Ensuring Timely Access to Antiviral Treatments for Older Adults and Other High-Risk Groups

Why It Matters

An estimated 74% of American adults have at least one condition that increases their risk of severe illness from COVID-19, RSV, flu and other respiratory illnesses. Antiviral treatments can help reduce the risk of hospitalization and death by 80-90% and they are most effective when treatment begins within the first few days after symptoms appear.

However, timely access to antivirals remains a challenge – barriers such as cost, confusion about coverage, and limited awareness can delay critical access to treatment.

Centers for Disease Control (April 2025), ACIP Workgroup Considerations Use of COVID-19 Vaccines

THE PROBLEM

New Barriers to Timely, Affordable Treatment

Access to antivirals has always depended on quick diagnosis and a prescription, but limited awareness of treatment options, new financial requirements to determine whether patients are eligible for assistance, and questions about cost sharing and co-pays are added barriers that cause confusion and can delay care.

For example, throughout much of the pandemic, COVID-19 antivirals were provided at low or no cost to eligible patients. These new barriers, layered on top of existing challenges —like limited awareness, hesitancy, uneven distribution, and access — risk increased delays and may discourage patients from seeking and starting treatment.

Why Cost Matters

Research consistently shows that out-of-pocket costs reduce medication use and worsen health outcomes:

Even modest costs deter use: Patients facing high co-pays are less likely to start treatment.
National Pharmaceutical Council (2022, April), High Patient Out-of-Pocket Costs Lead to Worse Medication Adherence Without Overall Health Care Savings
Higher out-of-pocket costs = lower use: When out-of-pocket costs rise, patients are more likely to skip or stop their medications.
Karter et al. (May 2017), Effect of Out-of- Pocket Cost on medication Initiation, Adherence, and Persistence among Patients with Type 2 Diabetes: The Diabetes Study of Northern California (DISTANCE)
Cost support improves outcomes: Patients receiving copay support are significantly more likely to start and continue treatment.
National Institutes of Health (January 2023), Cost-sharing and adherence, clinical outcomes, health care utilization and costs: A systemic literature review
Costs are rising for older adults: In 2025, more than half of Medicare Part D enrollees are not expected to reach the $2,000 spending cap. Without ﬁnancial assistance, many will face treatment delays or go without.
KFF (July 2025), Key Facts About Medicare Part D Enrollment, Premiums, and Cost Sharing in 2025

THE PATH FORWARD

Keep Access Simple and Affordable

When treatment needs to begin quickly, complex eligibility rules and cost-sharing can be life-threatening barriers. Policymakers can ensure continued access to antivirals by:

Maintaining affordability by minimizing or eliminating cost-sharing, particularly for Medicare beneficiaries and other vulnerable groups.

Supporting patient education and continued access to low- and no-cost testing to raise awareness of available treatment options and help individuals know when and how to seek care.

Investing in practitioner education to increase prescribing confidence and ensure patients are offered treatment in a timely manner.

WHO WE ARE

We are working together to protect access to respiratory antiviral treatments. Our goal is to ensure that older adults, the immunocompromised and people with underlying medical conditions can get the treatments they need when they need them.