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White House working to make Pfizer’s Covid-19 antiviral pill more ‘widely available’

By Jacqueline Howard and Betsy Klein, CNN

The Biden administration is set to unveil new details and announcements Monday on Paxlovid, Pfizer’s antiviral Covid-19 pill, a White House official tells CNN.

The administration has plans underway to increase the availability and uptake of the drug, White House Covid-19 Response Coordinator Dr. Ashish Jha announced on Twitter.

“Over the next week, you’ll hear a lot more about what the Biden Administration is doing to make Pax widely available and easily accessible to all Americans,” Jha wrote in a Twitter post Friday.

According to Jha’s tweets, the administration is working on establishing more places where Paxlovid will be available, including more test-to-treat sites.

The administration’s nationwide test-to-treat initiative involves “one-stop” sites where people are offered free Covid-19 testing and, if they test positive, can be prescribed free antiviral medications on the spot.

Certain pharmacies across the United States — including CVS, Walgreens and Walmart — participate in the test-to-treat program at some locations.

All of the 1,200 MinuteClinics at CVS pharmacy locations are participating in the test-to-treat program, CVS spokesperson Matt Blanchette wrote in an email Monday.

“The CVS Pharmacy adjacent to each participating MinuteClinic location has received supply of COVID-19 oral antiviral medication from the federal government and can fill prescriptions for patients as prescribed,” he said.

“The number of patients being prescribed oral antiviral medications at our MinuteClinic locations has increased steadily over the last three months,” he added. “Also, nearly all CVS Pharmacy stores without an associated MinuteClinic are also currently dispensing Paxlovid and Molnupiravir, and have the ability to fill prescriptions as received.”

Jha tweeted that the Biden administration’s plans include more education for health care providers on how to use Paxlovid “more regularly” for eligible patients.

The administration’s plans signal “some positive changes” with regard to treating Covid-19 infections, and in some ways, the test-to-treat model “transforms medicine,” Dr. Daniel Griffin, an instructor in clinical medicine and associate research scientist in the Department of Biochemistry and Molecular Biophysics at Columbia University, said Monday.

“When you get sick with a viral illness, the last thing you want to do is try to get an appointment at a physician’s office, get out of bed, wait in the waiting room, get seen, then have to drive somewhere else to pick up at your pharmacy,” Griffin said, adding that “being able to get taken care of as soon as possible without all the delays that our system has introduced” is a positive.

‘Uptake is very, very low and slow’

On the ground, it appears that the pace of Covid-19 antiviral prescriptions under the test-to-treat program has not reached the level that health officials expected by this point, said Lori Tremmel Freeman, chief executive officer of the National Association of County and City Health Officials.

“The bottom line is, the uptake is very, very low and slow despite there being a lot of these drugs in the market and available,” Freeman said.

“But it doesn’t seem like there’s an embracing of prescribing and doing these test-to-treat programs,” she said. It seems “providers are worried about potential interactions with these drugs or that the drugs are not effective,” and that might be why they’re not prescribing them as expected.

But some providers worry that Paxlovid isn’t safe for people with certain health conditions — for instance, it is not recommended for those with severe kidney disease — or that the medications people take for other conditions might interact with the Covid-19 antiviral drugs.

“Timing is also essential” when prescribing the drugs, Freeman said, as the therapies have to be introduced quickly once someone tests positive for Covid-19, “especially with rapid spreaders like Omicron and the BA.2 subvariant.”

“People may not be tested quickly enough to make prescribing antivirals for treatment possible, which is the key tenet of the test-to-treat program.”

Freeman said that releasing more educational materials and provider instructions and raising awareness around how to safely prescribe Covid-19 antivirals might help providers feel more comfortable participating in test-to-treat.

Griffin said that “education around the drugs is huge — and I find maybe this area to be one of the most painful from my perspective.”

Traditionally, “most physicians learn about new drugs from pharmaceutical reps,” but because the Covid-19 antivirals are being handled under emergency use authorizations, “there are limitations on how much marketing versus education the pharmaceutical companies can be doing or providing.”

“I often get calls from physicians where they have someone who acutely has Covid, who clearly would benefit from the therapy, but then they say, ‘I don’t really feel comfortable with this medication.’ And I try to talk, and I try to educate them,” Griffin said. “But because they don’t feel comfortable, they say, ‘You know what, I’m going to have them see their endocrinologist. I’m going to have them go see their primary care doctor.’ And the day, the minutes, are ticking away.”

A call for Congress to pass Covid funding

There are two antiviral pills authorized by the US Food and Drug Administration to treat Covid-19 at home: Pfizer’s Paxlovid for people 12 and older, and Merck’s molnupiravir for adults. Anyone in those age groups who tests positive for Covid-19 could be prescribed the medications to take at home.

“Paxlovid first became authorized by the FDA at the end of December. And there were very, very few pills around. The administration worked incredibly hard to both increase production and acquisition and the good news is we’ve made really substantial progress,” Jha said on NPR on Monday.

“Now, we’ve got to turn those pills into prescriptions and into the things that patients can get so that they can get better if they get infected. We have a big set of efforts that we have been working on and launching, and we’re going to be doing a lot more this week.”

There are enough Paxlovid pills “for the short run,” Jha said, calling on Congress to pass an additional package to “fund acquisition of more pills” as well as possibility of other treatments.

The House and Senate are back this week as the White House is renewing its push for Covid-19 response funding. A $10 billion package stalled in the Senate ahead of the Easter recess amid disagreements over the administration’s immigration policy.

“There’s a lot of progress ahead, but we really need Congress to step up and fund that progress,” Jha said.

He laid out some of the consequences should Congress fail to pass additional funding.

The US will run out of money for Paxlovid “reasonably soon,” he said, warning, “we actually aren’t even going to be able to pay our bills for what we’ve already entered into a contract with Pfizer for, so that’s going to be a problem.”

Noting that the FDA is working to identify and develop “the next generation” of “more effective and more durable” vaccines, he suggested that “Americans aren’t going to access to any of those vaccines” without more funding.

And a lack of funding will affect US access to new Covid treatments, he said.

“We will not only not be first in line, we’ll probably be last in line in getting those,” Jha warned.

He expressed some confidence that Congress would come to an agreement but reiterated that the administration’s request for $22.5 billion for the global Covid response was “really the bare minimum” for funding required.

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