In B.C., it's tougher to access COVID antiviral Paxlovid than in the rest of Canada, doctor says

Series of drugs have to be taken within 5 days of infection to reduce severe illness and hospitalizations

Image | Pfizer Paxlovid Covid Pill

Caption: Pfizer Paxlovid oral Covid-19 antiviral therapeutic treatment. See box and tablets on table on 21 Feb 2021. Traitement thérapeutique antiviral oral Covid-19 de Pfizer Paxlovid. (Cory Herperger/CBC/Radio-Canada)

A family doctor is asking B.C. to reduce the barriers to Paxlovid, an antiviral drug that reduces the severity of illness for those most at risk from COVID-19.
Research has shown that Paxlovid — a drug that must be taken within five days of the onset of infection — is effective at preventing hospitalizations and deaths, even against the newer Omicron variants.
In B.C., the treatment has to be prescribed by a family doctor, nurse practitioner, or specialist and then obtained from "select" community pharmacies across the province.
But the criteria for eligibility are narrow. Paxlovid isn't largely available to those under 50 in B.C., except if you're immunocompromised or clinically extremely vulnerable.

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"I want to give more Paxlovid away," said Dr. Susan Kuo, a family physician in Richmond, B.C., who said she has prescribed the drug dozens of times as COVID infections increased. "As a family doctor, I feel that I am being really restricted.
"If you take a look across the country, we are actually the most restrictive in terms of who can get Paxlovid."
Kuo says that the criteria requiring a fully vaccinated person to have three or more conditions, along with a general lack of education about the benefits of Paxlovid, has led to poor uptake in B.C.

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Data obtained last month by CBC News showed that the province had dispensed just over 12,000 doses out of a supply of 73,533 — a rate of 16.5 per cent as of Sept. 22.
"[Long-term care residents] are still getting COVID cases, even though the patients have all had three or four doses of vaccine," Kuo said.
"We would be seeing a lot more deaths without Paxlovid."

'Barriers in access'

Lyne Filiatrault, a retired ER doctor and member of Protect Our Province B.C., says B.C.'s criteria would lead to "barriers in access" to COVID mitigation tools, and residents would not go through the hoops if access to antivirals continues to be restricted.
She says that B.C. has generally been reluctant to provide easy access to COVID mitigation tools throughout the pandemic, such as rapid tests, which were only made available well after other provinces, or vaccines, which generally require invitations to book.
"Given our hospital capacity is so poor, we should be looking at everything we can do to limit the need for hospitalization," she said. "We should be looking to limit severe infections."
In addition to the eligibility criteria, Filiatrault also noted that almost a million British Columbians don't have access to a primary care provider, which could lead to prescriptions arriving too late for Paxlovid to be effective. 
The province says anyone trying to get Paxlovid without a family doctor should go through Service B.C. to receive a prescription, which is valid across Canada.

May interact with other drugs

In a statement, a spokesperson for B.C.'s Health Ministry said they weren't "aware of any issues with patients obtaining appropriate access" to Paxlovid.
"The Ministry, at the advice of the B.C. COVID-19 Therapeutics Committee and health authority partners, continues to review evidence and data for Paxlovid, assess the need and consider additional measures to improve access to this drug," the spokesperson said.
Provincial Health Officer Dr. Bonnie Henry has said that only around 50 per cent of those trying to access Paxlovid actually get it. 
She said that's largely because the drug can negatively interact with other medications, such as those used for kidney disease, which can cause complications.

Image | BC COVID UPDATE OCT 5 2021


"There is no issue of supply. It is available across the board, across the province for people as they need it," she said on Sept. 28.
With supply not a factor, Filiatrault and Kuo said eligibility requirements should be lowered in B.C. — pointing to nearby Washington state, which has a "Test to Treat" program to access prescriptions.
The state allows those over 18 "at high risk for progressing to severe COVID-19" to receive the drug.

Should pharmacists be able to prescribe?

Another way that other jurisdictions are easing Paxlovid access is by allowing pharmacists to prescribe the drug.
When asked whether new prescribing powers for pharmacists in B.C. would include Paxlovid, the ministry spokesperson said no.
"The Ministry is committed to optimizing the scopes of practice of existing regulated health professionals to enable efficient and effective use of resources," they said.
While Filiatrault says pharmacists should be able to prescribe Paxlovid across Canada, Kuo is more skeptical — saying that if pharmacists don't know a patient's medical history, it could lead to a fatal drug interaction.
Kuo says that another way to ease access is to help doctors who may want to prescribe it but don't have as much awareness of how the antiviral works.
"If you're not someone that does a lot of elder care, you might not have that much experience," she said. "Once you've done it a few times, you get the hang of it."