Tested positive for Covid and at high risk? How to get antiviral pills

With at-home Covid-19 testing kits beginning to arrive in Americans’ mailboxes nationwide, people who test positive for Covid and at high risk for severe illness may want to seek out two newly authorized antiviral pills that have been shown to cut the risk of hospitalization or death.

Unlike all other FDA-authorized Covid treatments, which need to be given intravenously or by injection from a health care provider, the two antiviral pills — Pfizer’s Paxlovid and Merck’s molnupiravir — can be picked up at a pharmacy and taken at home.

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The two easy-to-administer treatments add to the nation’s Covid arsenal at a time when federal regulators have asked states to stop using certain antibody drugs because they don’t work against the omicron variant, which now accounts for virtually all new cases in the United States. Pfizer and Merck have said their pills should work against the new strain.

Jan. 25, 202206:38

To be sure, the process for obtaining the pills is more complex than for Covid vaccines and other treatments, and both drugs come with risk of side effects for certain groups of people.

Additionally, finding the pills won’t be easy for everyone, health experts say, as they are currently in short supply in the U.S. The Department of Health and Human Services has already allocated hundreds of thousands of courses of the antivirals, but the distribution has varied by state and some state governments may have different eligibility requirements for who can receive the drugs. In some places, preference is given to the unvaccinated or those with weak immune systems who don’t respond well to vaccination.

“There is very limited supply at this point and they are for very specific types of patients,” said Kurt Proctor, senior vice president of strategic initiatives at the National Community Pharmacists Association. “It certainly isn’t like every person who gets one of these [over-the-counter] tests and, if they test positive, should start trying to get one of these meds.”

These are the steps experts say you should take to get the drugs.

A positive Covid test is required before a health care provider can consider prescribing the pills.

The FDA has permitted a Covid diagnosis from both over-the-counter rapid antigen tests — like the ones being distributed by the federal government — and PCR, or polymerase chain reaction tests, often referred to as the “gold standard” because they are considered the most reliable.

People who suspect they have Covid should get tested as early as possible because both treatments must be started early to be effective — within five days of symptoms.

Get a test “as quickly as possible,” especially if one already has symptoms, said Dr. William Schaffner, an infectious disease expert at Vanderbilt University Medical Center in Nashville, Tennessee. “In other words, don’t put it off if you’re becoming ill because you’re wasting time.”

He added that patients may prefer a rapid test, if available, since PCR tests require special lab equipment and the turnaround time can average several days.

The pills are not available to everyone.

The FDA authorized Paxlovid for at-risk people as young as 12 with mild to moderate Covid to receive a five-day course of the medication. The agency authorized molnupiravir for at-risk adults with the illness. Molnupiravir is also limited to situations where other authorized treatments are inaccessible or not “clinically appropriate,” according to the FDA.

Because of supply shortages, some states and local governments may have even narrower eligibility requirements and some people at high risk may be turned away. Additionally, unvaccinated patients may get priority when there is a limited supply under National Institutes of Health guidelines.

The guidelines have “rubbed some people the wrong way,” said Dr. David Boulware, an infectious disease physician at the University of Minnesota Medical School. “But as far as if you want to maximize the absolute benefit, that’s sort of the best way.”

For example, in Clark County, Nevada, Paxlovid is initially being given first to patients who arrive at the county’s public health department testing site who are:

• Symptomatic
• Have a positive Covid test
• Over the age of 65.

New York state is prioritizing treatments to those who are:

• Moderately to severely immunocompromised, regardless of vaccination status
• Older and not fully vaccinated, with at least one risk factor for severe illness. 

If you’re uncertain if you qualify, you can check your local health department website or ask your primary care physician.

“If you’re overweight and you’re over 50 and you’ve got some high blood pressure, like boom, boom, boom, you might be able to fall into a high-risk category pretty quickly,” Boulware said.

Reach out to your primary care physician, urgent care doctor or local health system to get a prescription. A pharmacist cannot prescribe these medications.

Both antivirals come with certain side effects, and so underlying health conditions may affect which drug people get, if any, Boulware said. Availability may also affect which drug a patient gets.

Pregnant women, for example, should not take the Merck pill because of risks to the fetus, according to the FDA. The agency has also recommended that patients use contraception while using that treatment and for four days after the last dose.

The FDA has noted that the Pfizer pill may also be unsuitable for some people, such as those with HIV or some organ transplant patients, because of the potential for interactions with other medications.

Though since both treatments are taken for only five days, a physician may be able to adjust or temporarily suspend medication for other ailments.

“Common things, like cholesterol medicines, you could probably skip for five days,” Boulware said. “Those are not life-sustaining.”

The pills are scarce: Merck said it has shipped 2 million treatment courses to the U.S. government so far, while Pfizer said it has shipped 250,000 courses.

The U.S. has agreed to purchase about 3.1 million courses of Merck’s drug, most of which could be available to states by the end of the month. The government has purchased 20 million courses of Pfizer’s drug. Allocations are expected to ramp up over the next several months, officials say, with at least 10 million courses delivered by the end of June.

The federal government has a database where patients may be able to find the treatments. GoodRx, a digital health care platform, also created an interactive map where people can see which pharmacies near them have the pills in stock.

Doctors may look at the availability of the treatments in the area before prescribing the pills, but because the pills are so hard to find, some doctors are putting the burden on sick patients.

Roy Nwaisser, a Los Angeles resident who sought the Pfizer pill for his father who suffers from a heart condition, said a pharmacy he called didn’t even know about the pills.

“It was shocking to me that when I called the pharmacy that, in the middle of Covid and an omicron surge, that they don’t even know that there is a pill for Covid,” he said.

Experts hope that will change as the supply of tests and pills become more readily available.

“I can envision a future in which you know you feel bad … you go to the drugstore and you get a test. You’re positive. You call your doctor. They call in a prescription and you know, within a couple of hours, you can start therapy,” said Dr. Carlos del Rio, an infectious disease physician at Emory University School of Medicine.

The antivirals, allocated through the federal government, should come at no cost to patients, said Katherine Yang, an infectious diseases pharmacist specialist at UCSF Health.

Once at the pharmacy, the pharmacist may call the provider to go over the patient’s risk factors and the safety of the prescription, including the potential for drug-to-drug interactions, Yang said.

If the pharmacist feels the patient doesn’t qualify or is outside the five-day window, they could refuse to dispense the drugs, she said.

“We do ask our providers to attest when they prescribe that the patient is within our guidance and it’s within five days of symptoms,” she said.

Pharmacists also stress that it’s important to take the full course of the treatments as prescribed.

A full course of Pfizer’s treatment is a total of 30 pills, taken three pills twice daily for five days. The treatment includes a low dose of ritonavir, a commonly used HIV drug, along with an antiviral developed by Pfizer called nirmatrelvir.

A full course of Merck’s treatment is a total of 40 pills, taken as four 200-milligram pills, twice a day for five days.

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