Oral antivirals are here.
In late December, the FDA authorized Pfizer's oral antiviral, Paxlovid, which was shown to reduce the risk of hospitalization and death in high-risk adults with Covid-19 by 89 percent, and Merck's oral antiviral, molnupiravir, which was shown to reduce the likelihood of hospitalization by 30%.
Several infectious disease experts have hailed new antiviral Covid-19 drugs as a potential "game-changer" in the course of the pandemic. However, initial supply is limited. In fact, it is likely there won't be substantial supply until summer 2022. Let's be clear about one thing: At the population wide level, it is unlikely these pills will be gamechangers if the supply can't match the demand. We don't expect the antivirals to have a strong dent in the omicron surge right now, but that doesn't mean we can't make the most of the limited supply while preparing for what is down the road in this pandemic. And if we can help even just a fraction of the eligible folks, it is a worthy act to get right.
To ensure antivirals live up to be 'game changers', there are 9 critical considerations that all health care leaders should be thinking about as they manage Covid-19 antivirals, many of which draw upon lessons learned from Covid-19 vaccine rollout.
1. Don't start from scratch—leverage existing infrastructure to distribute treatments.
To get oral antivirals right, especially early on, health care leaders don't need to re-invent the wheel. They should look to existing distribution channels, clinics, and pop-up sites to get treatments to patients. For example, in Ohio, the same network of providers that handles monoclonal antibodies will be responsible for distributing antivirals. Draw on your existing systems to efficiently hit the ground running.
2. Ensure providers are experts in antiviral treatment eligibility and guidance.
Although hospitals and clinics are quickly reaching capacity from the omicron surge and the workforce is burnt out, education about antivirals and treatment eligibility is pivotal to success of antivirals, especially in the midst of conflicting guidance. Provider leaders should ensure staff understand how treatments work, what contraindications exist with other medications, and what side effects patients may encounter. Start making a clinical plan now.
The critical role of access:
3. Quick and easy testing will be as important as ever.
The availability of rapid tests will play an important role in the success of oral antivirals, which must be administered shortly after symptoms begin. But since rapid tests are increasingly difficult to access amidst this surge (and some may not be as accurate), health care leaders must continue to invest in building out testing infrastructure across sites of care and communities. Some of this will be up to the local public health teams across states, but every effort counts here.
4. Revisit community partnerships to help get treatments to patients—especially in hard-to-reach areas.
In this initial phase of antiviral rollout, treatment distribution is limited to few state-allocated hospitals, pharmacies, and clinics. However, patients may live far from these sites or are unable to take time off to pick up their prescriptions. They also may not have sufficient transportation to far-away pharmacies or distribution sites. Health care leaders should leverage lessons learned from Covid-19 vaccine rollout and revisit community partnerships to help patients access needed medication. Among many others, consider questions like:
- Are Covid-19 testing centers located near treatment distribution sites and in areas with particularly vulnerable patients?
- Do we have transportation or delivery options to reach vulnerable patients?
- Are our pharmacy or testing center hours of operation convenient for patients who need treatment?
- Do we have relationships with community partners that can help educate patients on the availability and importance of treatments?
Patient support and navigation:
5. Help patients navigate the complex pathway from diagnosis to treatment.
Although the oral antivirals are significantly easier to take than existing infusion-based monoclonal antibody treatments, the pathway from testing to diagnosis to treatment may be complex. After receiving a positive Covid-19 test, patients need a provider to prescribe the treatment and then find a pharmacy that has their prescriptions. Some may be difficult to access, given limited drug supply. Consider assigning patient navigation roles now, so when demand rises patients have the support they need.
6. Deploy staff to support patients with medication adherence.
For both treatments, patients must take 30 tablets over five days. Patients may require support or assistance in adhering to this complex schedule—and pharmacists, nurses, and other care team members can play a critical role in supporting adherence. At the bare minimum, develop easy to understand guides and reminders for medication protocol, or consider deploying telehealth-based tools to support patients while in quarantine.
Communication and public health messaging:
7. Don't fall behind—start educating the public about the risks and benefits of oral antivirals.
Right now, amidst the omicron surge, oral antivirals are not completely in the public spotlight—and some patients with the coronavirus might not know they are an available treatment option. Health care leaders across all industry segments must play a critical role in alerting patients about the availability of these drugs, how they work, and for whom they are most effective. If we don't act now, it might be too late.
8. Prepare for patient hesitancy—especially amongst those who may need the drugs the most.
New data from STAT found that vaccinated Americans far more likely than unvaccinated people to take Pfizer's Paxlovid—which means that the people who might benefit most from treatments may not actually take them. Health care leaders must prepare for this hesitancy and anticipate patient concerns and questions.
9. Stay on top of the fight against misinformation.
Unlike Covid-19 vaccines, which were widely publicized and politicized for months, oral antivirals are not a current target of medical misinformation. That said, it's time to prepare for the potential of false information to circulate. Leveraging lessons learned from vaccine rollout, heath care leaders should take the time to listen to patients in the community to understand concerns and questions and get ahead of misinformation that may arise.
It takes a village
All parts of the health care industry—providers, life sciences, payers, regulators, community organizations—must come together to get these oral antivirals to patients in time to have an impact. As we move forward with antiviral rollout, we must not lose sight of lessons learned from Covid-19 vaccine rollout.
I believe these tools can be the “game changers” we believe them to be, as long as we get distribution, access, equity, and messaging right.
Andrew Mohama contributed to this article.