Anti–SARS-CoV-2 Monoclonal Antibody Distribution to High-risk Medicare Beneficiaries, 2020-2021

Abstract

Monoclonal antibodies (mAbs) are highly effective in treating mild to moderate COVID-19 among nonhospitalized patients. 1 Given limited supply, federal guidelines prioritize patients at higher risk of progression to hospitalization or mortality from COVID-19, with risk factors including age and comorbid conditions. 2,3 Antibodies were initially allocated to states by the federal government, 4 then distributed through suppliers in 2021. 5 We assessed how the limited supply of mAb therapy was allocated to patients at highest risk of severe disease.

Receipt of anti-SARS-CoV-2 pharmacotherapies among U.S. Veterans with mild to moderate COVID-19, January-February 2022

“…Consistent with findings in other studies, Black Veterans were less likely to receive newly available outpatient treatments for COVID-19; Hispanic Veterans in our study were also slightly less likely to receive treatment, whereas other studies have been mixed. 13,25 While demographic differences in access to care, including lower use of COVID-19 monoclonal antibody treatments among racial and ethnic minorities have been well-described in non-Veteran populations, 25 disparities in COVID-19-related care within the VA system have been less pronounced. 16,31 Possible reasons for observed racial and ethnic differences in treatment of mild to moderate COVID-19 include structural barriers such as limited access to testing, lower awareness of COVID-19 therapies, differences in care-seeking, and lower trust in the healthcare system impacting acceptance of recommended investigational therapies.…”

“…Although these therapies have been demonstrated in clinical trials to be effective in reducing the short-term risk of hospitalization or death, [9][10][11][12] early limited drug supply, the requirement for prompt recognition of symptomatic disease and linkage to treatment, logistical barriers to administration, and the need for provider and public awareness of therapeutic options have hampered widespread use. 13,14 To date, utilization of outpatient SARS-CoV-2 pharmacotherapies in the U.S. has not been well-described.…”

Rising from the pandemic ashes: Reflections on burnout and resiliency from the infection prevention and antimicrobial stewardship workforce

“…During the onset of the massive surge of the SARS-CoV-2 ο (o)micron variant, effective antiviral agents were scarce but demand was extremely high. 12,13 Despite significantly improved national reserves, utilization in poor, disconnected communities remains grossly inadequate, 14,15 compounding the moral injury experienced by providers.…”

“…26 In conclusion, we have adapted to multiple COVID-19 surges and have developed coping strategies centered in personal and professional connections across the globe. 15 We should intensify efforts to collaborate virtually or in person, pursue professional activities that hold value, and take advantage of pandemic "respites" to invest in the activities that renew us and bolster resilience.…”

Pharmacists as important prescribers of coronavirus disease 2019 (COVID-19) antivirals

“…Reasons for this include difficulty navigating the healthcare system, limited and complicated treatment availability, time constraints between diagnosis and administration, and geographic limitations. 14 Additionally, Black, Asian, and other non-White races received monoclonal antibody therapy 22%, 48%, and 47% less frequently than their White counterparts, respectively. 15 Pharmacists have been instrumental in increasing access to monoclonal antibodies in rural and minoritized communities, 16 subsequently increasing the number of Black patients receiving treatment.…”