(There are also monoclonal antibody treatments, which differ from antiviral medications. Monoclonal antibody treatments are suitable for certain people at higher risk from severe illness from COVID, and are given as a single IV injection. See the CDC’s full list of treatments available for COVID patients.)

Should I take Paxlovid if I’m eligible?

According to Wachter, starting a course of Paxlovid is the “right thing to do” if you’re high-risk and eligible for the prescription, and aren’t taking any other medications that would interfere with the treatment.

Wachter also notes that taking Paxlovid could also decrease your chances of developing long COVID. While he says the evidence isn’t yet there, Wachter’s hopeful that because Paxlovid quickly lowers the amount of virus in a person’s body, it might, in theory, “decrease the rate of long COVID.”

A box of the COVID antiviral drug Paxlovid, placed on a shiny wooden table. The box says
A box of the COVID antiviral drug Paxlovid. (EUROPA PRESS/C.Lujan.POOL via Getty Images)

When should I think twice about taking Paxlovid?

For Wachter, the “judgment call” enters when your risk of hospitalization or death from COVID is low to start with — in which case you’d “be taking Paxlovid for no real benefit.” That said, it’s unlikely a provider would even prescribe you Paxlovid if they didn’t feel your personal risk factors justified it.

You may also have heard about the “Paxlovid rebound” phenomenon, which is when people taking Paxlovid start testing positive again for COVID after a week. Read more about rebound cases below.

Who qualifies for Paxlovid or other COVID antiviral treatments?

COVID antiviral treatments aren’t prescribed to every person who gets COVID.

Treatments are usually reserved for adults and children age 12 years and older who are deemed to be at higher risk for severe illness from COVID, because they have one or more risk factors or health conditions that increase their chances of becoming very sick.

According to the CDC, these include people over 65, people who are immunocompromised or have a weakened immune system, people with some types of disabilities, people with chronic liver, kidney or lung disease (including moderate to severe asthma) and people with heart conditions. See the CDC’s list of conditions that may put people at higher risk from COVID.

If you’re not sure whether you’re eligible for a COVID antiviral treatment, it’s worth getting a professional opinion on your eligibility from your own health care provider, if you have health insurance, or by visiting an Optum Serve Test to Treat location if you don’t have insurance. Don’t automatically assume you aren’t eligible — you may have risk factors you aren’t aware of that a medical professional will ask you about.

You may not also be familiar with all the conditions that put a person at higher risk for COVID. For example, the CDC’s list of possible risk factors includes mental health conditions and mood disorders like depression, and also lists being a current or former smoker.

What else do I need to know about Paxlovid and COVID antiviral treatments?

You can’t mix Paxlovid with certain other medications

“You need to make sure your doctor or the pharmacist who’s helping you understands the other drugs you’re on, because you may need to change the doses,” notes Wachter. “You may even need to stop some of them for five days.”

This is the reason it’s really important to be clear about any other medications you’re taking when you speak to a health care provider about getting Paxlovid or another COVID antiviral: Mixing them could be dangerous to your health. If you’re taking medications that would interact badly with Pfizer’s Paxlovid, a provider may prescribe you another COVID antiviral — Merck’s molnupiravir — instead.

A woman with black hair and dark brown skin, wearing a black skirt and bright pink sweater walks across a stone plaza in the background. In the foreground is a blue sign saying
A person walks past a COVID-19 testing location in Arlington, Virginia, on March 16, 2021. A new website launched by the Biden administration will provide a locater for test-and-treat facilities, among other services. (Stefani Reynolds/AFP via Getty Images)

Paxlovid and other COVID antivirals have to be taken within the first five days after you test positive

Be clear with any provider you speak with about how long ago you tested positive.

If you’ve tested positive heading into a weekend, or on the weekend itself, remember that some treatment locations may be closed at this time.

The ‘Paxlovid rebound’ is a thing

In a nutshell, the ‘Paxlovid rebound’ is when someone tests positive for COVID and takes Paxlovid, and tests negative on an antigen test for COVID after several days — but then redevelops their COVID symptoms and tests positive again on an antigen test after that. Wachter says that in these cases, the negative test comes on average on Day 7 or 8 of a COVID infection, and the positive “rebound” test and return of symptoms happens around Day 11 or 12.

How common is a Paxlovid rebound? Wachter says it’s “really a rapidly emerging story,” since only 2% of people in Paxlovid’s clinical trials experienced it but it might now seem more common among the general public because of the “amplification phenomenon of social media.” He says rebound infections “tend to be mild,” albeit lasting roughly five to seven days, and you should assume you’re infectious again if you test positive that second time.

So should the risk of a rebound infection make you think twice about taking Paxlovid? For Wachter, the benefits of the treatment are still so strong that “if I was at high risk, I definitely would take it,” he says. “But you have to have your eyes open to the possibility of rebound.”

“To me, it doesn’t change the overall benefit of practice of it, but it clearly is an area that is crying out for research,” says Wachter. “We don’t even know legitimately what percentage of people get it.”

Many people report Paxlovid has a strong metallic taste

Paxlovid is highly effective at preventing hospitalization and death from COVID, and “the side effect profile is very, very mild,” says Wachter — but “about 1 in 20 people in the clinical trials were reported to have a metallic taste in their mouth.” Or as The Atlantic puts it, “it might make your mouth taste like absolute garbage the whole time you’re taking the pills.”

