Having spent the past year writing about
COVID-19 vaccines and treatments for The New York Times, I knew a lot about the
options available to people like my mother. Yet I was about to go on a
seven-hour odyssey that would show me there was a lot I didn’t grasp.
My mother, Mary Ann Neilsen, is fully
vaccinated, including a booster shot, which sharply reduced the odds that she
would become seriously ill from the virus. But she has several risk factors
that worried me. She’s 73. She has twice beaten breast cancer.
Her age and cancer history made her
eligible to receive the latest treatments that have been shown to stave off the
worst outcomes from COVID. The trouble, as I knew from my reporting, was that
these treatments — including monoclonal antibody infusions and antiviral pills
— are hard to come by.
Demand for the drugs is surging as the
omicron variant of the coronavirus infects record numbers of Americans. But
supplies are scarce. The two most widely used antibody brands don’t appear to
work against omicron, and the antiviral pills are so new and were developed so
quickly that not many have reached hospitals and pharmacies.
I set out to track down one of two
treatments: GlaxoSmithKline’s antibody infusion or Pfizer’s antiviral pills,
known as Paxlovid. Both have been found to be safe and highly protective
against severe COVID when given to high-risk patients within a few days of the
onset of symptoms. Both are potent against omicron.
One of my first steps was to search
online for lists of pharmacies and clinics near my mother’s home in Santa
Barbara, California, that might have one of the drugs in stock. (I live in
Washington state, so my quest was conducted, like so much else these days,
remotely.)
Some states, like Tennessee and Florida,
have useful online tools for finding a facility with monoclonal antibodies in
stock. But I couldn’t find one for California. I checked a federal database,
which had only one listing within 25 miles of my mother.
When I called that health system, I was
told that it had run out.
I also hunted for Paxlovid. From my
reporting, I knew about a federal database of pharmacy chains, hospital systems
and other providers that have placed orders for the pills. A Times colleague
downloaded the data, as anyone can do, and sent it to me in a more easily
searchable format.
The list turned up only a few
possibilities, mostly pharmacies, near my mother. I dialled the closest one, a
CVS, but an employee informed me that the store had quickly run out of the
first shipment of pills and didn’t know when more would come.
After a few more calls, I found a Rite
Aid, more than an hour’s drive from my mother’s apartment, that had Paxlovid in
stock. The pharmacy warned me that the supply was going fast.
Still, this was good news. I figured I
had just surmounted the toughest obstacle, and only two hours had passed since
my mother tested positive. Now I just needed to get her a prescription.
I had already asked my mother to call
her doctor’s office and request a phone call with her physician so she could ask
for a prescription for one of the treatments. She reported back to me that the
receptionist had told her that they “don’t do” either the Glaxo or Pfizer
treatments.
That didn’t make sense to me. The Food
and Drug Administration has authorised the drugs. Why wouldn’t doctors be
prescribing them? Frustrated, I called her doctor’s office to get an
explanation. (I did not identify myself as a Times reporter, in that phone call
or the others I made that day, in part because I did not want to create the appearance
of seeking preferential treatment.)
The employee who answered the phone told
me that the doctors there had yet to conduct their own medical review of
Paxlovid and, as a matter of policy, could not yet prescribe it. Moreover, the
employee told me, my mother would need an appointment to speak to a doctor, and
there were no slots until a week later.
I began hunting for another doctor who
would promptly write a prescription.
I tried scheduling visits with several
telemedicine providers, including CVS and Teladoc, but I kept seeing a
similarly worded notification on the intake forms: They were not writing
prescriptions for Paxlovid or molnupiravir, a similar antiviral pill from
Merck.
(Later, I asked both companies about
these policies. A CVS spokesperson said providers were prescribing the
antiviral pills to patients they saw in person at some stores but not via
telemedicine. A Teladoc spokesperson said the company believed at this point
that “it’s most appropriate” for the antiviral pills to be prescribed in
person.)
I started calling urgent care clinics
and health systems near my mother to see if they would write her a
prescription. At one point, we even got her on a video call with a doctor at a
nearby health system.
Maddeningly, we were repeatedly told the
same thing: Their doctors couldn’t write prescriptions for Paxlovid during
virtual appointments. My mother would have to be evaluated in person —
seemingly defeating the purpose of a remote doctor’s appointment.
In any case, this was a nonstarter,
because my mother lives alone and doesn’t drive, and the clinics weren’t within
walking distance. She would not consider taking a taxi or a bus and risk
exposing others to the virus. In this regard, my mother isn’t alone. Tens of
millions of Americans rely on public transportation. And those with cars risk
spreading the virus while seeking prescriptions in person.
Other medical facilities I called that
afternoon provided me with information that was just plain wrong. One person
told me that no monoclonal antibody treatments were available in California.
Another insisted that Paxlovid was only for hospitalised patients.
In the end, my scramble to find a
prescriber turned out to be unnecessary. In the early evening, my mother got an
unexpected call from a doctor with her primary care provider. She told the
doctor about her symptoms and about the Rite Aid I had found with Paxlovid in
stock.
The doctor told her that he was
surprised that we had been able to track down Paxlovid. He phoned in a
prescription to the Rite Aid.
Now we just needed to pick up the pills
before the pharmacy closed in about an hour.
Uber came to the rescue. I requested a
pickup at the Rite Aid and listed the destination as my mother’s home, some 60
miles away.
Once a driver accepted the ride, I
called him and explained my unusual request: He’d need to get the prescription
at the pharmacy window and then drive it to my mother’s. I told him I’d give
him a 100% tip.
The driver, who asked me not to use his
name in this article, was game. He delivered the precious cargo just after 8
pm. My mother swallowed the first three pills — the beginning of a five-day,
30-pill regimen — within minutes of the driver’s arrival.
“Taking meds & very thankful to have
them,” she texted in the family group chat.
By some measures, my search was
successful. My mother started taking the pills only 2 1/2 days after her
symptoms began and within eight hours of testing positive.
Within a few days, she started feeling
better. She finished the regimen this past weekend.
But the fact that the process was so
hard for a journalist whose job it is to understand how Paxlovid gets delivered
is not encouraging. I worry that many patients or their family would give up
when told no as many times as I was.
I was also reminded that even a “free”
treatment can come with significant costs.
The federal government has bought enough
Paxlovid for 20 million Americans, at a cost of about $530 per person, to be
distributed free of charge. But I spent $256.54 getting the pills for my
mother. I paid $39 for the telemedicine visit with the provider who told my
mother that she would need to visit in person. The rest was the Uber fare and
tip. Many patients and their families can’t afford that.
President Joe Biden recently called the
Pfizer pills a “game changer.” My experience suggests it won’t be quite so
simple.
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