With COVID cases rising this summer, what to know about the Paxlovid treatment

COVID-19 is rising in prevalence in many states following the July 4 holiday week, but the role of the main therapy to treat it — the antiviral drug Paxlovid — has become less clear.

Research studies over the past year found the drug less effective with patients than it was in clinical trials during the race in 2020 and 2021 to find treatments for COVID-19 and slow the global pandemic.

“Data from the original research studies conducted in 2021 among those with their first COVID-19 infection are not valid in extrapolating benefit today in 2025,” said Dr. David Boulware, an infectious disease specialist at the University of Minnesota. He added, “there likely is minimal benefit from antiviral therapy” for people who had previous infections or COVID vaccinations.

Prices for Pfizer’s drug remain elevated, though discount programs are widely available.

It is clear, however, that COVID infections are rising again, following the pattern of higher prevalence seen in prior summers. Testing of wastewater samples in Minnesota is showing another slight increase so far in levels of the coronavirus that causes COVID-19.

Holiday travel and family gatherings are believed to be among the main drivers in the virus’ spread this time of year. National trends show rising and even high levels of COVID-19 in many southern and western states.

Only one in five Minnesotans are up to date with federal COVID vaccine recommendations.

Prescribed as a course of multiple pills per day, for five days, Paxlovid contains an antiviral drug, nirmatrelvir, that slows the spread of the coronavirus. It also contains ritonavir, which is commonly used to treat HIV but also increases the virus-fighting effectiveness of nirmatrelvir.

GoodRx estimates a five-day course of Paxlovid costs $1,400 or more. That amount raises concerns among health economists, even though Paxlovid is covered by most insurance plans and eligible for discount programs operated by its manufacturer. An analysis by the Institute for Clinical and Economic Review in 2022 found that a price of $600 to $900 would make Paxlovid cost-effective, because it would have prevented at least some patients with COVID from enduring more expensive hospitalizations.

The federal government was paying $530 per course of Paxlovid in 2022, in part because it placed a bulk order of 24 million courses during the pandemic. The cost increased after the therapy received FDA approval and payment shifted to patients and health insurers.

This follows historical patterns in which drug companies charge higher prices for newly approved drugs to recoup the cost of research and development. Harvard University researchers estimated in 2023 that Paxlovid costs $13 to produce.

Enthusiasm for Paxlovid waned after some studies found weaker-than-expected benefits, especially for people up to date on COVID-19 vaccines. UCLA researchers this winter found, at best, modest reductions in COVID hospitalizations among vaccinated adults, despite earlier clinical trial data that found a 90% reduction in COVID-related hospitalizations and deaths.