Paxlovid—an oral COVID-19 pill—received full FDA approval on May 25 as a treatment for adults with COVID-19 who are at high risk for severe disease. The antiviral, which has so far been under emergency use authorization, earned endorsement from the FDA’s advisers in March.
But despite evidence of Paxlovid’s benefits, many people, including some health care providers, remain hesitant about the drug. “Not enough patients are aware of the importance of going on Paxlovid, and even among primary care physicians there seems to be some misunderstanding about how and when to administer it,” says Dr. Peter Hotez, professor and dean of the National School of Tropical Medicine at Baylor College of Medicine.
Here’s what you need to know about Paxlovid’s benefits and risks and how to access the COVID-19 treatment. This article is meant for informational purposes and does not substitute for professional medical advice or conversations with your health care provider.
Paxlovid prevents severe disease and may also lower the risk of long COVID
Data shows that Paxlovid reduces hospitalization and death by 58 percent in vaccinated, high-risk people and by 86 percent in unvaccinated, high-risk people. The drug has also been linked to preventing long COVID. Most recently, a study found that people who took Paxlovid shortly after testing positive had a 26 percent lower risk of experiencing long COVID symptoms compared to people who didn’t take the antiviral.
Paxlovid is currently authorized for people ages 12 and older who are diagnosed with mild to moderate COVID-19 and are at high risk for severe disease. It needs to be taken no later than five days after symptom onset for it to be effective. There are many factors that could qualify you as “high risk,” such as your age, weight, level of physical activity, mental health, and more. “Only if you’re really young and really healthy, then Paxlovid is not necessarily for you,” says Dr. Davey Smith, an infectious disease specialist at UC San Diego Health.
Paxlovid isn’t associated with COVID-19 rebound
One of the biggest misconceptions around Paxlovid is that it can lead to COVID-19 rebound. Some people who recover from COVID-19 experience a return of symptoms or test positive again a few days to a week later. Several high-profile people have experienced this rebound effect after taking Paxlovid, including President Joe Biden and Dr. Anthony Fauci.
But after looking at the data, the FDA concluded that COVID-19 rebound isn’t caused by Paxlovid and can occur among people who didn’t take the drug as well. In fact, rebound is likely part of the natural course of COVID-19 infection for some people and typically does not lead to worsening symptoms.
Although there’s still a lot of uncertainty around why and how often it happens, Hotez, who experienced rebound himself after taking Paxlovid, says he “wouldn’t hesitate to take it again,” given the protection the drug provides against severe disease for high-risk people.
Don’t rule out Paxlovid just because you’re on another medication
A recent survey found that health care providers are often hesitant to prescribe Paxlovid to older adults due to concerns around how it may interact with other prescription drugs that a patient is already taking. The National Institutes of Health provides a long list of medications that could interact with Paxlovid. While some drugs on the list should not be coadministered with Paxlovid under any circumstance, the majority can be paused, reduced, or monitored while a patient takes Paxlovid for the required five days.
“Paxlovid is only utilized for a short amount of time, so in certain patient populations, it’s absolutely possible to hold their immunosuppressant medications, and it won’t be life-threatening,” says Dr. Shikha Jain, a physician who treats cancer patients at University of Illinois Health. “I’ve done it before for my patients without negative repercussions.”
In one case, Jain paused a patient’s oral chemotherapy to put them on Paxlovid. In another, she delayed a patient’s routine intravenous chemotherapy appointment so that they could take Paxlovid and recover from COVID-19. Jain says there have been dozens more cases in which she helped patients get on Paxlovid, despite their current medications.
Don’t automatically rule out Paxlovid just because you’re on another prescription drug. Consult the NIH’s guidance on Paxlovid’s drug-drug interactions with your health care provider and discuss the best way forward. If you are at high risk for severe disease from COVID-19, it’s likely that pausing a current medication is worth receiving the benefits of Paxlovid.
Paxlovid is currently free for everybody
Misconceptions around how much Paxlovid costs may also stop people from seeking it. “Especially people who don’t have insurance or who aren’t used to receiving good care in general definitely aren’t asking for Paxlovid,” Smith says.
Paxlovid is currently free for everybody, even if you’re uninsured, because the federal government purchased a stockpile of the antiviral. Once this stockpile runs out, the cost of the drug will likely fall on insurers or patients themselves.
However, even though Paxlovid itself is free right now, some patients—especially those who are uninsured—may face out-of-pocket fees when they go in for a health care consultation to receive a prescription. To lower costs, people with health insurance should seek care in-network when possible. For people without insurance, some test-to-treat sites are federally qualified health centers that can provide free or low-cost COVID-19 care and prescribe you with Paxlovid.
Equip yourself with accurate information and talk to your doctor
In many ways, Paxlovid has been inconvenient to access or prescribe, Hotez says. On the patient side, Paxlovid’s use has been limited by inequitable access, as well as concerns around COVID-19 rebound and the pill’s “metallic” aftertaste. On the provider side, the potential for drug interactions has sometimes complicated the decision to prescribe Paxlovid. It also doesn’t help that there hasn’t been much education around Paxlovid for health care providers, Jain says.
In the unfortunate situation where even health care providers lack information, patients may need to advocate for themselves in order to get the care they deserve. This starts with being as informed as possible when you meet with your physician. “It’s important to evaluate the risks and benefits and have an honest discussion about your desire to get the drug,” Jain says. She recommends bringing this information sheet on Paxlovid eligibility and effectiveness to the doctor’s office in case your health care provider is not fully or accurately informed about the drug.
Paxlovid is one of the few COVID-19 treatment options that still work against Omicron strains. Although the antiviral is safe, effective, and especially important for people at high risk for severe disease, Smith says we shouldn’t stop pursuing “stronger and better” treatment options. “Everyone’s tired of COVID-19, but it’s not like COVID-19 is tired of us,” he says. “We need to make sure we have agents to fight it.”