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February 15, 2022

Aaron Carroll: How to improve access to Covid-19 treatments

Daily Briefing

    Writing for the New York Times, Aaron Carroll, the chief health officer of Indiana University, explains how the benefits of Covid-19 treatments have been hampered by lack of access—and what can be done to improve this problem.

    Covid-19 antivirals are here: Here's how to make them 'game changers'

    The difficult path to getting Covid-19 treatments

    Covid-19 vaccines are essential for developing widespread immunity against the coronavirus, but other treatments, such as monoclonal antibodies and antiviral drugs, are also critical to combatting the pandemic, Carroll writes.

    However, while the available Covid-19 treatments can effectively reduce the risk of hospitalization and death, particularly for those who are immunocompromised or unvaccinated, gaining access to them can be difficult for many people.

    For example, Pfizer's antiviral drug Paxlovid can reduce people's risk of hospitalization and death from Covid-19 by more than 85%, but people need to take the drug within five days after being infected—something that may be hampered by "the deficiencies of our testing system," Carroll writes.

    Finding a Covid-19 test and getting results back in a timely manner can be difficult. PCR tests are typically the most reliable, but it can take a day or more for patients to receive results. In comparison, at-home tests return faster results, but they largely remain in limited supply and may be too costly for some people, such as the uninsured.

    After testing positive, people often face another obstacle to accessing necessary treatments: a prescription. Many people don't have a primary care provider, Carroll writes, and for those who do, getting an appointment quickly is often difficult. Even before the pandemic, fewer than half of Americans could get a same-day or next-day appointment with their doctor when they were sick.

    And then, even with a prescription, people are not guaranteed the antiviral pills they need since "it's hit or miss whether [pharmacies] will have pills in stock," Carroll writes, meaning people may lose "precious days" just waiting for the medication to be available.

    Overall, Carroll writes that "the U.S. health care system is set up to make it harder for people to get care," and poorer people often shoulder the most burden. In fact, a recent study published in JAMA found that Medicare beneficiaries at the highest risk for Covid-19 were the least likely to be treated with monoclonal antibodies, largely because of difficulties accessing the treatment in a timely manner after being infected.

    How the health system could improve access to Covid-19 treatments

    According to Carroll, there are several ways to improve the country's health care system to ensure people can access Covid-19 tests and treatments.

    Currently, the federal government is sending four free at-home antigen tests to all households in the United States, and Carroll says this practice should continue to increase the accessibility and affordability of these tests for many Americans.

    Carroll also recommends physicians prescribe Covid-19 antiviral pills to high-risk individuals ahead of time, similarly to how EpiPens are prescribed, so they can start the medication immediately if they are infected.

    Pharmacists could also help provide care to patients, Carroll writes. Instead of waiting for a doctor's prescription, pharmacists could talk to patients about whether certain Covid-19 treatments are safe for them and distribute medication without a prescription if patients qualify.

    Finally, Carroll writes that insurance companies could change their cost-sharing requirements to incentivize people to get care for serious illnesses instead of avoiding it.

    However, "[m]aking changes like these will not be easy," Carroll notes, particularly because the country's "fragmented multipayer system is ill equipped to think and act collectively."

    Ultimately, Carroll writes that the pandemic may not improve in the United States, "not because [Covid-19] medications don't work well ... [but] because our health system doesn't." (Carroll, New York Times, 2/13)


    Advisory Board's take

    The system may be broken, but there are still actions health care leaders can take. Here's where to start.

    What Aaron Caroll highlights in this piece is what we have been saying at Advisory Board for months. It doesn't matter how effective a medication is if it can't reach the people who need it most.

    This is the unfortunate reality of a disjointed health care system—much of the burden is placed on patients. If patients can't access the necessary therapies, then the medications will not be the "game changers" we once hailed them to be. And while that sounds harsh, it is the reality that Caroll dissects.

    So what can we do?

    Right now, oral antivirals and other Covid-19 treatments are slowly increasing in supply and availability. However, much of the issue in getting these treatments to patients is systemic in our health care infrastructure and the lack of coordination across the industry. But it's not too late: there are still tactics we can employ to make the most out of these highly effective Covid-19 treatments.

    To ensure antivirals live up to be 'game changers', I've written about nine 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. These considerations require heightened collaboration from leaders across the health care ecosystem. I detail tactics on treatment distributions, the critical role of access, patient support and navigation, and communication and public health messaging. You can review a deep dive into these considerations here.

    The most important questions to consider

    The burden shouldn't be on patients to access Covid-19 treatments, but consistent public health messaging and guidance, coupled with resources dedicated to patient navigation and support, will be essential to helping patients get treatments in time to have an impact. As we observed with Covid-19 vaccine uptake, it is essential that patients understand that the authorized treatments are safe and effective, can identify whether they are eligible to receive such treatments, and know when and how to access them. Health care leaders must also be prepared to respond to any mis or dis-information that may arise. Consider the following questions for your Covid-19 treatment communication strategy, and check out our Covid-19 communication strategy audit for more guidance:

    1. Are we using multiple communication channels to share information about authorized antibody and antiviral treatments? Are we reaching community members across different demographics, geographies, and with differing levels of access to the internet and information?
    2. Are we updating our channels to communicate information about prioritization criteria and rollout timelines?
    3. Are we clearly communicating the testing requirements necessary for certain treatments?
    4. Do we have clear instructions on how patients can find available treatment centers or pharmacies? Do we offer multiple channels (phone, online, etc.) with information?
    5. Do we have prompts or conversation starters ready for clinicians and other front-line personnel to discuss treatments with Covid-19 positive patients? Are we prepared to sufficiently explain the differences between various treatments (e.g., antibody therapies vs oral antivirals)?
    6. Have we prepared our staff to answer questions about the various treatments authorized for emergency use by the FDA—including questions about safety, efficacy, and adverse events?
    7. Are we prepared to address questions from potential treatment "shoppers" and patients who seek out, but are not eligible to receive, treatment?
    8. Do we have a coordinated approach to regularly surfacing community concerns about Covid-19 therapeutics? Are we using and developing relationships with community partners to better surface and understand patient concerns and questions?

    Andrew Mohama contributed to this article.

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