Paxlovid is expensive for Alberta pharmacies to stock and harder for patients to find

In Alberta, concerns are growing about the accessibility and affordability of Paxlovid after the federal government halted its program to provide the COVID-19 treatment to provinces. Provinces had been providing the drug free to specific groups of high-risk patients.

Paxlovid is an antiviral 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 the onset of symptoms.

Before the change, Alberta pharmacies paid a small fee to stock the drug. Now they must pay the full cost up front.

According to Randy Howden, president of the Alberta Pharmacists’ Association, one course of treatment costs about $1,400.

“So it’s quite expensive to hold inventory,” Howden said.

“I think the number of pharmacies that have the product in stock has probably decreased. … So it’s probably more difficult to get access to it in those cases.”

According to Howden, Paxlovid cannot be returned to the warehouse for a credit note if it is not issued within the expiration date.

“That could also deter some pharmacies.”

He said demand has dropped and most pharmacies can order Paxlovid and have it delivered the next business day. That’s also an option if no other store in the area has the drug in stock.

At Sage Plus Clinical Pharmacy in Calgary, manager Joyce Choi says she can’t afford to keep it in stock all the time.

“That’s $1,400 sitting on my shelf that may or may not sell,” Choi said.

“It’s a big financial burden for a small business.… For me, it’s hard to ask if I can keep a product that may or may not sell to a very limited group.”

In a recent update to its membersThe Alberta College of Pharmacy says it is aware of several reports of patients having difficulty obtaining Paxlovid.

“If Paxlovid is out of stock, teams must identify an alternative source where patients can be reliably referred for rapid access,” the website states, adding that patients often present with a prescription at the end of the five-day window.

“Remember that in many of these cases time may be of the essence.”

The university told CBC News it had heard directly from two patients who had concerns about the cost of the drug, or access to it, since the federal program ended.

Pharmacist Heba ElBayoumi said she has received a number of questions lately from patients trying to find Paxlovid.

“I’ve had a lot of calls over the past month from people wanting to know whether or not I have the medication,” said ElBayoumi, owner of Heathers Pharmacy in northwest Calgary.

She decided to include Paxlovid in her range, despite the high price tag.

“It is becoming increasingly difficult for people to access such a product in the short term,” said ElBayoumi.

“Timing is crucial.”

According to Dr. Lynora Saxinger, an infectious disease specialist at the University of Alberta, Paxlovid may still be useful for some at-risk groups.

But, she noted, patients must go through a number of steps, including identifying symptoms, getting tested, getting a prescription and finding a pharmacy that can fill the prescription, before they can even begin treatment.

“It definitely makes it a little more difficult administratively,” she said.

“It’s really much, much better to get it within the top two [or] three days of symptoms. So you test early in the symptoms. And within the first five days, that’s certainly where you get the most benefit.”

Admission requirements and costs

Alberta also has the list of who is eligible for paxlovid.

It is now limited to Albertans 18 and older who have moderately to severely compromised immune systems, including patients undergoing cancer treatment, organ transplant recipients and people taking immunosuppressive medications.

According to Alberta Health, the latest eligibility criteria are based on recent recommendations from the Canadian Drug Agency.

The province is now covering the cost of Paxlovid for people on a government-sponsored drug plan, including seniors, if they test positive for COVID-19, develop symptoms within five days of symptom onset, and meet eligibility criteria.

A fee of $25 applies to these patients.

Others may be eligible for coverage through private insurance, if it is included in their policy.

People without any insurance can choose to pay the cost of the drug themselves if it is prescribed, an Alberta Health spokesperson said.

ElBayoumi fears that some patients cannot afford it.

Even if Paxlovid is covered by private insurance, co-pays can run into the hundreds of dollars, she said.

“I see that many patients do not have access to care due to financial problems,” she said.

“[They could end] “He is admitted to hospital, which of course means a further financial burden for the province.”

Meanwhile, Dr. Daniel Gregson is concerned that there is confusion among patients and doctors about who qualifies, as rules vary by province.

“If you have a friend in Ontario who is 65 and has COVID, they would be eligible for Paxlovid. You, here in the province of Alberta, would not be unless you have specific medical conditions,” said Gregson, a Calgary-based infectious disease physician.

“Under the current criteria in the province of Alberta, very few people would be eligible for Paxlovid.”

According to Gregson, the drug’s availability varies.

An Alberta Blue Cross pharmacy inventory card For example, there were 19 locations listed as of Thursday in Edmonton and Calgary, two in Red Deer, five in Lethbridge and none in Fort McMurray where Paxlovid was sold.

Some pharmacies on the list were out of stock when CBC News contacted them.

“It would be helpful if the government could ensure that there was reasonable access across the province,” Gregson said.