The prescription antiviral drugs that can keep high-risk individuals from getting very sick or even dying of COVID-19 are in stock throughout Northeast Ohio, according to health officials.
But some patients have reported issues getting them - because the pills are time-sensitive, and some providers still aren't familiar with them.
The Biden Administration also recently rolled out a new online dashboard, Test to Treat, that shows which pharmacies have the pills in a given area to make it easier for patients.
Chesterland resident Abby Chew wanted an antiviral pill after she tested positive for COVID-19 because she has Type 2 diabetes and was worried about her symptoms.
“I was exposed on Friday. I started feeling symptoms on Sunday night. So it was a really quick turnaround,” Chew said. “I tested positive Monday morning and then symptoms got pretty bad through the week.”
The Food and Drug Administration approved two oral medications, Paxlovid and molnupiravir, earlier this year, which suppress the virus and shorten the duration of the illness in high-risk individuals, such as people over the age of 65 and patients who have diabetes.
Under the emergency use authorization, patients must get the pills within five days of showing symptoms, so Chew was on a time crunch. To make matters worse, she ran into several hurdles along the way.
Chew scheduled a telehealth appointment with a nurse practitioner at Cleveland Clinic. The employee, however, was hesitant to prescribe the pill and said she had not done so before, according to Chew.
“I am not a person who pushes back against doctors’ advice in general. I trust them. But in this case … I said, ‘I'm going to push back a little bit here because I'm very afraid that this is going to take a turn and my child's going to be left without a parent,’” Chew said. “And she said, ‘okay, I'll call it in.’”
Chew, who had already tested positive on multiple at-home tests, said the nurse practitioner told her a PCR lab test was needed to confirm she was positive before the prescription could go through.
Dr. Michelle Hecker, an infectious disease physician specializing in antimicrobial therapies at MetroHealth, was surprised to hear a PCR test was ordered.
“Under the emergency use authorization, it absolutely does not have to be a PCR test. It can be a home test,” Hecker said.
University Hospitals also does not require PCR tests, according to a UH physician.
Cleveland Clinic officials would not comment on Chew's situation directly, but spokesperson Andrea Pacetti told Ideastream Public Media via email that while PCR tests are not required for the antiviral medication at Cleveland Clinic, a doctor may choose to order one.
Waiting on these test results further delayed Chew from getting the medication, she said.
Once the lab test came back positive the next day, though, there was yet another hurdle: the employee said Chew needed to get bloodwork done but did not give her a name or number to call.
“It just seems like it's so easy for us to hyperlink things, to give phone numbers. Putting the onus on the person who is already very sick to continue to do research on what lab is closest to you, and if they do the tests that you need, that seems like we're putting the onus in the wrong spot,” Chew said. “This is a sick person, and we're treating it's almost like there's still some sort of judgment on you for being sick with COVID.”
Bloodwork is often ordered to check patients’ kidney function because that determines which dosage of Paxlovid should be administered, Pacetti said in an emailed statement.
At that point, Chew was already three days into her symptoms. She was not feeling well and decided to give up.
Chew is not the only patient who has experienced issues accessing the antiviral pills.
A UH patient who had COVID-19 in early April told Ideastream Public Media her doctor wrote incorrect instructions on her Paxlovid prescription, which permitted a CVS pharmacy from filling it. By the time the issue was fixed, she was out of the 5-day window of when she could take the pill, she said.
Hecker at MetroHealth said there is still not enough awareness and guidance for both patients and medical providers about how to order the pills, since not all pharmacies have them on hand.
“Any nurse practitioner or whoever has prescribing abilities can certainly prescribe it, but they also need to be aware of which pharmacies to send it to … and we certainly could do a better job of educating our providers,” Hecker said.
How do I get an oral antiviral?
First, patients must get a COVID test as soon as possible, given the 5-day window for the medication, Hecker said.
From there, Hecker recommends checking out the Test to Treat program, as participating pharmacies can administer your COVID test and fill the prescription in the same place on the same day, she said.
"It's one-stop shopping," Hecker said.
Dozens of pharmacies, like CVS and Rite Aid, are participating in Northeast Ohio, according to the website’s map. The map also shows which locations have pills in stock.
The downside is, some locations may have all of their appointment slots booked. Patients can also call their doctor, or go to an urgent care to get tested and get the prescription, Hecker said.
MetroHealth reaches out to patients that test positive at the health system and meet the criteria for the prescription, and in some cases ships the pills to their home, Hecker added.
Some cities, like New York City, have a prescription delivery program in place, which can make it easier to get the pills, but there is no service like this in Ohio yet.
Chew, who is feeling better now, hopes the process becomes easier to navigate, so future COVID-19 patients do not have to deal with the frustration she experienced.
"I feel lucky that I have people I know that I was asking for advice, who gave me some tips, and even those were leading me to not answers," Chew said. "So, yeah, it was difficult to navigate, to say the least. It seemed that things would be more streamlined at this point two years into this."
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