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.
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, Calif., 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 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. 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 authorized 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 spokeswoman said providers were prescribing the antiviral pills to patients they saw in person at some stores but 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.)
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.
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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 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 hospitalized 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 percent tip.
The driver, who asked me not to use his name in this article, was game. 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.
By some measures, my search was successful. My mother started taking the pills only two and a half 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 an in-person visit. The rest was the 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 : Nytimes