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GAVIN NEWSOM
Governor

State of Californiaā€”Health and Human Services Agency
California Department of Public Health


ā€‹ā€‹ā€‹ā€‹ā€‹ā€‹ā€‹ā€‹ā€‹ā€‹ā€‹                                                            Health Advisory                                                            ā€‹

TO: Healthcare Providers
Update on COVID-19 Medications and Transition to Commercial Marketplace
12/18/2023



ā€‹ā€‹Key Messages

  • There is an ample supply of COVID-19 therapeutic agents, but they have been underused ā€“ especially among populations disproportionately impacted by COVID-19, including communities of color, low-income communities, and residents of long-term care facilities. Studies have shown that COVID-19 treatments reduce the risk for hospitalization and death among individuals with varying illness severity and risk factors.  ā€‹

  • Lack of familiarity with new medications (understanding contraindications, side effects, and drug-drug interactions), and the misperception of drug scarcity have contributed to low treatment rates, including reports of eligible patients ultimately being denied treatment. 

  • This health alert aims to remind providers that all symptomatic patients with a positive COVID-19 test should be evaluated for treatment with one of the U.S. National Institutes of Health recommended treatment options.

  • While previously available free of charge, patients will start to see cost-sharing and co-pays for all COVID-19 medications (like all prescribed drugs) once the U.S. Government (USG) purchased product supply has run out. This will vary by geographic location and pharmacy, but patients should NOT be charged for USG purchased product if it is still available. 

  • The commercial price charged to patients and insurance will vary. If accessing service from an out-of-network provider, you may be charged cost sharing, such as a co-pay or co-insurance, or it may not be covered at all. As an example, a patient could be charged up to $1,400 for a course of Paxlovid if not obtained in-network.ā€‹

  • Free telehealth and treatment options remain available to patients seeking prescriptions through June 2024. 


ā€‹ā€‹Background

Once an individual is diagnosed with COVID-19, early treatment with antivirals is the only existing strategy to decrease the risk of serious illness and prevent hospitalization. All available COVID-19 oral antivirals have now transitioned to the commercial market after almost two years of being available free of charge through the U.S. government, representing a significant change for patients and providers alike. This health alert outlines the broad changes in this transition and highlights the importance of continuing to offer and prescribe therapeutic agents for COVID-19 when appropriate. ā€‹

Recommendations 

  • The greatest benefit of antiviral treatment is seen in those at highest risk for severe disease, including the elderly, those who are immunocompromised, under/unvaccinated, have underlying chronic health conditions, and certain minority groups. 

  • Early evidence suggests COVID-19 treatment may decrease the risk of developing post-COVID symptoms.  

  • COVID-19 oral antiviral prescription rates are lowest among racial and ethnic minority communities and in high vulnerability geographic regions. 

  • Prescribing options have been shown to be safe, including in fragile, elderly populations even among those on multiple medications (check resources below for helpful drug interactions tools). Risks including Paxlovid rebound, are minimal, especially when weighed against benefits. 

  • The commercialization of COVID-19 oral antivirals means that these products will be available through the normal commercial marketplaces for drugs. Private insurance plans may require patients to pay a copay like any other prescription medication. Manufacturers are offering programs to assist patients who are uninsured, underinsured, cannot afford their copays, and patients who have Medicare or Medi-Cal:

  • Free telehealth options continue to be available to all Californians through June 2024.

    • Option 1: Utilize Californiaā€™s current free telehealth provider, Sesame Care. Available to all Californians ages 12 and up, regardless of insurance status, until February 2024. There is no appointment fee charged to patients during this time period but the prescription cost will be subject to the commercialization rules above. Call 833-686-5051 or go toā€Æ the Sesame Care websiteā€‹ā€‹ā€‹. Offered in 200+ languages. 

    • Option 2: The National Home Test to Treat Programā€Æalso offers free COVID-19 telehealth care, as well as free home delivery of medications and free COVID-19 tests. Visitā€Æthe Home Test to Treat website to sign up. Available in English and Spanish. The program is expected to run through early summer 2024. 

ā€‹ā€‹ā€‹Resourcesā€‹

Call the California Department of Public Health Call Center for questions and help at 833-422-4255. ā€‹

ā€‹ā€‹References

Hammond, Jennifer, et al. "Oral nirmatrelvir for high-risk, nonhospitalized adults with Covid-19." New England Journal of Medicine 386.15 (2022): 1397-1408. 

Paxlovid Associated with Decreased Hospitalization Rate Among Adults with COVID-19 ā€” United States, Aprilā€“September 2022 | MMWR (cdc.gov). 

Boehmer TK, et al. Racial and Ethnic Disparities in Outpatient Treatment of COVID-19 - United States, January-July 2022. MMWR Morb Mortal Wkly Rep. 2022 Oct 28;71(43):1359-1365. doi: 10.15585/mmwr.mm7143a2. PMID: 36301738; PMCID: PMC9620572. 

Shishkov, Alyssa, et al. ā€œCounty-Level Sociodemographic Characteristics and Availability of COVID-19 Therapeutic Drugs.ā€ JAMA Network Open, vol. 6, no. 9, Sept. 2023, p. e2334763.