Paxlovid shortage frustrates Vermonters seeking Covid treatment – vtdigger.org

The message from state officials was clear: If you test positive for Covid-19 and are at high risk of severe disease, call your doctor. You could get a prescription for antiviral medications that lower your risk of hospitalization and death.

But Vermonters that have recently sought out those pills — particularly Paxlovid, reportedly the more effective of the two types on the market — said they’ve faced challenges getting a prescription, or finding the medication if they do have a prescription. 

Robin Scheu said both she and her husband tested positive for Covid five days apart. Her husband got the “last dose” of Paxlovid in the area, a pharmacist told them, and recovered within a few days.

But when Scheu, who is also a Democratic state representative from Middlebury, contracted Covid, her doctor called every pharmacy in a 45-minute radius and couldn’t find a single dose of the drug.

Scheu said she was symptomatic for 11 days, far longer than her husband, and remains exhausted. She gets winded from climbing up stairs.

“We’re sort of an interesting control group,” Scheu said. She believes that her experience was far worse than her husband’s because she did not get treatment for the virus.

“I’m really unhappy that I didn’t get Paxlovid,” she said. 

Vermont received 200 doses of Paxlovid for the week of April 18, according to the most recent available data from the U.S. Department of Health and Human Services. The state’s allocation has been roughly level for the past three weeks. 

Meanwhile, Covid cases detected through PCR tests have been rising statewide since early March, and hospitalizations have spiked in recent days.

“We’re getting more hospitalizations, and what the heck? We need more doses,” Scheu said. 

Scheu and her husband are both over 65 but in “great shape” otherwise, she said. 

“(If) I’m still tired three weeks later, what is this doing for people who were not in such good shape and have underlying conditions and can’t get the medication?” she asked.

In January, the Biden administration announced plans to make antiviral treatments more widely available through its “test-to-treat” program, which would allow people to receive an antigen test and get antiviral treatment in a single location.

But Vermont does not have any pharmacies or health centers that qualify for the program, meaning that anyone who tests positive must talk to their doctor, get a prescription, then find a pharmacy that carries the antiviral medication and has it in stock.

One elderly Vermonter who sought Paxlovid for her partner in Washington County said she had to do the legwork of contacting pharmacies in her area, hoping that one of them would have the drug in stock. (She asked to remain anonymous to keep her partner’s health information private.)

Other patients may not have the ability to make such efforts, she noted. “We’re pretty good at doing this stuff” for people in their 70s, the woman said, “but a lot of people aren’t.” 

Some Vermonters told VTDigger that their health care providers were overly restrictive in prescribing the medications, even for patients who met Vermont Department of Health and U.S. Centers for Disease Control and Prevention criteria for being high-risk.

Wendy Rice, the principal of a Burlington-based volunteer coordinator startup, said she knew to call her doctor when she tested positive because her immunocompromised friend told her about the drugs. “And she’s like, ‘you’ve got to do this quickly, because you lose your window of time after five days,’” she said. 

Paxlovid and the other antiviral on the market, molnupiravir, are both recommended for use early in the course of the disease, to prevent more severe complications from occurring, rather than battling those complications once you’re suffering from them, according to treatment guidelines from the National Institutes of Health.

Yet when Rice reached out to her primary care provider, the provider insisted upon an in-person appointment, wasting a day’s time. Then, Rice recounted, the provider told her that “visibly you don’t really seem that bad. Like, this is really only for our emergency cases.”

“I had to say, basically, ‘I meet three of the criteria for the health standards, so this could be a bad thing,’” she said. She had also recently recovered from a difficult bout of pneumonia.

Another Vermonter, who asked to remain anonymous for health privacy reasons, said she sought a Paxlovid prescription because she has asthma, a high-risk medical condition according to the CDC. Her provider at the Central Vermont Medical Center told her that she still wouldn’t be considered eligible for a prescription, she said.

In an email the patient shared with VTDigger, the provider wrote, “Unfortunately many people were being (prescribed) paxlovid who really did not meet criteria nor really needed it as not high risk for hospitalization.”

The provider specified that they were limiting their prescriptions to people who met one of three criteria: immunocompromised people; unvaccinated people at high risk of severe disease; and vaccinated individuals who are either 75 or older, or 65 and older with high-risk medical conditions.

That doesn’t account for anyone under the age of 65 who may have high-risk medical conditions, such as heart conditions, diabetes, lung disease or kidney disease. 

Neal Goswami, a spokesperson for the University of Vermont Health Network, of which CVMC is an affiliate, said the health network used the drug’s authorization guidelines “to try to ensure that the highest risk patients are able to access it.”

Prioritization guidelines from the National Institutes of Health state that when there are logistical or supply constraints, providers should prioritize “patients at highest risk of clinical progression,” such as the unvaccinated, high-risk people mentioned in the email to the patient.

There’s some hope ahead for people looking for antiviral medications in the coming weeks. On Monday, the federal government announced that it would begin distributing antivirals directly to pharmacies, nearly doubling the number of locations where the medications would be available, according to a White House fact sheet. As a result, more pharmacy locations in Vermont could begin receiving doses as soon as next week, according to health department spokesperson Ben Truman.

The state still expects to receive 200 doses per week from the federal government, in addition to the supply that will go directly to pharmacies, Truman said. The health department expects to reserve those doses for congregate care settings, hospitals and pharmacies that still have supply gaps. “The number and scope of any gaps won’t be apparent until at least next week when therapeutics have been delivered,” Truman said via email.

In the meantime, Vermonters over 65 with high-risk conditions should continue to contact their health care providers as soon as they test positive, either on an antigen or PCR test, he wrote. Anyone without a primary care provider can also contact a local health clinic.

Providers and their patients can use the federal lookup tool to check for pharmacies in their area that carry antivirals, Truman wrote. “Until next week when we receive more paxlovid to retail pharmacies, some locations will remain low or out of supply,” he wrote.

For more details on how antiviral treatment works and whether you qualify, check out VTDigger’s frequently asked questions about the drug.