opinion | Covid medication may work well, but our healthcare system does not
Vaccines are essential to create broad immunity against the coronavirus. But drugs to treat Covid-19 are also crucial to combating the pandemic. This is especially true in places where large numbers of people remain unvaccinated and unboosted. These individuals could benefit from treatment if they become ill. Others, like the immunocompromised, may need extra help to fight off the disease.
Unfortunately, almost every step in the path by which Americans could get these drugs seems designed to prevent it (making vaccination even more important).
But first the therapies that we have very helpful, are not ideal in some ways. A course of newer Covid-19 therapies requires a person to take 30 pills of Paxlovid or 40 pills of Molnupiravir, a burden many might find difficult.
While Paxlovid appears to reduce the likelihood of hospitalizations and deaths by more than 85 percent, recent data shows that molnupiravir doesn’t seem to work as well, possibly reducing hospitalizations and deaths by only 30 percent. There are also some concerns that molnupiravir might not because of its mode of action could lead to new variants.
But having medication, especially potent ones like Paxlovid, is crucial. And for these drugs to be successful, they must be taken properly. People need to start them within five days of being infected, and due to the shortcomings of our testing system and other public health issues, it’s difficult to start treatment that quickly.
Let’s start with the diagnosis. If you feel sick, you need a coronavirus test. A PCR test would most likely take at least a day or two to return results and that is if you can find the test. An alternative would be to use a home antigen test. Like everything else, these tests run out when people need them most. The government sends some to families for free if they sign up on a website, but you can only get four per household at the moment.
Additional tests at home cost money. The Biden administration has pledged to cover the costs (up to eight a month) with insurance, but that pledge often requires you to pay them out of pocket and get reimbursed later.
And that’s if you have insurance. For those who don’t, the administration plans to make tests available at locations in underserved communities, but to get some people need to know when they’re there and be able to pick them up. The uninsured will most likely have the most difficulty doing this.
If you test positive, you cannot go directly to a pharmacy for drug therapy like you did for the test. You need a prescription for the drug, which often requires a doctor’s visit. That assumes you have a doctor (many people don’t) and that an appointment is available. Before the pandemic, less than half of people in the United States could get a same-day or next-day appointment with their provider when they were ill.
However, if you are lucky enough to successfully traverse this gantlet, you must now have your prescription filled. Most insurance companies limit where you can get your medication paid for, and it’s a godsend if that pharmacy stocks pills. If not, hopefully they’ll be there a few days later, but those are precious days.
Too few people understand that much of the US healthcare system is designed to make it harder for people to get medical care in an attempt to reduce overall healthcare spending. Because of this, your insurance is likely to have higher deductibles than it used to and more visits come with co-payments or co-insurance. But poorer people have a harder time meeting those costs, making inequalities worse and making it harder for those who need help most to get it.
We are seeing this play out with Covid-19 treatments. ONE Recent study examined how efficiently and effectively Medicare beneficiaries (all of whom were elderly) received anti-Covid monoclonal antibody therapy in 2020-2021. It found those at highest risk were the least likely to be treated, in large part because these hurdles were difficult to overcome within the 10 days of infection required for treatment.
It doesn’t have to be like this. The government could continue to send free antigen tests to everyone like other countries are doing. Doctors could prescribe packs of pills for high-risk people, as is the case with EpiPens, so that if they test positive at home, they can start medication immediately. Pharmacists could be more empowered to talk to patients about whether the pills are safe for them and to hand out packs of pills without a prescription if patients qualify. Insurance companies could change their co-payment requirements to give sick people an incentive to take care of a serious illness instead of avoiding it.
Making such changes will not be easy. Before the pandemic, a possible pregnancy was one of the few “conditions” that allowed for home testing and diagnosis. Such tests were strongly against by doctors and much of the rest of the healthcare system. Medical associations have also repeatedly fought to enable pharmacies to provide care. Even if we were willing to make changes, who would pay for it? Our fragmented, multi-payer system is ill-equipped to think and act collectively.
Some of these treatments, like the vaccines, can be life-saving. They still couldn’t improve things enough here in the United States. But that’s not because the drugs aren’t working well. That’s because our healthcare system doesn’t.