Access to oral therapies for COVID-19: The stubborn reality of geography

Throughout the COVID-19 pandemic, one stubborn reality has remained constant — that of healthcare disparities, from prevention, to diagnosis, to treatment. Since the earliest days of the pandemic, racial, geographic, age, immune status, and other health disparities have been highlighted as key fixtures for those impacted by COVID-19. As the pandemic continues to evolve, and with various therapies available to combat the virus, these disparities have remained an entrenched problem. While oral therapies targeted against COVID-19 such as Paxlovid (Nirmatrelvir/ritonavir) and Lagevrio (molnupiravir) have been shown to prevent severe outcomes and potentially reduce the risk of long-COVID, questions remain regarding rebound symptoms or benefit in younger populations. While scientists continue to study Paxlovid and Legavrio to answer these open questions, they remain key tools for those in need of COVID-19 therapies.

In a recent paper published in JAMA Network Open, we examined the ways in which oral therapies directed against COVID-19 became available to patients across the country, starting in January 2022 when these were approved. We found that in the initial months when Paxlovid and Lagevrio became available, access to these medications rapidly increased such that by May 2022, the majority of Americans had ready access to these medications at a location less than 15 minutes from their home.

Looking at updated data from the federal government not available when our paper was written, it has become clear that efforts to broaden access to these therapies have plateaued. Between August 2022 and November 2022, no significant changes in availability have occurred, suggesting that the number of pharmacies or locations currently available to receive these therapies have been saturated.

While for most Americans, this new reality brings with it access to Paxlovid and Lavegrio within 15 minutes of their home. There are still more than 7.1 million Americans, particularly those in rural communities, who do not have access to these therapies in under 30 minutes of driving. Unsurprisingly, this is due to structural factors that have long plagued areas of our country, including predominantly rural communities. These barriers to care were present before the COVID pandemic and will almost certainly continue to be present after it as well.  

Within the limitations of infrastructure, community preference, and financial considerations, there remain other ways to gain access to oral therapies directed against COVID. Telemedicine, test-to-treat sites, and mail order pharmacies can all be crucial links to care for communities. Additionally, while Pharmacists can now prescribe Paxlovid, many barriers remain in implementing this approach for broadening access.

As the COVID pandemic continues to evolve, infrastructure and policies must continue to evolve with it to ensure equitable distribution of crucial medications to combat COVID.

Dr. Peter Kahn is a fellow in the Section of Pulmonary, Critical Care and Sleep Medicine at Yale School of Medicine. He graduated from the Albert Einstein College of Medicine with honors and his M.P.H. from the Johns Hopkins Bloomberg School of Public Health in the department of Health Policy and Management. Dr. Kahn’s research has focused on health policy with a particular interest in the impact of climate change and utilities on health policy. Follow him on Twitter @PeterKahnMD

Dr. Xiaohan Ying is a resident in the department of internal medicine at New York Presbyterian Hospital/Weill Cornell. He graduated from Wharton with a focus in Healthcare Management and Policy and received his MD from Weill Cornell Medicine. Dr. Ying previously worked as a healthcare consultant, and his research focuses on health disparities and health policy.

Dr. Stan Mathis is the medical director of an ACT team and assistant professor in Yale’s Department of Psychiatry. A background in architecture and urbanism informs his clinical and research/teaching work. Taking care of patients in their homes or in the community, he sees firsthand the impact of the extra-clinical environment on their lives and wellbeing. He also co-developed a curriculum that combines data-driven and experiential learning to help psychiatry residents develop a deeper understanding of New Haven and the forces, historical and current, that impact its population.