Dispensing of Oral Antiviral Drugs for Treatment of COVID-19 by Zip Code–Level Social Vulnerability — United States, December 23, 2021–May 21, 2022
Jeremy A.W. Gold, J. Paul Kelleher, Jake Magid, Brendan R. Jackson, Meghan E. Pennini, Diana Kushner, Emily Weston, Bobby Rasulnia, Sachiko Kuwabara, Kelly Bennett, Barbara E. Mahon, Anita Patel, John Auerbach
Abstract
The COVID-19 pandemic has highlighted and exacerbated long-standing inequities in the social determinants of health (1-3). Ensuring equitable access to effective COVID-19 therapies is essential to reducing health disparities. Molnupiravir (Lagevrio) and nirmatrelvir/ritonavir (Paxlovid) are oral antiviral agents effective at preventing hospitalization and death in patients with mild to moderate COVID-19 who are at high risk* for progression to severe COVID-19 when initiated within 5 days of symptom onset. These medications received Emergency Use Authorization from the Food and Drug Administration (FDA) in December 2021 and were made available at no cost to recipients through the U.S. Department of Health and Human Services (HHS) on December 23, 2021. Beginning March 7, 2022, a series of strategies was implemented to expand COVID-19 oral antiviral access, including the launch of the Test to Treat initiative. Data from December 23, 2021-May 21, 2022, were analyzed to describe oral antiviral prescription dispensing overall and by week, stratified by zip code social vulnerability. Zip codes represented areas classified as low, medium, or high * Groups at high risk include persons aged 65 years and those with certain medical conditions. https://www.cdc.gov/coronavirus/2019-ncov/need-extraprecautions/people-with-medical-conditions.html Lagevrio and Paxlovid are oral antiviral therapies indicated for the treatment of patients with mild to moderate COVID-19 who have received positive results of direct SARS-CoV-2 viral testing and are at high risk for progression to severe COVID-19. Lagevrio is indicated for the treatment of adults aged 18 years for whom alternative COVID-19 treatment options approved or authorized by FDA are not accessible or clinically indicated. Paxlovid is indicated for persons aged 12 years who weigh at least 88 lbs (40 kg). https://www.fda.gov/ media/155050/download; https://www.fda.gov/media/155054/download Strategies implemented included the Test to Treat initiative, increased communication to providers and patients, and direct distribution to Federal Retail Pharmacy Therapeutic Partners, enabling expansion of the number of dispensing sites. A program of HHS, Test to Treat is a federal initiative designed to provide rapid access to lifesaving COVID-19 treatments at no cost to recipients. https://aspr.hhs.gov/TestToTreat/Pages/default.aspx The launch of this program garnered media attention and heightened the visibility of oral antivirals to health care providers and the public. At Test to Treat sites, patients can receive COVID-19 testing, obtain assessment by a qualified health care provider who can prescribe antivirals, and receive oral antiviral treatment. Providing these services at a single location ensures rapid and convenient access to treatment. Test to Treat program sites accounted for 6% of all oral antiviral dispensing sites and dispensed 17% of all prescriptions.