3 ways to get COVID pills, if you've just tested positive

If you've just tested positive for COVID-19, and you have common risk factors for serious illness, there are now ample treatments available – generally at little or no cost – that could help you avoid the worst and recover more quickly from a mild or moderate case of COVID.

Paxlovid, a five-day course of pills from Pfizer, is at the top of the list of recommended treatments. Studies from the drugmaker showed that – in unvaccinated people at risk of serious COVID medical risk factors – Paxlovid was nearly 90% effective at cutting the risks of getting hospitalized or dying because of COVID.

People who are vaccinated or who have recovered from COVID could still benefit from the drug, says Dr. Priya Nori, an infectious disease physician at Montefiore Health System in Bronx, New York, and a professor at Albert Einstein College of Medicine. Taking Paxlovid could "help you get back on your feet faster, feel better faster, and be potentially less infectious faster," Nori says.

The Biden administration has been talking up the treatment. "We want all individuals to know about this effective medication, and to have a conversation with their health care provider about if they are eligible, and whether they should be making a plan" for accessing the drug if they do test positive, says Dr. Meg Sullivan, chief medical officer for the Office of the Assistant Secretary for Preparedness and Response in the Department of Health and Human Services.

But some people have had trouble getting the medicine quickly, when it can make a difference in the progression of the disease, despite the administration's effort to make the medicines easy to obtain after a positive test for COVID-19.

Quick access to Paxlovid can be a challenge

Dan Weissman, 54, tried three different routes to access Paxlovid in the Chicago area when he got COVID in April. First, the nearby CVS Minute Clinic didn't have any appointments readily available. Then, the nurse practitioner at the urgent care clinic he went to initially misunderstood his medical conditions and refused to prescribe the pills. Eventually, his wife tracked down his recently retired primary care doctor, who wrote him a prescription. Weissman is glad he got the pills; his condition improved after taking them. But he says it took "an unusual amount of knowledge, connections and assertiveness," to obtain them. Luckily, Weissman, host of the health podcast An Arm and A Leg, had all three.

In upstate New York, after a few days of COVID symptoms, Pamela Coukos' college-age son tested positive on a recent Friday. "He has one of the risk factors; he seemed pretty sick. And also, it would be better if he didn't spend, like, 10 days feeling terrible because he was in the middle of final exams," Coukos says. But the university health service was closing, and the nearest "test to treat" location wasn't open on weekends. He managed to book a Saturday telehealth appointment with his primary care doctor in his home state of Maryland, who sent a prescription to a pharmacy in upstate New York. A friend drove 26 miles each way to pick it up. The sick student took the pills, recovered by Wednesday and went on to complete his exams. "It was ultimately successful, but more complicated than it needed to be," Coukos says.

COVID pills are authorized by FDA for people at high risk of disease progression – and in practice, the risk criteria have broadened as supply has increased, says Dr. Phyllis Tien, an infectious disease physician at University of California, San Francisco, who serves on the National Institutes of Health's COVID-19 Treatment Guidelines Panel.

During the winter omicron surge, pill supplies were limited, and many health care providers prescribed Paxlovid only to those who were most vulnerable, due to older age or serious underlying illnesses. Now, health conditions such as high cholesterol, depression, smoking-related lung disease, obesity, not being fully vaccinated or boosted – all factors that increase a person's risk for severe COVID outcomes – might qualify a recently infected COVID patient for a course of Paxlovid. "If someone wants it, and is eligible for it, they should be able to access it," Tien says.

A prescription is the key

The antiviral pills require a prescription, and need to be started within five days of symptoms appearing. To get a prescription you'll have to show positive COVID-19 test results, and review your risk factors and any medications you take with a health care provider.

Paxlovid – a combination of two antiviral drugs called nirmatrelvir and ritonavir – can't be taken at the same time as some common supplements and medications, including statins and some birth control pills. "There's a long list of drug-drug interactions," says Jacinda Abdul-Mutakabbir, an assistant professor at Loma Linda School of Pharmacy, "You want to make sure you bring forth any other medications you may be taking" for medical evaluation before you receive the medication.

The drug could also be dangerous for those with reduced kidney or liver function.

