Paxlovid Prescribing Changes May Improve Access and Equity

IDSA supports efforts to ensure broad and equitable access to COVID-19 treatment, a goal that has not been realized to date. FDA’s decision to authorize state-licensed pharmacists to prescribe Paxlovid, within the limitations of and for those indications stated in the emergency use authorization, has the potential to expand access to timely treatment.

Despite their wide availability, Paxlovid (nirmatrelvir and ritonavir) and other outpatient COVID-19 therapies have been underutilized in the United States. Moreover, recent data show people who may be most in need of antiviral treatment for COVID-19, including Paxlovid, may not be receiving it because of where they live. Barriers to treatments are particularly steep for many people of color and individuals with lower incomes who have been disproportionately impacted by COVID-19 and who live in underserved communities with fewer health care providers.

IDSA recommends that, whenever possible, patients should seek therapy from their primary health care provider (physician or advanced practice provider), as they are most knowledgeable about a patient’s medical history and potential interactions. Pharmacists should seek primary health care provider advice and have a mechanism to refer patients to another care setting when necessary. The populations at highest risk (including the immunocompromised, unvaccinated individuals with multiple risk factors and other medically complex patients) should have physician evaluation as part of treatment decision-making and monitoring.

In addition to improving access to prescribing clinicians, IDSA recommends additional steps be taken by the federal government, health care systems, public health officials and clinicians to ensure equitable access to Paxlovid and other antiviral therapies.

Daniel P. McQuillen, MD, FIDSA – President, Infectious Diseases Society of America