Pharmacists are now able to prescribe an antiviral pill treatment for COVID-19.
The decision by the federal Food and Drug Administration announced Wednesday means someone who’s sick will be able to quickly start the five-day course of Paxlovid pills from Pfizer that are intended to keep high-risk patients out of the hospital by easing the effects of the virus that continues to spread.
The treatment, authorized late last year for emergency use by COVID-19 patients 12 and older whose medical conditions, age or other factors make them the most likely to develop severe illness, must be taken within five days of the first symptoms.
Utah pharmacist Tad Jolley, the owner of Jolley’s Pharmacy Redwood in West Jordan, has had to tell customers seeking the treatment that they need to get a prescription from their doctor. He’s looking forward to being able to help them himself.
“It goes back to, pharmacists are the most available health care professionals,” Jolley said. “People come in and ask us things, and generally, they come in and talk to us before they go to their doctor a lot of times. So we’re on the front line.”
Besides, he said, many of his customers already come to the pharmacy to get tested for the virus, “so it just makes sense if they have a positive test and they’re having symptoms to make it easier for them to get the Paxlovid.”
But he and his brother, Trevor Jolley, who’s also a pharmacist at the Redwood pharmacy, are waiting for more information from state health officials before prescribing it. Trevor Jolley said they need to know how to identify who is eligible for the treatment and other details
The Utah Department of Health and Human Services is currently working those out with the Utah Board of Pharmacy, said Charla Haley, a spokeswoman for the department, but “any pharmacist in Utah, acting in accordance with the EUA (emergency use authorization) can now prescribe Paxlovid.”
The FDA advised patients who want a pharmacist to prescribe the treatment that they should bring their health records from the past year, including any recent lab blood work, as well as a list of all medications so they can be screened for kidney or liver problems, and potentially serious drug interactions.
If electronic or paper copies of medical records aren’t available, pharmacists can consult with the patient’s health care provider, the federal agency said. But patients must be referred to a doctor or other medical professional if enough information is not available, or if other medications need to be adjusted.
Dr. Brandon Webb, an Intermountain Healthcare infectious diseases physician, said the treatment needs to be prescribed carefully.
“When it’s used correctly in people who are not taking medications that interact, and who do not have issues with their kidneys or liver, generally speaking, Paxlovid is very safe,” Webb said. He said many common medications, including those for blood pressure, cholesterol and mental health issues interact with the drugs in the treatment.
“Pharmacists are truly the experts in drug interactions. We’ve leaned on our pharmacy colleagues heavily so far to help us prescribe Paxlovid safely,” the doctor said, adding he’s confident pharmacists will be able to do that on their own as long as they have the information they need from patient health records.
“They’d really be relying on the patient bringing an accurate medication list and being able to provide accurate health information about themselves that would be necessary to determine whether the drug is the right choice and how to dose it correctly,” Webb said.
The dose of the two-drug treatment taken twice a day can vary depending on kidney function, he said.
It’s also important to use the treatment for those at high risk for hospitalization or death, Webb said, since the benefits to others are limited. He said recent studies have not shown it reduces the duration of COVID-19 symptoms and is less effective against the omicron variant of the virus and its subvariants.
Although the treatment initially reduced the risk of hospitalization by 89% in clinical trials, Webb said new data shows the treatment is just 45% to 55% effective in preventing hospitalization in the omicron era, and is as low as 20% to 30% in fully vaccinated people.
There is also what’s known as the “rebound effect,” where COVID-19 symptoms come back after finishing the treatment. Dr. Anthony Fauci, President Joe Biden’s top adviser on the pandemic, said he ended up testing positive for COVID-19 after three days of negative tests following the treatment, The New York Times reported.
Still, the 81-year-old Fauci said, “Paxlovid did what it was supposed to do,” by keeping him out of the hospital.
Webb said rebound cases are an “inconvenience” that happens rarely.
An employee at Jolley’s Pharmacy Redwood who asked not to be named said the treatment helped him get over COVID-19 quickly in April and he’d take it again. Other than experiencing a metallic taste in his mouth, the employee said he had no side effects.
“I had some essentially flu-like symptoms, some body aches and fever and planned on just treating it like the flu,” the employee said, until someone he’d been in contact with tested positive. After he did, too, the employee said he decided to track down the treatment, not yet available at the pharmacy where he worked.
“In my case,” he said, “it helped shorten the course and mitigate the symptoms.”