For those who can't take Paxlovid, there are several other early COVID-19 treatments that a health care provider might prescribe, such as remdesivir or monoclonal antibody infusions. Molnupiravir, a five-day pill treatment from Merck, is another option, although it is prescribed far less often than Paxlovid. In a clinical trial the Merck drug reduced hospitalization by only 30%.

Common side effects of taking Paxlovid include a metallic taste, diarrhea, increased blood pressure and muscle aches – all temporary. "While these side effects are not ideal, they're definitely better than what we would see if these individuals were to go forth and develop severe COVID," says Abdul-Mutakabbir.

Here are three ways to access COVID pills, if you're eligible to get them.

Contact your primary care doctor

For those with health insurance and access to their primary care providers or health care team, you can make an in-person or telehealth appointment to get tested (or share your positive test results), assessed for risks and medications and, if eligible, obtain a prescription for the pills.

You'd then get the prescription filled at a nearby pharmacy.

Having a provider that knows your medical history, as well as the details of your current situation, can be very helpful, says Dr. Ulrika Wigert, a family medicine physician at CentraCare in Sauk Center, Minnesota. "Did you test the first day [of symptoms]? Did you test the second day? How sick were you when you tested?" And, if you're starting to feel better by the time you get the medication, do the benefits of taking the medication outweigh any risks? "Having a provider help navigate that on the individual patient basis" can help guide you through an appropriate course of care, she says.

Visit a test-to-treat site

Another route to getting Paxlovid is visiting one of the 2,300 health centers, urgent care clinics and pharmacies that are designated by the government as "test to treat" sites. These are locations that have on-site prescribing capabilities and pills on-hand.

"For individuals who do not have a health care provider, or are unable to access their health care provider within a short time frame...test-to-treat locations offer testing and evaluation with a health care provider to determine if that medication is appropriate, and can dispense the medication on-site," says Sullivan of HHS.

Test-to-treat locations can be found on this map.

Before you go, "check with your health plan to make sure that they are in-network with your plan," says Sabrina Corlette, co-director of the Center on Health Insurance Reforms at Georgetown University, "So theservices you receive there will be fully covered, or at least you'll be subject only to a nominal copayment."

For those without insurance, some of the test-to-treat sites are federally qualified health centers that can provide low cost COVID testing and treatment services to the uninsured.

Try online urgent care

For those who prefer telehealth visits – and may not be able to get an appointment quickly through their primary health care provider – virtual healthcare platforms such as Plushcare, eMed and Truepill offer online visits to test, assess and prescribe COVID medications. The appointments are available at all hours, and may come with some out-of-pocket costs. A prescription can be sent to a nearby pharmacy, or filled and shipped to you, depending on what the service offers.

"The pro of this approach is that it's designed just for this purpose – of testing and treating for COVID," says Montefiore's Nori. "You'll efficiently get the service you need." The cons, she says, are that they don't know your full situation, such as your home context and your medical history. "They're relying on you to convey all your medications, herbal remedies," she says, but it can provide you with timely access to treatment.

What you can do ahead of time

If you're concerned about getting COVID and want to make a plan of action ahead of time, experts recommend four steps:

Be prepared to test quickly, if you suspect you might have COVID. "Have tests available at home, or know where you can access a testing site," says Sullivan at HHS.

Know whether you're a person with risk factors. Check to see if you have a condition that puts you at high risk for COVID, and talk with your medical provider about COVID treatments to know if you're eligible and to get questions answered ahead of time.

Check what your insurance covers, and figure out where you can get a timely consultation. Services in-network are more likely to be covered by your insurance

Find pharmacies near you that stock Paxlovid, so you know where you can fill a prescription.

And, stay up to date on your COVID-19 vaccinations, to help protect yourself and those around you from getting infected.

Now, a caveat on costs: although the pills themselves are free, there may be some out-of-pocket fees. Testing, getting a health care consultation and prescription, and follow up can cost you, depending on whether you're insured and what your insurance covers, says Georgetown's Corlette. To lower costs, those with health insurance should seek care in-network when possible; for those without insurance, a federally qualified health center may provide services that are free or very low cost, she says. [Copyright 2022 NPR]