Boston—After reviewing the clinical evidence and doing a cost-benefit analysis, an independent nonprofit research institute found Paxlovid to be the best option for the treatment of COVID-19.

"The evidence on outpatient treatments for COVID-19 must be viewed as highly sensitive to the evolving landscape of COVID-19 variants and vaccination status in the US. As indicated by the votes from the independent appraisal committee, the current evidence was judged more persuasive for Paxlovid and fluvoxamine than for molnupiravir, but clinical trials are ongoing for all three treatments," explained Steven Pearson, MD, MSc, president of the Institute for Clinical and Economic Review (ICER).

"At their current negotiated price (molnupiravir and Paxlovid) or their generic market price (fluvoxamine), these drugs appear to have prices reasonably aligned with patient benefits," Dr. Pearson added. "One of the key lessons to be learned from the development of these drugs is that the federal government's advance market commitment mechanism was effective in reducing the financial uncertainty that could have deterred manufacturers from bringing a drug to market, and ultimately resulted in multiple drugs becoming available in a relatively short time at prices that were aligned with clinical benefit. That experience has many lessons for the future of U.S. policy in preparing for future pandemics."

ICER's Midwest Comparative Effectiveness Public Advisory Council evaluated the long-term value of the therapies, finding that all three treatments had prices that fell below the level of ICER's health benefit price benchmarks derived from cost-effectiveness modeling.

"Due to uncertainty in the net health benefit for molnupiravir, a majority of panelists voted that it represents 'low-to-intermediate' long-term value for money," according to an ICER report. "A majority of panelists found that Paxlovid represents 'high' long-term value for money. A majority of panelists found that fluvoxamine represents 'intermediate-to-high' long-term value for money."

The ICER produces reports analyzing the evidence on the effectiveness and value of drugs and other medical services, including evidence-based calculations of prices for new drugs that accurately reflect the degree of improvement expected in long-term patient outcomes. The group also takes into account price levels that might contribute to unaffordable short-term cost growth for the overall healthcare system.

Meanwhile, the Biden Administration is vowing to increase access to COVID-19 antivirals by allowing pharmacies to get free supply directly from the federal government.

"One of the most effective available treatments is Pfizer's oral antiviral pill, Paxlovid, which has been shown to reduce the risk of hospitalization or death by about 90 percent," according to a White House fact sheet. "The U.S. has committed to purchase 20 million treatment courses—more than any other country in the world. Although Paxlovid was initially in short supply after Food and Drug Administration (FDA) authorization, the administration has worked with Pfizer to accelerate the delivery of these pills, and they are now in ample supply."

The drugs have been underused, although, earlier this month, Pfizer CEO Albert Bourla reported in an earnings call that nearly 80,000 patients were treated with Paxlovid in the U.S. toward the end of April. That was up from about 8,000 patients in late February.

In addition, Mr. Bourla said that more than 33,000 U.S. sites now have supply of Paxlovid, a fourfold increase compared with February.

The Biden Administration also stated that the use of the oral antivirals doubled over several weeks in April and May. The White House announced new actions to make these treatments even easier to access and to make sure healthcare providers and patients know about their safety, efficacy, and availability.

Assuming Congress provides the funding, President Joe Biden seeks to double the number of locations in the near future. "Right now, oral antivirals are available in about 20,000 locations across the country—including pharmacies, community health centers, hospitals, urgent care centers, and Veterans Affairs clinics, and Department of Defense Medical Treatment Facilities," according to the fact sheet. "Now that the United States has ample supply of these treatments, the administration is making it easier for pharmacies to order antivirals from the federal government. Starting this week, the administration will allow all pharmacy partners in the federal antiviral pharmacy program—tens of thousands of pharmacy locations nationwide—to order free oral antiviral treatments directly from the federal government."

The press release points out that pharmacies will also continue to be able to receive treatments from state and territorial health departments and through the Test-to-Treat initiative.

"For many Americans, pharmacies are the most common and convenient place to pick up their prescriptions and receive other forms of health care," the White House stated. "Opening ordering to all of these pharmacies will dramatically expand the number of local pharmacies with oral antivirals in stock for patients in their community."

It added that the Department of Health and Human Services will partner with pharmacies to increase availability to up to 40,000 sites over the coming weeks.

The White House also announced more Test-to-Treat facilities, building on the 2,200 current locations that are mostly in pharmacies with clinics.

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