Don’t be shocked if you’re one of the percentage of people who report an “altered sense of taste” from taking Paxlovid, which is temporary.

How to get Paxlovid without health insurance

What to know before you begin, if you’re uninsured

Make sure you have the following on hand:

  • Proof of a positive COVID test (either a PCR result certificate or document, or your at-home COVID test itself)
  • Any medications you’re currently taking, or a list of those medications (as COVID antiviral drugs can have dangerous interactions with other drugs)

Throughout the process, be clear with the provider about any symptoms you’re experiencing, and make sure they know how long ago you tested positive, since Paxlovid and other antiviral drugs must be taken within five days of a positive test.

A hand holds an at-home COVID-19 test. (Beth LaBerge/KQED)

Also, since you’re not seeing a regular provider, keep reminding any representative or health care professional you talk with, either in person or on the phone, that you don’t have health insurance and get them to confirm you won’t be asked to pay out-of-pocket costs when you’re being evaluated, when you’re being offered a prescription or when you’re filling a prescription. This may help avoid nasty surprises later down the line.

Also, be very clear with whomever you speak with that you don’t necessarily know where to fill any prescription for Paxlovid that you receive. Ask repeatedly, if necessary, where the provider recommends you fill that prescription locally — since that could end up being the hard part.

1. Find a Test to Treat site that’s run by Optum Serve

As the name “Test to Treat” implies, these locations are places where you can get tested for COVID and then potentially treated for it by being prescribed COVID antivirals on-site. Since the Test to Treat program has recently been expanded, visiting a Test to Treat site should — in theory — have gotten easier in the last several weeks.

Some Test to Treat sites also have supplies of COVID antivirals on-site, meaning you could (in theory) walk away from a Test to Treat site having been tested for COVID, evaluated for eligibility for COVID antivirals, prescribed the right treatment(s) and handed your medications.

Services at Optum Serve Test to Treat sites are free to uninsured people (this means: those Test to Treat sites run by Optum Serve, which is the federal health services business of Optum and UnitedHealth Group). So if you’re uninsured and you visit a Test to Treat location that isn’t run by Optum Serve, you could potentially find yourself asked to pay costs out of pocket.

See a list of Test to Treat sites near you on the State of California’s map tool. When you input your city or ZIP code into the Test to Treat locator map, you’ll be able to see:

  • Test to Treat sites themselves, i.e., locations that offer testing, medical visits and medication
  • Places where you can fill an existing prescription for COVID treatment that you’ve obtained elsewhere (these locations aren’t Test to Treat sites)

If you’re uninsured and using the Test to Treat locator map to find a site, make sure you look specifically for the locations that say “Optum Serve.” You can also use Optum Serve’s own location finder tool online to see their sites on a map. The site will invite you to make an appointment for a rapid antigen COVID test and then stay on-site for your results and get medication (if eligible), all in one appointment. You can also call Optum Serve direct at (888) 634-1123. Visit the Optum Serve COVID testing and treatment site.

You can call the Test to Treat call center at (800) 232-0233 (TTY 1-888-720-7489) — assistance is available 5 a.m. to 9 p.m. PT seven days a week, in English, Spanish and more than 150 other languages. The Disability Information and Access Line (DIAL) is also available to help people with disabilities access services: (888) 677-1199, Monday-Friday, 6 a.m.-5 p.m., or email [email protected]

A screenshot of the federal Test to Treat locator map, which shows a map of San Francisco and the nearby site locations. (Office of the Assistant Secretary for Preparedness and Response)

If the Test to Treat site you’ve visited doesn’t have supplies of the antiviral drug they’ve prescribed you, ask for staff’s assistance and advice on where you should then go to refill that prescription.

2. Visit a CVS pharmacy

CVS pharmacies offer a range of testing and treatment options for COVID, and a CVS spokesperson confirmed that currently, there is still no cost for uninsured people to access testing, vaccinations or oral antiviral medications at CVS Pharmacy.

To start the process, schedule an appointment for a COVID test at one of CVS’s MinuteClinics in their pharmacies (or find the closest MinuteClinic to you using their map). If you test positive for COVID at the appointment, the site says you will be able to discuss treatment options with the provider on-site — and, if you’re eligible, get a prescription that you may be able to fill at that same CVS pharmacy. If you don’t have insurance, both the test and the prescription will be free, but you’ll need to get the test at the CVS MinuteClinic first; otherwise, you may be charged for the prescription. Find a CVS MinuteClinic near you.

3. Contact a community health center near you

Use the U.S. Department of Health & Human Services’ Find a Health Center map to see community health centers near you, and get their contact details.

Contact a nearby health center to ask about your options for COVID treatment and getting a Paxlovid prescription without insurance.

4. See if your county is offering special assistance on COVID treatment

San Francisco residents can call the San Francisco Health Network for treatment and to learn who’s eligible for Healthy San Francisco and Medi-Cal: (415) 682-1740. Read more about getting COVID treatment in San Francisco.

Contra Costa County residents can call the Contra Costa Health Services Advice Nurse line for a potential referral to a doctor: (877) 661-6230. Read more about getting COVID treatment in Contra Costa County.

By Percy