Just after 1 p.m. on Tuesday last week, my phone buzzed with a text message from my mother: “Well, came down with cold, aches, cough etc over wknd.” She had taken an at-home coronavirus test. It was positive.
I was a writer for The New York Times for the past year about Covid-19 vaccines, treatments, and other options. Yet I was about to go on a seven-hour odyssey that would show me there was a lot I didn’t grasp.
Mary Ann Neilsen is my mother. She has been fully vaccinated. This booster shot significantly reduced her chances of getting seriously ill. She has several risk factors that concern me. She’s 73. She has twice beat breast cancer.
Because of her age and past cancer history, she was eligible for the most recent treatments that have been proven to prevent the worst 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.
The Omicron coronavirus, which infects record numbers Americans, is driving the demand for these drugs. But supplies are limited. 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 are safe and highly protective against severe Covid if administered to high-risk patients within a few hours of 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, Calif., that might have one of the drugs in stock. (I am in Washington State, so my search was done remotely.
Some states, like Florida and Tennessee have online tools that can help you find a facility that stocks monoclonal antibodies. But I couldn’t find one for California. I searched a federal database and found only one listing within 25 miles from my mother.
I called this health system to find out if it was closed.
I also searched for Paxlovid. I had information from my reporting that there was a federal database of pharmacie chains, hospital systems, and other providers that had placed orders for the drugs. A Times colleague downloaded this data, as anyone can, and sent it back to me in a more searchable format.
I was only able to find a handful of options, mostly pharmacies close to my mother. I dialed 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. I was warned by the pharmacy that the supply was limited.
This was still great news. I thought I had successfully negotiated the hardest obstacle. My mother had only tested positive two hours earlier. I needed to get her 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 authorized the drugs. Why wouldn’t doctors be prescribing them? Frustrated, I called her doctor’s office to get an explanation. (I didn’t identify myself as a Times reporter in the phone call or in the other calls I made that day because I didn’t want to give the impression that I was seeking preferential treatment.
The person answering the phone said that the doctors had not done a medical review of Paxlovid yet and could not prescribe it as a matter policy. Further, the employee informed me that my mother would need to schedule an appointment to speak with a doctor. However, there were no slots until a few weeks later.
I started looking for a doctor who would quickly write a prescription.
I tried scheduling visits with several Telemedicine providers, including CVS or Teladoc. But I kept seeing a similar notification on the intake forms. They were not prescribing Paxlovid or Molnupiravir, an antiviral pill similar to Merck.
(Later I asked both companies about their policies. A CVS spokesperson stated that the antiviral medication was being prescribed to patients by providers who were present in some stores and not via telemedicine. A Teladoc spokesman said the company believed at this point that “it’s most appropriate” for the antiviral pills to be prescribed in person.)
To see if they could write her a prescription, I began calling local urgent care clinics and health system offices. One time, we were able to get her on a live video call with a doctor at the nearby health system.
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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 wouldn’t consider taking a bus or a taxi to risk spreading the virus to others. In this regard, my mother isn’t alone. Tens of millions of Americans depend on public transportation. People with cars are at risk of contracting the virus while they seek prescriptions in person.
Other medical facilities I called that day provided me with incorrect information. One person said that monoclonal antibodies treatments were not available in California. Another claimed that Paxlovid was not available for patients in hospitals.
My search for a prescriber ended up being unnecessary. My mother received an unexpected call in the early hours of the evening from her primary care provider. She spoke to the doctor about her symptoms, and also about the Rite Aid she had found in stock with Paxlovid.
She was told by her doctor that he was shocked that we had been successful in finding Paxlovid. He called the Rite Aid to get a prescription.
We just needed to get the pills before the pharmacy closed at 1:45 p.m.
Uber came through for me. 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 percent tip.
The driver, who requested that I not use his name in this article was open to the idea. He delivered the precious cargo just after 8 p.m. 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.
My search was successful by some measures. My mother began taking the pills two and a quarter days after her symptoms started. She also tested positive within eight hours.
She felt better within a few days. She completed the program this weekend.
It is disappointing that the process was so difficult for a journalist who is supposed to understand how Paxlovid is delivered. 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 purchased enough Paxlovid at a cost approximately $530 per individual to provide free distribution. I spent $256.54 to get the pills for my mom. The telemedicine visit was $39 and my mother was told by the provider that she would need a visit in person. Rest was Uber fare and tip. Many patients and their families can’t afford that.
President Biden recently called the Pfizer pills a “game changer.” My experience suggests it won’t be quite so simple.
Source: NY Times