Clinical Risk and Outpatient Therapy Utilization for COVID-19 in the Medicare Population

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Abstract
Multiple therapeutic agents have been developed for the treatment of outpatient COVID-19 infection that are highly effective at preventing hospitalization and mortality, particularly for those at high risk for severe complications.1-3 The first available outpatient COVID-19 treatments, monoclonal SARS-CoV-2 antibodies (mAbs), required access to an infusion center, likely explaining why fewer than 7% of Medicare beneficiaries with confirmed COVID-19 used mAbs in 2020 and 2021.4,5 In December 2021, emergency use authorization of the oral agents nirmatrelvir (available via prescription as a formulation with ritonavir to boost drug levels)6 and molnupiravir7 for outpatient COVID-19 treatment raised hopes that access would improve,8 especially because these treatments were provided at no cost to patients.9,10 This was followed by the approval of intravenous remdesivir, which had previously been limited to inpatient use, for outpatient therapy in January 2022.11

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