To keep COVID at bay, lift treatment barriers

With COVID-19 cases on the rise once again in Virginia, it is crucial that residents can quickly access critical treatments they need in order to stay healthy. COVID-19 antiviral therapies are an essential step in alleviating symptoms and lowering the risk of hospitalization or death, yet Virginians continue to face financial barriers when seeking such treatments. To reduce health care barriers that patients continue to confront, the Centers for Medicare and Medicaid Services (CMS) released new guidance urging health insurers to ensure COVID antiviral treatments are available and affordable for patients.

However, without action from Virginia lawmakers, COVID-19 antiviral treatments may remain out of reach for patients in need, leaving residents vulnerable to severe COVID complications this winter.

The Centers for Disease Control and Prevention has already warned about the rise of a "triple-demic," or a collision of rising RSV, flu and COVID cases that's likely to overwhelm our local emergency rooms. Improving access to effective treatments can help mitigate this risk. In just a six-month period, COVID-19 treatments can decrease the risk of hospitalization by 24% and the risk of death by 47%. Additionally, the risk of hospitalization or death was 81% lower for unvaccinated patients who took the antiviral treatment.

While treatments are available for Virginians at their doctor's office and local pharmacy, it is critical to ensure that patients can access and afford them in a timely manner.

Antiviral treatments must be administered within five days of symptom onset to maintain full efficacy, meaning every minute counts when treating COVID-19. Patients don't have time to wait and first determine if they can afford a treatment.

In order to ensure patients can stay healthy, slow the spread of this illness and help keep emergency rooms from overcrowding, Virginia lawmakers must follow CMS guidance and urge health insurance plans to keep any copayments required for patients to access antiviral therapies low. Health insurance plans must include such treatments on a preferred or $0 cost-sharing tier, which helps ensure that any copayments Virginians may be required to pay to access antiviral treatments are low.

If Virginians are met with high out-of-pocket costs that they can't afford and choose to forgo an antiviral treatment, patients will be more likely to contract severe symptoms, potentially leading to increased emergency room visits and stress on local hospitals while also escalating the chances of a major COVID-19 outbreak in the commonwealth. We know that high out-of-pocket costs have an outsized impact on patients being able to take medications they need, with more than 2 out of every 3 Americans abandoning their prescriptions when their out-of-pocket costs reach $250.

Doctors' offices and hospitals continue to be strained by cases of severe respiratory illnesses. It's more critical than ever that patients can access necessary treatments as soon as they need them. In addition, last year the Virginia General Assembly passed legislation that empowers local pharmacists to test and treat their patients for the flu, COVID-19, strep throat and more. This legislation went into effect this year but won't realize its full potential if patients are not able to afford COVID tests, treatments and therapeutics because of insurance and cost barriers.

To continue empowering community pharmacists, Congress should enact bipartisan federal legislation to ensure seniors maintain access to pharmacist services that protect them from COVID-19, flu, RSV and other infectious diseases through the Equitable Community Access to Pharmacist Services Act. There's more work to be done to improve equitable patient access to preventative health care in Virginia. However, by following clear CMS recommendations, continuing to empower pharmacists, and ensuring that health insurance plans alleviate cost-sharing burdens that put effective COVID antivirals out of reach for Virginians, lawmakers can ensure Virginians can access critical treatments when they need them.

As Virginians continue to confront COVID-19 and other public health challenges, we should be taking steps to improve access to timely and effective care, not putting up additional hurdles. Virginia lawmakers must adhere to CMS guidelines and support the removal of affordability barriers to ensure access to critical COVID-19 antiviral treatments and guarantee the safety of all Virginians.

Jamie Fisher is executive director of the Virginia Pharmacy Association. Contact Fisher at jfisher@virginiapharmacists.org.