The Biden administration on Tuesday announced a plan to increase the supply of Paxlovid, a Covid-19 antiviral made by Pfizer, throughout the United States. But many experts say supply of the drug isn't the problem—it's a lack of awareness and hesitance from the public.

The plan to increase Paxlovid supply

Currently, Paxlovid is available at roughly 20,000 pharmacies nationwide as part of the administration's "test-to-treat" program in which an individual diagnosed with Covid-19 at a pharmacy can immediately receive Paxlovid following their positive test.

How to improve access to Covid-19 treatments

According to a White House fact sheet, the administration is looking to double the number of pharmacies, community health centers, and hospitals where Paxlovid is available, and the administration will allow all pharmacies to order the antiviral directly from the federal government.

The administration will also increase federal support of test-to-treat sites and offer providers and patients more guidance about the treatment.

The use of oral antiviral pills increased 103% in the United States between March 27 and April 10, according to a White House official, and the Biden administration wants to increase that number, signaling to health care providers to err on the side of caution and prescribe the medication without worrying about supply.

Supply of Paxlovid isn't always the problem

However, there are a number of pharmacies in the United States with plenty of Paxlovid available, and experts say the public is often either unaware they qualify for the antiviral, hesitant to take it, or find it difficult to make an appointment to get it.

Adeolu Odewale, the owner of a pharmacy in Maryland, said he has only distributed Paxlovid to seven people so far. "I didn't expect that I was still going to be sitting on that many of [the pills]," he said. "It's just that people need to know how to get it."

Health experts have said navigating the test-to-treat program can be difficult. Dania Palanker, an assistant research professor at the Center on Health Insurance Reforms at Georgetown University, attempted to navigate the program and described a "maze" of attempting to find an appointment on CVS' website. Palanker said she worries those who need treatment might fall through the cracks of the complicated American health care system.

"You still have to have access to health coverage or be able to pay for a test upfront," she said.

Paxlovid is free to patients, but those who are uninsured or have high deductible health plans can still get hit with high consultation charges, the New York Times reports.

Amanda Fuller Moore, a pharmacist in North Carolina's Department of Health and Human Services, said uninsured people in her state were worried about the cost of seeking out a test or prescription, "especially in a setting where it can [be] difficult to figure out what that charge might be."

"That makes them even more reluctant to seek" Paxlovid, she added.

Test-to-treat is "a good idea, except for all of the barriers," said Walid Gellad, a pharmaceutical and drug safety expert at the University of Pittsburgh.

One barrier is different interpretations of who is eligible for the antiviral, Gellad said. Some health care providers may use CDC's definition of those at high risk of severe Covid-19, including those 65 and older, those with chronic medical conditions, and those at an increased risk based on "where they live or work, or because they can't get health care."

"In other cases they say, 'Because of a shortage, we're limiting it to extremely high-risk patients," Gellad said.

Mark Levine, the top health official in Vermont, said use of Paxlovid has increased in his state as Covid-19 cases have climbed, but he said that's largely because Vermont has many people with both health insurance and primary care providers.

"Test-to-treat is most ideal for where you have the most trouble connecting people with health care," he said. "Generally those places don't have as much capacity in primary care systems, or don't have a highly insured population." (Wingrove/Rutherford, Bloomberg, 4/22; Weiland, New York Times, 4/26; Armour/Hopkins, Wall Street Journal, 4/26; Abutaleb, Washington Post, 4/26)