Outpatient Use of COVID-19 Medications

This section describes trends in the use of COVID-19 medications that have been shown to be effective in lowering risk for severe health outcomes, including COVID-19–related deaths. Data presented are from PCORnet, a network of healthcare facilities that contains electronic health record data for over 30 million people. Note that PCORnet data are derived from a convenience sample of healthcare facilities and captured approximately 2% of COVID-19 patients reported to CDC during January–July 2022, therefore the results presented here might not be nationally generalizable.²¹

Outpatient COVID-19 Treatment Increased from January to July 2022

A variety of outpatient therapies are authorized or approved for treatment of mild to moderate COVID-19 for patients who are at risk for progression to severe COVID-19, including hospitalization or death.⁷ The antiviral drugs Paxlovid (nirmatrelvir/ritonavir) and Veklury (remdesivir) are the preferred treatments for eligible adult and pediatric patients (as of November 9, 2022).⁷ In situations where these two treatments are not accessible or clinically appropriate, bebtelovimab, a monoclonal antibody, or molnupiravir, an oral antiviral, can be used.⁷

Early observational studies suggest that hospital admission rates and mortality rates are lower among those treated with Paxlovid compared to those who are not treated, in particular among older adults.^{4, 5} Paxlovid use among COVID-19 patients in the PCORnet network increased substantially during the first seven months of 2022 from 0.6% of COVID-19 patients in January to 20.2% in April and 34.0% in July (Figure 20). However, differences in uptake of Paxlovid by age and immunocompromising conditions were observed among COVID-19 patients.

During April–July 2022, when Paxlovid use became more prevalent, the proportion of COVID-19 patients receiving any COVID-19 outpatient treatment was highest among adults aged 65–79 years (~50%), followed by those aged ≥80 years (~45%), 50–64 years (~40%), and 20–49 years (~22%) (Figure 21). Of note, patients aged ≥80 years received monoclonal antibody treatment more often than younger age groups. Among COVID-19 patients with immunocompromising conditions, the proportion receiving any treatment ranged from 50–60% (Figure 22). Patients with previous organ transplant were treated with Paxlovid less often and with monoclonal antibodies more often than patients with other immunocompromising conditions. Differences in Paxlovid use by age group and among patients with immunocompromise might be related to contraindications to Paxlovid use or health conditions that require treatment with medications that have drug-drug interactions.

A separate analysis of PCORnet network outpatient COVID-19 treatment data from January–July 2022 found significant disparities in receipt of COVID-19 treatment by racial and ethnic groups. ²¹ During April–July 2022, when Paxlovid use was highest, among COVID-19 patients aged ≥20 years, Black patients were prescribed Paxlovid 36% less often than White patients and, Hispanic patients were prescribed Paxlovid 30% less often than non-Hispanic patients.²¹ These disparities were seen among all age groups and among patients with immunocompromising conditions. Additional studies are needed to examine the relationship between disparities in therapeutic use and severe COVID-19–outcomes.