Should You Take Paxlovid?

Most adults in the United States have one condition or another that makes them a candidate for Paxlovid, which can cut the risk of a severe case of Covid. Obesity, diabetes, depression, heart conditions and dozens of other issues all put people at high risk, according to the Centers for Disease Control and Prevention.

And yet Dr. Davey Smith, an infectious disease specialist at the University of California, San Diego, regularly gets calls from patients who were not able to get prescriptions, often because urgent care or primary care doctors denied their requests.

More than two years after Paxlovid became widely available in the United States, and in the middle of yet another summer surge, patients and doctors are still frequently confused about who qualifies for the medication and exactly how beneficial it might be.

It’s well-established that Paxlovid saves lives. But it can be costly, and it can interact with a lengthy list of medications. Some people avoid the drug, in part because they worry about experiencing a rebound case. One study found that only about 15 percent of people who were eligible for the medication took it when they had Covid.

“In my experience, it’s usually that the provider doesn’t have enough experience with it or enough time to want to go through somebody’s medication list,” Dr. Smith said. “So they just get told, ‘Oh, you’re going to be fine.’ And most of the time, they are fine. It’s just when they’re not, it can be really bad.”

Who should take Paxlovid?

Paxlovid is designed to prevent Covid from progressing into more severe disease. It is for people who have mild or moderate symptoms but are at risk of getting very sick. (Doctors can prescribe the drug to adults and children 12 and older who weigh over 88 pounds.)

The greater your risk for hospitalization or death from Covid, the stronger your case for taking Paxlovid.

“If you’re like an 80-year-old out there who finds himself or herself coughing with fever and test, and it’s positive for Covid-19, I would immediately call my provider and ask for Paxlovid,” said Dr. Ziyad Al-Aly, the chief of research and development at Veterans Affairs St. Louis Healthcare System.

People who are 65 or older, are immunocompromised or have chronic conditions like cancer, diabetes and obesity are considered among those at highest risk, and should consider the medication even if they don’t have symptoms, said Dr. Amesh Adalja, an infectious disease physician and senior scholar at the Johns Hopkins Center for Health Security.

“Sometimes primary care physicians will tell their patients, ‘You look really good, so I’m not going to give you Paxlovid,’” he said. “That’s the point. You want to keep them looking good.”

Pregnant women are also at higher risk for serious illness. The C.D.C. has said that doctors do not need to withhold Covid treatments like Paxlovid from pregnant and breastfeeding women out of “theoretical safety concerns.”

The calculus is less clear for some people who technically qualify as high-risk, but may not get as much of a benefit from the medication. Someone who is young and otherwise healthy but has attention deficit hyperactivity disorder, depression or other mood disorders may fare well without the medication, for example.

“That C.D.C. list is quite expansive, and there’s not great data showing that everybody on that list would benefit from the drug,” Dr. Smith said. “But at the same time, that’s the best list we have.” Anyone who is eligible for the medication should speak with a doctor about the drug, he said, which must be taken within the first five days of symptoms.

How effective is it?

A large clinical trial from 2022 showed that people who took Paxlovid had an 89 percent lower risk of hospitalization or death. More recent studies have backed up those benefits: a real-world study of the medication’s effectiveness found that people who took it had a 68 percent lower chance of hospitalization. (That study has not been published or peer-reviewed.)

What are the side effects?

The most common ones are an altered sense of taste and diarrhea. Some people experience headaches, nausea, high blood pressure, vomiting and stomach pain. In rare cases, Paxlovid can cause allergic reactions. Some people with kidney disease may be prescribed a lower dose of the medication, and people with severe kidney or liver disease should not take the drug.

Paxlovid interacts with certain medications, including some blood thinners, antidepressants and heart drugs. Some patients taking these drugs may not be eligible to take Paxlovid. Pfizer, which makes Paxlovid, recommends telling your health care provider about all the medicines, vitamins and supplements you take. The drug may also make hormonal birth control less effective; the Food and Drug Administration recommends using another form of birth control or a barrier method while taking Paxlovid.

What about rebound?

Your symptoms can come back after you recover from Covid, whether you took Paxlovid or not. While Pfizer researchers have estimated that just over 2 percent of people who take the drug experience rebound, outside estimates are closer to 14 percent. But the possibility of symptoms returning should not dissuade people from taking the medication, said Dr. Marc Sala, co-director of the Northwestern Medicine Comprehensive Covid-19 Center in Chicago.

Does Paxlovid protect against long Covid?

Some scientists have theorized that because Paxlovid prevents the virus from replicating in the body, it may also reduce the risk that a patient will develop long Covid. Early trials testing this idea appeared to show a protective benefit, but there is no clear answer yet. Some studies have found that the medication does not have an impact on whether someone has prolonged Covid symptoms. But that research is “definitely not settled,” Dr. Smith said. “What I can tell you is that it definitely doesn’t increase the risk of long Covid.”

How much does it cost?

Paxlovid has a list price of around $1,400, but most patients should be able to get it for far less. Many insurance companies fully or partly cover the drug. People should check to see if the drug is available at an in-network pharmacy, said Cynthia Cox, a vice president at the health policy nonprofit KFF. If you cannot find Paxlovid in-network, she suggested appealing to your insurer for out-of-network coverage and stressing the time sensitivity for the prescription.

Pfizer also offers a co-pay savings program and rebates to help eligible people with private insurance get reimbursed for out-of-pocket costs, as well as a patient assistance program that gives people who are uninsured or covered by Medicare or Medicaid a voucher for free Paxlovid.