In Boca Raton, Dr. Steven Reznick’s senior patients call to report positive COVID test results and want Paxlovid prescriptions. Then, they call back to tell him they can’t find the medication.
COVID is on the rebound in Florida as new variants spread, but pharmacies aren’t stocking antivirals like they did during the pandemic. Those who want Paxlovid for COVID may have to call dozens of local pharmacies to find it in stock.
“We call pharmacies to try to get it for our patients and they don’t have it,” said Reznick, a geriatric internal medicine doctor. “Everyone blames it on someone else. For some of our patients, the antivirals are the best way to ensure they don’t end up in the hospital in respiratory distress.”
Doctors often prescribe Pfizer-made Paxlovid to treat moderate to severe COVID cases, particularly in people who are older or immuno-compromised. Research has found the medication is extremely effective at shortening the severity and duration of the virus when taken within five days of the onset of symptoms.
In November 2023, Paxlovid transitioned from government-managed distribution to commercial distribution. The federal government required pharmacies to dispose of or return packages labeled “emergency use.” Pharmacists nationwide say the medication that previously arrived in cratefuls is now trickling in by one or two packages at a time. Wholesalers are unable to supply independent pharmacies, and chain pharmacies cannot keep up with current demand.
New versions of the coronavirus, nicknamed “FliRT” variants, are circulating in the United States, and Florida sewage tracking shows a surge in virus levels in the last three weeks. WastewaterSCAN, a project from Emory and Stanford universities, analyzes samples from 13 sites in the state, including four in South Florida and four in Central Florida.
Dr. Zynab Hassan, medical director at Holy Cross Urgent Care in Fort Lauderdale, said she has seen a rise in COVID cases since school let out for the summer. On Sunday of the holiday weekend, Hassan said about 30% of patients tested positive for the virus. “Some people are surprised because they are getting it for the first time,” she said, adding that the spread appears to be travel-related.
A half-dozen pharmacists at Walgreens, CVS and Publix locations in Broward and Palm Beach counties told the South Florida Sun Sentinel they had no Paxlovid in stock, or only one box left. Several Publix locations said they just sold their last box in stock. Some locations offered to order Paxlovid, but said the medication could take two days to arrive, a risky option when the medication is most effective when taken within the first five days of symptoms. At Tamarac Pharmacy in West Broward, a pharmacy manager said her wholesaler is out of stock and she is unable to order any supply. In other parts of the U.S., pharmacies also are reporting shortages.
Paxlovid manufacturer Pfizer did not respond to a request for comment on the shortages and distribution.
Along with being difficult to find, Paxlovid can be costly. Without the government’s free distribution program, Pfizer has set the price for a five-day treatment of Paxlovid at $1,390. With insurance, the price varies based on an individual’s plan. All patients on Medicare or Medicaid can get free Paxlovid through the end of 2024.
“Some of our patients are asking for Paxlovid, and as long as there are no contraindications we prescribe it,” Hassan said. “It can be expensive though. Some insurances don’t cover it.”
The less commonly used COVID-19 treatment Lagevrio, manufactured by Merck and approved for emergency use, also must be taken within five days of the onset of symptoms. Known as monulpiravir, the antiviral medication has fewer drug interactions than Paxlovid and costs about $800, but it is even more difficult to find in South Florida pharmacies.
“We give that to patients who cannot take Paxlovid because they are on blood thinners, or have kidney failure, or have an interaction with some other medication,” Hassan said. “It has some protection, but not as much as Paxlovid and is harder to get.”
The government offers a nationwide COVID-19 medication locator, but the site lists pharmacies that may sell Paxlovid without indicating whether it is in stock at those sites. CVS spokeswoman Amy Thibault said, “We have been able to fill Paxlovid prescriptions across our pharmacies. If there are shortages, we work with our suppliers to replenish supply as quickly as we can.”
Hassan said patients with COVID at her urgent care mostly have symptoms such as cough, congestion and fatigue, which she tries to manage with cold medications. “The COVID variants now might be more infectious, but they are not lasting as long, usually about five days, and we treat it like a common cold,” she said.
Reznick said many people who equate COVID with a common cold believe they don’t need to test for the virus. “Seniors, though, need to test,” he said. “They need to call their doctor and discuss whether or not to go on an antiviral.”
With the Paxlovid shortage, Reznick says he now relies on his patients for updates.
“Our patients eventually find Paxlovid, and we ask them to let us know where and how many doses the pharmacy has so when our next patient is COVID-positive, we know where to direct them,” he said.
South Florida Sun Sentinel health reporter Cindy Goodman can be reached at cgoodman@sunsentinel.com.