Although the U.S. massively ramped up prescriptions for COVID-19 oral antivirals through early 2022, dispensing rates among ZIP codes with greater social and economic disadvantages were roughly half those of other regions between March to May, according to a Centers for Disease Control and Prevention study published Tuesday.
Lower dispensing rates came despite these socially vulnerable ZIP codes hosting a greater number of dispensing sites, which researchers said underscores the need for additional public health, regulatory or policy efforts to ensure the treatments reach underserved patients.
“Oral antivirals, particularly Paxlovid, provide an essential tool that can prevent hospitalization and death from COVID-19,” CDC, Department of Health and Human Services (HHS) and Palantir Technologies researchers wrote in Morbidity and Mortality Weekly Report. “The findings in this report highlight an ongoing need to identify and eliminate barriers to oral antiviral access, particularly within socially and economically disadvantaged communities.”
In their review of oral antiviral dispensing data reported daily to HHS, the researchers found nearly 1.1 million prescriptions for Paxlovid and Lagevrio were dispensed in the U.S. between Dec. 23, 2021—shortly after the treatments received emergency use authorization—and May 21, 2022. Nationwide dispensing sites increased from 49 during the study’s first week to almost 40,000 by its end.
Paxlovid made up more than three-quarters of oral antiviral prescriptions, although use of both antivirals rose substantially over the course of the study period. The increase, researchers wrote, coincided with increased government and pharmacy efforts to expand access to the therapies, such as the Test to Treat program.
Researchers reviewed dispensing rates and sites across ZIP codes determined to be low, medium or high vulnerability using the Equitable Distribution Index scale. These ZIP codes contained 20%, 31% and 49% of U.S. residents, respectively.
High-vulnerability ZIP codes contained 47.5% of the country’s dispensing sites by the study’s end, while 32.9% were in medium-vulnerability ZIP codes and the remaining 19.6% in low-vulnerability zip codes, the researchers wrote.
However, oral antiviral prescription dispensing rates were highest in low-vulnerability ZIP codes (373.3 per 100,000 people) across the full study period, followed by medium- (359.5 per 100,000 people) and high- (287.4 per 100,000 people) vulnerability ZIP codes, they wrote.
Slimming down the window to the back half of the study, however, revealed a broader gap between these populations.
From March 6 to May 21, low- and medium-vulnerability areas saw antiviral dispense rates of 77.4 and 70 per 100,000 people, according to the study. High-vulnerability areas came in at just 35.7 per 100,000 people, “approximately one half the rate” of less vulnerable ZIP codes, they wrote.
Researchers hypothesized that the reduced rate among higher vulnerability ZIP codes could be the result of limited access to healthcare providers who could prescribe the treatments.
“In addition, the end of reimbursement for testing, health care provider assessment, and oral antiviral dispensing through the Health Resources and Services Administration Uninsured Program on March 22, 2022, might have contributed to lower oral antiviral dispensing rates for certain populations living within high-vulnerability zip codes,” they wrote.
Single-visit testing, assessment and dispensing were chief among the team’s potential recommendations, as were continued education and outreach and the removal of additional costs such as deductibles or copays.
The CDC’s dispensing study was published alongside another investigation jointly conducted with Kaiser Permanente, which suggested early-stage Paxlovid could cut down COVID-19-related hospitalizations among those at risk for severe disease progression.
CDC leadership and others involved in the White House’s COVID-19 response have frequently pointed to the oral antiviral treatments as a likely explanation for lower hospitalization and death rates seen in recent months.
But while the Biden administration pushed to increase oral antiviral supply and access shortly following their authorization, the White House has warned that the continued supply of these and other next-generation COVID-19 treatments are in jeopardy without new funds from Congress.
The administration said its current 2022 plan is to shift funds away from other areas such domestic testing manufacturing and equipment initiatives and toward other priorities like vaccines. Republican leaders in Congress have since pointed to this strategy as evidence against the need for a new round of COVID-19 funding and criticized the administration for seeking additional funds.