Supplies of COVID-19 antiviral pills touted as a game changer will be scarce in the short term, a major problem for the Biden administration’s new “test to treat” initiative, meant to make the pills available as soon as someone tests positive.
Pharmacies will be strapped for courses of the treatments, which were promised to be a tool for preventing hospitalizations, for at least another month while Pfizer ramps up the supply of its treatment Paxlovid. Merck’s treatment Molnupiravir is less scarce, though the Food and Drug Administration has advised against prescribing it unless another treatment is unavailable due to its markedly lower effectiveness. The Biden administration has been criticized for not procuring more doses ahead of the Emergency Use Authorization for the Pfizer pill late last year, before the omicron surge struck and then receded.
“The supply is definitely tight, very limited. And, you know, on where those supplies are set, and then continued up to this point, to be in control of the states, and probably about the same amount of the product will remain in that channel,” said Dr. Kurt Proctor, the senior vice president of strategic initiatives at the National Community Pharmacists Association.
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Paxlovid showed an 89% reduction in hospitalization for patients who received the medicine within three days of symptom onset compared with those who received a placebo. People who took the drug within five days of experiencing symptoms were also 88% less likely to be hospitalized or die due to COVID-19. The drug was tested in adults who are at high risk of severe disease, including seniors and people with underlying health conditions. The Merck treatment, meanwhile, reduced the risk of hospitalization by 30%.
The Biden administration announced the “test to treat” initiative ahead of President Joe Biden’s Tuesday night State of the Union address. The plan is to stand up sites at pharmacy-based clinics, community health centers, long-term care facilities, and Veterans Affairs facilities starting this month. However, only about 513,000 courses of Paxlovid have made it out to states since it was granted authorization in December, and manufacturing is taking a while to scale up. In part, that is due to the length of time required to make the pills, approximately six months.
“Sadly, I don’t see how that puts us in a position for a national Test-to Treat in local pharmacies later this month,” said Eric Topol, a professor of molecular medicine at Scripps Research.
The White House projects that the United States will have one million courses of the Pfizer treatments by the end of March and double that by the end of April. To date, the U.S. has purchased 20 million courses. With the recent ramping up of manufacturing, Pfizer expects to have the ability to produce six to seven million courses by the end of the quarter.
Pharmacists might also lack the necessary financial incentives to stock up on the treatments, which are not uniformly reimbursed by insurers and could cost a lot to procure. The government spent billions on the pills but did not specify how much insurers should cover in costs to dispense the medication. Insurers are paying as little as 1 cent to about $10 for filling each prescription, according to pharmaceutical transactions reported by the Wall Street Journal. The burden of swallowing these dispensing fees, pharmacists said, is discouraging them from stocking the pills.
“I think the angst is around, ‘Why are we being paid $1 for all of these products that take us 45 minutes or an hour to help a patient with?’” Proctor told the Washington Examiner. “So you had pharmacies who were allocated products that have either returned it or they said, ‘When I’ve used this, I don’t want any more, I can’t stay in this program,’ so that’s a problem.”
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Such low reimbursements threaten to push away small pharmacies, in addition to big retail pharmacies such as CVS and Walgreens, further exacerbating the difficulty for high-risk patients to find these treatments.
