Here's What You Need To Know About COVID-19 Treatment Pills

Key takeaways:

• In December 2021, the FDA granted emergency use authorization (EUA) to two new antiviral pills to treat mild to moderate COVID-19 in people at high risk of developing severe illness. The pills are called Paxlovid (nirmatrelvir and ritonavir) and molnupiravir.
• The antiviral pills represent an advance over current antiviral therapy because they are cheaper, more convenient, and less invasive than intravenous (IV) therapy with monoclonal antibodies. But use is highly restricted, and you need to start taking the pills early in the diagnosis to get the benefit of a lower risk of hospitalization and death.
• The COVID-19 pills are in short supply. Eligible patients can receive the treatment free of charge during the public health emergency.

When the FDA authorized two different antiviral pills to treat mild to moderate COVID-19, it brought hope for people at high risk of severe illness from the virus. The oral medications promised something that had been missing from COVID treatment: a user-friendly way of intervening early in the diagnosis to potentially change the course of the disease.

Right now, the pills can’t be prescribed for everyone who tests positive for COVID-19. They also aren’t a substitute for free COVID-19 vaccines. But some COVID-positive people with weakened immune systems or other risk factors for severe outcomes may want to ask their healthcare providers if they are candidates for either antiviral pill.

Similar to at-home COVID rapid tests, supply shortages are stalking the antiviral pills just as the Omicron surge fans out across the U.S. Eligible patients can receive the treatment free of charge during the public health emergency.

Below, we answer questions about Paxlovid and molnupiravir and show you where you may find antiviral pills at pharmacies near you.

Patients eligible for the antiviral pills can check availability at a pharmacy near you with the GoodRx COVID Antiviral Treatment Locator.

Antiviral pills for COVID-19

What is Paxlovid?

In late December 2021, the FDA granted emergency use authorization (EUA) to Pfizer’s Paxlovid (nirmatrelvir and ritonavir) after clinical trials showed it cut the risk of hospitalization and death for people at high risk of severe COVID-19 by nearly 90 percent.

Paxlovid is authorized for eligible adults and children age 12 and older who weigh at least 88 pounds. You would take 3 pills (2 nirmatrelvir pills and 1 ritonavir pill) by mouth twice a day for 5 days. You should start taking the pills within the first 5 days of feeling COVID-19 symptoms.
In studies, Paxlovid interacted with many common medications.

What is molnupiravir?

Molnupiravir is an oral antiviral pill from Merck and Ridgeback Biotherapeutics. Clinical trials showed it cut the risk of hospitalization and death by about 30 percent among high-risk adults in the earliest stages of COVID-19.

Like Paxlovid, it should be started within the first 5 days of feeling COVID-19 symptoms. You would take 4 capsules of molnupiravir by mouth every 12 hours for 5 days.

Unlike Paxlovid, molnupiravir is only authorized for adults age 18 and older. It’s not known to interact with any medications, but further studies are needed to confirm this.

Can I get Paxlovid or molnupiravir if I need it?

Supplies slowly increasing as millions of treatment courses on the way

Supplies of antiviral pills are scarce as manufacturers work to increase production. States with larger populations have received more treatment courses from the federal government than those with fewer residents. States also have different ways of distributing the antiviral pills. As the U.S. ramps up its roll out, you can check availability at pharmacies near you by using the GoodRx COVID-19 Antiviral Treatment Locator.

The U.S. expected to deliver 265,000 courses of Paxlovid in late December and January, rising to a total of 10 million courses by the end of summer, White House officials said in late December 2021. The federal government doubled its order in early January and now expects delivery of the first 10 million Paxlovid courses by the end of June.

Projections for molnupiravir are more encouraging in the near term. The U.S. expects 300,000 of the three million treatment courses it ordered to start coming online in late January. The Biden administration also said it would distribute Paxlovid to community health centers in all 50 states to reach some of the most vulnerable people.

What if I can’t get a test to confirm if I have COVID-19?

Handling dual shortages of COVID-19 tests and antivirals

Public health officials agree that at-home rapid tests are an important tool for controlling the spread of the virus. But shortages of the tests threaten to make antiviral pills a less realistic treatment option in the short term. Stores and pharmacies are having trouble keeping up with overwhelming demand for COVID at-home rapid tests. Detecting COVID-19 at its earliest stages is important for Paxlovid or molnupiravir to be effective.

Rapid antigen at-home tests have been shown to be less sensitive to COVID-19 in its earliest stages compared with PCR (polymerase chain reaction) tests, making at-home kits slightly less accurate. But appointments for PCR tests can be just as hard to find as at-home tests.

President Biden announced the U.S. will buy an additional 500 million COVID-19 tests to distribute to Americans, doubling the government’s order to 1 billion. But until supplies improve, high-risk people may find themselves in a difficult position. Ask your healthcare provider how to proceed if you suspect you have COVID-19.

How much do Paxlovid and molnupiravir cost?

COVID-19 antivirals to be free to patients during public health emergency

Paxlovid cost the U.S. government about $530 per course. Molnupiravir cost the U.S. about $700 per course. Both antiviral drugs are “available to the applicable patient population free of charge during the COVID-19 public health emergency,” a spokesperson from the Centers for Medicare & Medicaid Services (CMS) said in an email. It’s unclear how long coverage will last.

Are there any COVID-19 preventive options for people who can’t get vaccinated?

New option for people who can’t get the COVID-19 vaccine

Evusheld is a combination of two monoclonal antibody medications: tixagevimab and cilgavimab. The FDA granted EUA for Evusheld for COVID-19 pre-exposure prophylaxis — to prevent an infection if you’re exposed to the virus in the future — for certain people age 12 and older who weigh at least 88 pounds. It’s an alternative option for people who can’t get a COVID-19 vaccine because of a serious allergy or likely won’t respond well to the vaccine because of a weakened immune system. A healthcare provider would give you 2 injections of Evusheld as a single dose.

The U.S. government ordered another 500,000 doses of Evusheld, White House officials said. In addition to the 700,000 doses already ordered, that’s a total of 1.2 million doses soon to be available through the end of March. Eligible patients can receive Evusheld at no cost. You may need to ask your healthcare provider how to get it, as it may not be available at your local pharmacy.

The bottom line

Antiviral pills for eligible high-risk people with mild to moderate COVID-19 promise to turn a life-threatening disease into a manageable one if patients start treatment within the first 5 days of feeling symptoms.

The FDA granted EUA for the two medications — Paxlovid and molnupiravir — in late December 2021. But the agency restricted their use to only the most vulnerable people as demand for the pills overwhelms supply. Frustrated people also face a dearth of testing kits to help them get the answers they need about their COVID-19 status as the highly contagious Omicron variant surges across the nation.

As the U.S. ramps up its production of antivirals, you can check availability at a pharmacy near you with the GoodRx COVID Antiviral Treatment Locator.