In Arkansas, covid pills struggle to catch on despite their effectiveness

Pharmacists and healthcare providers across the state say covid-19 antiviral pills dramatically reduce the impact of the disease, but limited distribution, poor access to testing and a lack of awareness are crippling the potential of pills.

US public health and government officials have touted the pills as major parts of the roadmap out of the pandemic, but adoption has been slow.

Less testing is done.

Finding the medicine can be difficult; only 1 in 7 Arkansas pharmacies carry it.

And despite marketing efforts, many are still unaware of antiviral pills, including health care providers, said Nicki Hilliard, director of professional affairs at the Arkansas Pharmacists Association.

“We have pills on the shelves that aren’t being used as they should be,” Hilliard said.

The antivirals – Pfizer’s Paxlovid and Merck’s molnupiravir – were approved in December by the US Food and Drug Administration for emergency use. The drugs are taken by mouth and are designed to slow the progression of the disease and reduce hospital stays and the risk of death.

“Both oral covid drugs work by stopping the body from making new covid virus particles. Once you infect a cell with the virus, it kind of hijacks your molecular mechanism of making new cells and turns into virus particles “said Dr. Robert Hopkins, chief of general internal medicine at the University of Arkansas for Medical Sciences. “So nirmatrelvir – or the active ingredient in Paxlovid – or molnupiravir stops that process of making new virus particles.”

Clinical trials have shown that Pfizer’s Paxlovid reduces the risk of death and hospitalizations by 88%, while studies have shown that molnupiravir reduces the risk by 30%. Both drugs should be taken within five days of the onset of symptoms.

The pills are only available for non-hospitalized patients at high risk of developing severe covid, for people with disabilities and for older Americans.

The earlier the patient is tested, the more effective the drug will be, Hopkins said.

“If you don’t take it early in the infection, you probably already have a generalized infection and the damage is done, so to speak,” said Hopkins, who is also chairman of the states National Department of Health and Human Services. -United. Vaccine Advisory Committee.

“So the goal is for you to start early in order to stop virus production, stop disease progression, and hopefully let the body’s immune system catch up and clean things up at take it from there and get back on your feet,” Hopkins said. .

Testing for the virus is not as easy or accessible as it once was, Hopkins noted. Many large-scale testing sites, such as those operated by UAMS, have closed and federal funding to cover the cost of covid-19 testing for the uninsured dried up last month.

“We had to put our staff back to work,” Hopkins said. “There are still pharmacies that will test and some still have home testing, but people without health insurance now have to pay a significant amount to get tested.”

The Arkansas Department of Health has pledged to continue providing free coronavirus testing to uninsured people despite the end of the federal program that funded testing for the uninsured.

Hilliard, of the Pharmacists Association, said it was essential that patients act quickly at the first symptom.

“If they get sick, they need to get tested,” Hilliard said. “And home testing is OK. It’s enough to move forward to get the antivirals.”

The federal government provides the antiviral pills free of charge to the states, which then distribute the drugs to pharmacies.

The Arkansas Department of Health has received 9,180 Paxlovid tablets and 16,912 molnupiravir tablets since they first became available. As of Friday, the department had distributed 5,800 Paxlovid tablets and 12,728 molnupiravir tablets to state pharmacies, Health Department spokeswoman Danyelle McNeill said.

Access to pharmacies that dispense the pills is limited in some places due to low take-up. Of more than 750 pharmacies in the state, only 100 pharmacies dispense the antiviral pills.

The state health department has partnered with the Arkansas chapter of the Community Pharmacy Enhanced Services Network as well as federal retail partner (Walmart) to register community pharmacies to dispense the pills, a said Dr. Atul Kothari, medical director of the Health Care Associated Infections Program at the Department of Health.

“There is a survey link on our Therapeutics webpage, which allows unaffiliated pharmacies to enroll directly in the program,” Kothari said. “Pharmacy outreach was also done through Arkansas [Pharmacists] Association.”

Pharmacist Philip Way, co-owner of Remedy Drug in Little Rock, said he agreed to supply the antivirals for the same reason the pharmacy supplies the vaccines.

“We want to be part of the solution,” Way said.

Eric Crumbaugh, director of clinical business development for Express Rx, said the company’s Paris store was chosen because Logan County did not have a federal partner to distribute the drugs.

None of the company’s other 10 pharmacies in the state dispense covid-19 antiviral pills.

Perhaps the biggest obstacle to getting antiviral pills out to the public is the fact that pharmacists can’t prescribe the pills, unlike monoclonal antibody infusion treatments.

The FDA included a “scope of authorization” in the emergency approval that limits the pills’ prescribing powers to physicians, advanced practice registered nurses and physician assistants.

“We fought that,” Hilliard said. “Covid patients need to be referred to a healthcare provider, and that’s been problematic. It slows down the process and shortens that window of opportunity. We’re working nationally to allow pharmacists to prescribe the antivirals. They don’t. This generally does not fall within the scope of these emergency use authorizations.If it was at the state level, the state would allow it.

Crumbaugh said not allowing pharmacists to prescribe the antivirals resulted in a very slow start to dispensing the pills.

“A lot of local providers didn’t feel comfortable prescribing it,” Crumbaugh said. “It didn’t take that fast.”

In Paris, Crumbaugh said there was to be a conference call with the pharmacist, the Department of Health and local health care providers to provide education on the pills and the process of prescribing them.

“Pharmacies are the most accessible healthcare providers. In many communities, we are the only providers,” Crumbaugh said. “We are up to date on products and therapeutics. We were more than willing to do so. Frankly, it has been an honor as a pharmacist to take on the role that we have in the fight against this pandemic.”

Way, the co-owner of Remedy Drug, said covid-19 antiviral pills require a much more thorough process by the healthcare provider and pharmacist because of the risk of interactions with conditions such as kidney or heart disease. . Longer conversations with patients are needed before filling the prescription and after it is dispensed, Way said.

“We usually have a pretty complicated conversation with the doctor or nurse who prescribes it,” Way said.

In the case of kidney disease, the prescribing provider should consider the patient’s kidney function test levels. Different levels require different doses of pills, Way said.

“We make sure the dose is right,” Way said. “In January and February, half of the prescriptions we received required dosage adjustments.”

Pharmacists must also submit daily reports detailing the number of antiviral pills dispensed and the number remaining in stock.

Unlike vaccines and monoclonal antibody infusions, pharmacists generally do not receive additional administration fees.

“Due to significant drug interactions, it takes pharmacists 40 minutes or more — talking to the healthcare provider and doing patient screenings — to process the prescription,” Hilliard said. “Forty minutes is a lot to invest in order not to be paid. Many pharmacists do it anyway because they serve the public.

In March, the state finance board voted to authorize a fee of $1.50 to $20 per prescription that is paid by the state benefits division to state pharmacists for dispensing covid-19 pills.

The Benefits Division administers the health insurance plans of more than 100,000 public school and state employees and retirees.

McNeill, the Department of Health spokeswoman, said the agency is actively promoting treatment options through a media campaign using digital, print, television and radio formats.

Yet awareness is lacking, pharmacists say.

Crumbaugh said the Express Rx in Paris dispensed fewer than 40 of the antiviral prescriptions, and Way said Remedy Drug only dispensed about 30.

“I don’t think there’s a lot of awareness about it,” Way said.

More people need to have access to the drugs as they are very effective against the virus, he added.

“I can tell you that we followed our patients and the medications were very well tolerated,” Way said. “The result was very good.”

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