Medicare beneficiaries at high risk for severe COVID-19 received less treatment. A new study examines why

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A recently published study in the JAMA Health Forum of a cross-section of patients enrolled in Medicare in 2022, found that those at the highest risk for severe COVID-19 infection received COVID-19 therapy less often than those with the least risk.

“We went into the study to find out why adoption of an effective COVID-19 treatment for high-risk individuals in the U.S. was so low,” says senior study author Michael L. Barnett, M.D., Associate Professor, Health Policy and Management, Harvard T. H. Chan School of Public Health. “Our first task was to identify the people who were using it.”

“When we looked at different COVID-19 risk factors, the people at highest risk should be getting treated anywhere from five to 10 times the rate of those with lower risk factors,” says senior study author Dr. Michael L. Barnett, associate professor, health policy and management, Harvard T. H. Chan School of Public Health. “But our findings showed the opposite.”

Free treatment for those at high risk for COVID-19

Barnett and the research team were surprised by the results. “We have a free, safe, outpatient treatment for COVID-19 that is very effective for people at risk for severe COVID-19 infection, and it’s substantially underused in the U.S.” That medication is an oral antibiotic, Nirmatrelvir, which goes by the brand name Paxlovid.

The study found that if the high-risk patients in their sample had received Paxlovid, 16% of COVID-19 deaths in their study would have been prevented, says Barnett.

The findings also showed that some high-risk Medicare beneficiaries were less likely to get treatment than other patients, based on race, age, and income. Black patients were substantially less likely to get treatment than white patients (3% vs. 6.4%), as were patients over 90 and Medicaid-eligible patients.

Education may increase the adoption of treatment

Barnett and his team believe that education is the key to helping COVID-19 patients at high risk.

“There needs to be a broader public awareness campaign,” says Barnett. “There’s a vastly disproportionate burden on older people with chronic conditions, and many are not aware of medication options.”

Another potential concern, says Barnett, is that patients may shy away from this drug due to a long list of other medications with drug interactions. Doctors may also hesitate to prescribe it for the same reason.

“We haven’t done a very good job educating primary care providers and physicians about just how frequently and under what circumstances we really should be using this medication,” says Barnett.

Most of the drug interactions can be managed, he says. “For a week or two, many of the drugs can be easily skipped, to allow for the benefits of Paxlovid.” One example is cholesterol-reducing drugs (statins). Skipping this medication for a week or two, says Barnett, would be worth the COVID-fighting benefits of Paxlovid.

However, other medications would provide a greater risk if they were stopped, such as blood thinners. “Most patients on blood thinners can just lower their doses on Paxlovid. But some people on blood thinners may not be good candidates for Paxlovid,” says Barnett.

In addition, says Barnett, patients need to be educated on when Paxlovid is helpful. “Patients need to act on COVID-19 symptoms within five days to benefit from Paxlovid.”

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