May 31, 2024
As of May 28, 2024, BC Pharmacare has confirmed that Paxlovid will be fully covered for eligible British Columbians. While we at DoNoHarm BC welcome the approval of coverage, we also find the new eligibility guidelines leave much to be desired.
On a positive note, BC has lowered the age threshold for those with “high-risk health conditions” from 70+ to 60+ years old. However, our province has significantly reduced the number of qualifying conditions – in marked contrast to Manitoba, where Paxlovid is freely available to anyone prescribed it by their healthcare provider.
In BC, eligibility is now restricted to two groups:
- People who are considered “moderately to severely immunosuppressed” due to a selective list of conditions and medications; or
- People aged 60 and over who have a narrowly-defined list of “high-risk health conditions”, which differs substantially from the list of conditions known to heighten risks of hospitalization or death.
We note that Indigenous and under-immunized people are no longer considered eligible for Paxlovid under this criteria (although our hope is that some individuals would be covered by the First Nations Health Authority). Also, contrary to our own recommendations, it is not clear that anyone with Long Covid could qualify as “high-risk” unless they have been diagnosed with another eligible condition as well.
Despite the lowered age requirement, we must conclude that the number of British Columbians who can access Paxlovid will be even smaller than before. This is currently compounded by a lack of supply: within the last few days alone, we have received multiple accounts of doctors and patients struggling to find a pharmacy that can fill a prescription.
BC’s new Paxlovid guidance evokes other concerns as well. Some of the criteria raise questions about their rationale; for instance, diabetic people aged 60+ are only eligible if treated with insulin. This is despite studies showing that diabetes is a large risk factor regardless of insulin use, and the fact that newer diabetes medications have reduced the need for insulin.
We are also struck by BC’s prominent use of discouraging language around using or prescribing Paxlovid, which includes some potentially misleading statements. For example, BC asserts that “Paxlovid is unnecessary for most people in BC” due to “stronger immunity to COVID-19 through previous infections and widespread vaccinations.” To clarify: data shows that previous infections actually multiply the long-term risks from COVID-19, rather than reducing them. And as of May 25, 2024, only 12.4% of immunocompromised British Columbians and 19.1% of elders have received a spring vaccine dose. (Data is unavailable for other demographics in BC.)
We recognize that for British Columbians who remain eligible, Pharmacare coverage of Paxlovid will make a massive and potentially life-saving difference. We are grateful for everyone who joined us in calling attention to this issue, and who sent nearly 5,000 messages to policy-makers across BC. At the same time, we are critical of the province’s decision to further increase barriers to access – and skeptical of communication choices that appear more focussed on discouraging treatment, than on facilitating it.
Special thanks to the medical professionals at Protect Our Province BC who contributed their insights and clinical experience to our analysis of this issue.
DoNoHarm BC is a non-partisan action group based in British Columbia, Canada. Our mission is to demand evidence-based safety measures in high-risk settings; advocate for effective and equitable public health policies; and help lead grassroots collective action promoting safety, equity, accessibility and resilience in response to the COVID-19 pandemic. www.DoNoHarmBC.ca
