Concerns are growing in Alberta about the accessibility and affordability of Paxlovid, after the federal government ended its program supplying the COVID-19 treatment to provinces, which provided the drug for free to specific groups of high-risk patients.
Paxlovid is an anti-viral medication used to treat mild to moderate COVID-19 in people at high risk of severe illness. It should be taken within five days of symptom onset.
Prior to the change, Alberta pharmacies paid a small fee to stock the drug. Now they’re required to pay the full cost upfront.
One treatment course costs approximately $1,400, according to Randy Howden, president of the Alberta Pharmacists’ Association.
“So it is quite a large cost to keep in stock,” said Howden.
“I think that there’s probably been a decrease in the number of pharmacies keeping the product in stock.… So it’s probably harder to access in those cases.”
According to Howden, Paxlovid can’t be returned to the warehouse for a credit if it isn’t dispensed before it expires.
“That might be scaring some pharmacies away as well.”
He said demand has decreased and most pharmacies can order Paxlovid and have it delivered the next business day, which is also an option if no other stores in the area have it in stock.
At Calgary’s Sage Plus Clinical Pharmacy, manager Joyce Choi said she can’t afford to have it on hand.
“That’s $1,400 that’s on my shelf that may or may not be sold,” said Choi.
“It’s a lot of financial burden for a small business.…. For me to keep a product that may or may not be sold for a very restricted population, it’s difficult to ask.”
In a recent update to its members, the Alberta College of Pharmacy said it’s aware of multiple reports of patients having problems obtaining Paxlovid.
“If Paxlovid is not stocked, teams should research an alternate source to which patients can be reliably referred for quick access,” the website reads, noting patients often show up with a prescription near the end of the five-day window.
“Remember, in many of these cases, time may be of the essence.”
The college told CBC News it has heard directly from two patients with concerns about the cost of the drug, or access to it, since the federal program ended.
Pharmacist Heba ElBayoumi said she’s received a number of recent inquiries from patients trying to track down Paxlovid.
“I’ve had a lot of phone calls over the last month, people just asking if I carry it or not,” said ElBayoumi, owner of Heathers Pharmacy in northwest Calgary.
She decided to stock Paxlovid despite the hefty price tag.
“It’s becoming, obviously, an issue for people to access a product like that on short notice,” said ElBayoumi.
“Timing is critical.”
According to Dr. Lynora Saxinger, University of Alberta infectious diseases specialist, Paxlovid can still be beneficial for some high-risk groups.
But, she noted, patients must go through a number of steps, including identifying symptoms, testing, getting a prescription and finding a pharmacy that can fill it, before they can even start the treatment.
“It does make it a little bit more difficult, administratively, for sure,” she said.
“It’s really much, much better to get it within the first two [or] three days of symptoms. So you test early in the symptoms. And within the first five days, for sure, is where you get the most benefit.”
Eligibility and cost
Alberta has also narrowed the list of who is eligible for Paxlovid.
It is now limited to Albertans, 18 and up, who are moderately to severely immunocompromised, including patients undergoing cancer treatment, organ transplant recipients and people on immunosuppressing drugs.
According to Alberta Health the latest eligibility criteria is based on recent recommendations by Canada’s Drug Agency.
The province now covers the cost of Paxlovid for people who have a government-sponsored drug plan, including seniors, if they are diagnosed with a positive COVID-19 test, are within five days of symptom onset and fall within the eligibility criteria.
There is a $25 fee for those patients.
Others may qualify for coverage through private insurance, if it’s included in their policy.
And those without any coverage can choose to pay out-of-pocket for the drug, if it’s prescribed, said an Alberta Health spokesperson.
ElBayoumi is worried some of those patients may not be able to afford it.
Even if private insurance covers Paxlovid, she said, co-payments can add up to hundreds of dollars.
“I see a lot of patients potentially not having accessibility due to financial burden,” she said.
“[They could end] up in the hospital, which obviously accumulates further financial burdens on the province.”
Meanwhile, Dr. Daniel Gregson is concerned there is confusion among patients and physicians about who is eligible because the rules vary from province to province.
“If you have a friend in Ontario who is 65 and has COVID, they are eligible for Paxlovid. You yourself, here in the province of Alberta, unless you have specific medical conditions, would not be,” said Gregson, a Calgary-based infectious diseases physician.
“There would be very few people eligible for Paxlovid with the current criteria in the province of Alberta.”
And, according to Gregson, the availability of the drug appears patchy.
An Alberta Blue Cross pharmacy inventory map listed 19 locations each in Edmonton and Calgary, two in Red Deer, five in Lethbridge and none in Fort McMurray stocking Paxlovid as of Thursday, for example.
Some of the pharmacies on the list did not have any in stock when contacted by CBC News.
“It would be worthwhile for the government to ensure there is some reasonable access throughout the province,” said Gregson.