Michigan gets first doses to treat COVID-19; here's where they're going

Michigan on Friday received its first shipment of oral medications recently authorized to treat COVID-19, the state health department announced.

The drugs, paxlovid and molnupiravir, were granted an emergency use authorization by the U.S. Food and Drug Administration in December and are in limited supply. They are only available by prescription.

Elizabeth Hertel, director of the Michigan Department of Health and Human Services, said the department has developed eligibility criteria to guide health care providers in determining which patients they should prescribe the medications to.

Health care providers must prioritize patients at risk of severe COVID-19, according to the state's Priority Eligibility for COVID-19 Outpatient Therapy.

Patients who are moderate to severely immunocompromised, regardless of their vaccination status, are eligible for either drug, according to the criteria updated Dec. 31. People over 75 who have not been fully vaccinated nor received a booster shot also are eligible.

Patients who are ages 65-74 and not fully vaccinated also could receive molnupiravir, although the health department said the drug should be used when alternative treatment options, like monoclonal antibody treatment, are not accessible or clinically appropriate. 

"We ask Michiganders to be patient as providers will prioritize people at highest risk for developing serious illness from the virus," Hertel said in a press release. "We are committed to distributing these pills equitably across the state, and access will increase as Michigan receives more allocations from the federal government."

The state health department said Friday that its first allocation of oral antivirals includes 7,080 courses of molnupiravir, enough to treat as many patients. Michigan was allocated 1,600 courses of paxlovid. The department is expecting an additional allocation Monday.

The antiviral drugs are designed for outpatient treatment of mild to moderate COVID-19. When they are administered within five days of initial symptoms, they can reduce a person's risk of hospitalization and death.

The antiviral drugs are promising and should continue to work well against new variants of the virus, said Dr. Subhashis Mitra, interim chief of Michigan State University's Division of Infectious Diseases. But their impact will depend on manufacturers’ ability to make them and whether the supply chain is ready to distribute them.

"I think the biggest challenge is just getting them in adequate supply," Mitra said. "Hopefully there’s a push from manufacturers and everyone else, so everyone can have easy access to it. It's one thing to get approval and another to have supplies."

Getting vaccinated and boosted remains the best protection against COVID-19, said Dr. Natasha Bagdasarian, the state's chief medical executive.

"It's important to remember these drugs are not a substitution for protecting yourself by getting vaccinated and wearing a mask in public places," said Bagdasarian. "Getting vaccinated continues to be the best protection against severe illness and hospitalization, and we urge all Michiganders over age 5 to get vaccinated as soon as possible.

"Continue to wear well-fitting masks over your nose and mouth, test and social distance to prevent the spread of COVID-19, avoid large gatherings and get vaccinated and boosted if you haven't already." 

Monoclonal antibody treatment also is available to some Michigan patients who are immunocompromised, have other risk factors, are 75 and older or are 65 and older but not fully vaccinated. 

Monoclonal antibody treatment is preferred over molnupiravir, one of the two available antiviral drugs. It is comparable to the other antiviral, paxlovid.

Paxlovid currently has limited availability through certain Federally Qualified Health Centers, tribal health centers and 10 Meijer pharmacies in southeast and east-central Michigan, the hardest-hit regions of the state. Patients must be 12 or older to receive paxlovid. 

Molnupiravir is available in limited quantities at Meijer pharmacies and selected retail pharmacies in regions without Meijer stores. Patients must be 18 or older to receive molnupiravir. 

A spokesman for the state Department of Health & Human Services said Meijer’s pharmacies cover a wider area than other chains, especially in rural areas and the Upper Peninsula.

Another benefit of using Meijer is that there was enough molnupiravir for all of its 118 pharmacies, said the spokesman, Bob Wheaton. That made it simpler for prescribers and patients in making or picking up prescriptions.

“Given little time to develop a distribution plan and not initially knowing what our supply would be, we decided to primarily start with Meijer,” Wheaton wrote in an email.

More information is available at Michigan.gov/COVIDtherapy.

ckthompson@detroitnews.