean patients shouldn’t take Paxlovid. For moderate kidney disease, some Paxlovid may be okay, but doctors have to figure out what the best dose is.
Federal officials once thought the special program for pharmacists, called Trials for Treatment, would be a game-changer to increase access to Paxlovid. But like many pharmacists, Katz worries about how the doctor’s notes or blood tests show the condition of a patient’s kidneys so as not to make a mistake when prescribing.
“We had it; we distributed it,” Katz said of Paxlovid. “I know there’s a process that allows us to prescribe and dispense drugs. But we want their primary care physician to recommend that and send the medication through.”
The pharmacy chain CVS allows patients to self-screen themselves online for Paxlovid eligibility, but apparently turns away patients who don’t have a recent blood test record.
The cost of ignoring Paxlovid remains clear. Even when other drugs had lost effect on the new variants, Paxlovid in a recent CDC study reduced a person’s chances of being hospitalized by 51 percent, regardless of vaccination status.
Garner, Piedmont’s doctor, noticed hesitation even among doctors who treat those most vulnerable to COVID. She works with transplant patients who take medications to suppress their immune systems. COVID infections can wreak havoc on them.
Like Smith in San Diego, Garner has built his expertise on Paxlovid in his day-to-day work. Almost all of her patients are also taking drugs that interact with Paxlovid. But she doesn’t let that rule them out.
When they tested positive for the COVID virus, Garner regularly received calls from their primary care physicians, apprehensive about giving them Paxlovid. To address drug interactions, she and her colleagues analyzed the drugs involved and created a protocol for changing patient‘ drug regimen to make Paxlovid accepted. They did “Because Paxlovid is so good — it’s so good — at preventing illness and death from COVID,” Garner said.
And when primary care doctors called asking if they should give Paxlovid, she said, “My answer, almost always, is yes.”
2022 Atlanta Journal-Constitution.
Distributed by Tribune Content Agency, LLC.
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