Paxlovid by mail brings U.S. closer to endgame

“The pandemic endgame is to get people treatment as quickly as possible so they can go back to their lives.”

San Francisco-based primary and urgent care provider Carbon Health has partnered with COVID test manufacturer Detect to announce a new service that lets people test themselves, consult online or by phone with a doctor who can prescribe antiviral pills, if appropriate, and get the pills delivered — all without leaving the house.

The service brings the approach of the federal government’s nationwide “Test to Treat” program — where people can visit government-run sites to get tested and, if eligible, get prescription antiviral pills on the spot — into the home. It marks a further evolution of COVID treatment as the virus continues its march toward becoming a more normal, “endemic” part of our lives.

Just a few months ago, the antiviral pill Paxlovid was in tight supply and given only to severely immunocompromised people. In the last several weeks, that has started to change as the pills become increasingly available at pharmacies for people with a wider range of less severe medical conditions. Now, the Paxlovid rollout is starting to go down a similar path as the earlier introduction of COVID test kits: initially very hard to find, then more accessible, and ultimately available via websites and mailorder.

Major players in the health care industry are making Paxlovid available for delivery, though they generally urge patients

San Francisco-based primary and urgent care provider Carbon Health has partnered with Connecticut-based COVID test manufacturer Detect to provide at-home testing and antiviral pill delivery.

to pick up the pills at a pharmacy drivethrough or send a caregiver to pick them up since that’s often faster and more reliable. Paxlovid treatment needs to be started within five days of symptom onset, and only after a positive COVID test result.

In California, Walgreens offers free sameday delivery for Medicaid patients. For patients on other types of insurance plans, Walgreens does same-day delivery for $10.99. CVS offers same-day delivery for $7.99 at many locations, one- to two-day delivery for $4.99, or free delivery for those with CVS’ loyalty program CarePass, which is $5 per month or $48 annually. Some large

health care providers are also mailing Paxlovid to patients’ homes. UCSF, for instance, can ship Paxlovid via FedEx overnight. Kaiser can do same-day delivery to patients’ homes.

“We are going to live with COVID for years to come, and we have to learn the best ways to deal with this,” said Hugo Barra, the CEO of Connecticut-based Detect. “The pandemic endgame is to get people treatment as quickly as possible so they can go back to their lives. So ‘Test to Treat’ at home in particular is the pandemic endgame.”

Making testing and treatment available fast in people’s homes is important because many

patients don’t live near testing centers or pharmacies that carry Paxlovid. This can prolong the time it takes to get the pills. And people who’ve tested positive for COVID should try to isolate and not go out in public, so the home delivery of pills solves the issue of having to go pick up a prescription in person.

It comes at a cost: You have to be a Detect user to access it, which means you have to buy the company’s home test components. That includes the $39 machine that processes the tests (a small tabletop reusable device), and the tests themselves, which are $49 each. Or you can buy the “starter kit,” which has the machine

and one test, for $85. The tests are a type of rapid molecular test similar to PCR in that they amplify the genetic material of the virus many times over until it’s detectable. Molecular tests are more sensitive than the now-common home antigen tests and can detect the presence of the virus earlier. Detect ships the test nationwide, offering next-day, same-day, and in some places two-hour delivery.

If you test positive, you can use the Detect mobile app to connect with a Carbon Health doctor, who conducts a virtual visit — or inperson, if you choose — and can prescribe Paxlovid if warranted. Then Carbon works with a

Hugo Barra, CEO of Detect pharmacy that can mail the pills to you or provide same-day pickup.

Carbon operates primary care and urgent care centers in 17 states including California, and has dozens of locations in the Bay Area. It was an early leader in coronavirus testing in the region, partnering with the city of San Francisco to run public testing sites and later making rapid molecular tests available at many of its centers before some other health care providers did.

You can pay for the Detect machine and tests out of pocket, and seek at least partial reimbursement from your health insurer. The federal government requires insurers to reimburse people for up to eight home tests a month, at a rate of $12 per test — roughly the retail cost of one home antigen test like the Abbott BinaxNow. The cost of the Carbon virtual visit is covered by most commercial insurers; if paying out of pocket, it’s $69. The Paxlovid itself is free.

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