Update, Nov. 15, 2023: Starting Nov. 12, there are some changes to how the drug Paxlovid is funded and paid for by insurers.

People with health insurance should now make sure they are requesting and filling their prescription “in-network” to avoid any unexpected bills. People without health insurance can still use Sesame Care, California’s COVID telehealth service.

Read our latest guide to why the cost of Paxlovid has changed and how to ensure your Paxlovid prescription remains free.

Original story:

If you test positive for COVID, you may be eligible to start a COVID antiviral treatment like Paxlovid.

Paxlovid is available free by prescription in California, and treatment is taking a pill orally twice a day, for five days. This antiviral medication has been proven to be highly effective at reducing severe disease and hospitalization from COVID, and there’s now evidence it can help reduce the risks of long COVID, too.

But if you test positive for COVID, what are the practical steps to finding a prescription for Paxlovid near you? Who exactly is eligible for Paxlovid now? And what is “Paxlovid rebound”?

Keep reading for everything you need to know about getting Paxlovid in the Bay Area. Alternatively, use these links to jump straight to the answer you’re looking for:

How to find Paxlovid near you:

• How to get a Paxlovid prescription (no insurance)
• How to get a Paxlovid prescription (with insurance)

Key facts about Paxlovid:

• How do antiviral treatments work?
• Am I eligible for Paxlovid?
• What do we know about “Paxlovid rebound”?

What is Paxlovid, and should I take it?

How Paxlovid works

Paxlovid (pronounced “PAX-loh-vid” or “Pax-LOH-vid”) is a highly effective antiviral treatment for COVID, available by prescription for people at higher risk from the disease. The treatment lasts five days, via a pill taken orally twice a day. Learn exactly who qualifies for Paxlovid.

Antiviral medications like Paxlovid work by stopping viruses from multiplying in the body. Studies by Paxlovid’s manufacturer, Pfizer, show that in unvaccinated people at serious risk of COVID complications, Paxlovid was nearly 90% effective at reducing the risk of hospitalization or death from COVID.

Paxlovid “attacks the virus in a mechanism that’s different than your immune system,” explains Dr. Bob Wachter, professor and chair of the department of medicine at UCSF. This is particularly beneficial for immunosuppressed people whose immune systems didn’t produce a good response after they got their COVID vaccine — because “the Paxlovid should still work fine.”

While Pfizer’s Paxlovid has become a more well-known COVID antiviral drug recently, a provider may suggest another medication for you: molnupiravir, which is only available to people age 18 and over. The U.S. Food and Drug Administration’s data has shown that molnupiravir is a much less effective drug than Paxlovid, but doctors may still prescribe it in place of Paxlovid for several reasons (including the risk of Paxlovid’s interactions with other medications you’re taking).

(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.)

How Paxlovid could reduce your risk of long COVID

In late 2022, the United States Department of Veterans Affairs (VA) released the results of a study that showed that COVID patients within the VA population who took Paxlovid within five days of their positive test had “a 25% decreased risk of developing 10 of 12 different long COVID conditions studied” — which include fatigue, neurocognitive impairment, muscle pain, shortness of breath and liver, heart and kidney disease.

Dr. Peter Chin-Hong, infectious disease expert at UCSF, says that he thinks the possible benefit of Paxlovid on long COVID could even exceed the findings of the VA study. The “biologic reason” for that, he says, is rooted in why people get long COVID in the first place. In the simplest terms, “it’s when the virus gets in the bloodstream, and your immune system gets super angry and whacked out,” he explains. “So things that kick the virus out of the bloodstream earlier would therefore potentially lead to a lower probability of long COVID.”

Wachter echoed Chin-Hong’s sentiments recently, telling The San Francisco Chronicle that while the VA study isn’t huge, it still shows Paxlovid can make “a meaningful difference” in the fight against long COVID. That’s one of the reasons he himself would take Paxlovid if he had COVID, said Wachter.

Who qualifies for Paxlovid or other COVID antiviral treatments?

In short: A lot more people are now eligible for Paxlovid.

After Paxlovid became the first oral antiviral treatment for COVID authorized by the FDA in Dec. 2021, limited supply meant that the drug was initially only used to treat the patients deemed most at risk from severe illness from COVID, which the Centers for Disease Control and Prevention said included people over 65 and immunocompromised people.

But now, in 2023, the FDA says that all patients with “mild to moderate COVID-19 who are at high risk of disease progression” should be eligible for Paxlovid. And in the last few months, California officials have gone even further to expand access to Paxlovid, reminding providers of the “ample supply” and urging that “all symptomatic patients with a positive COVID-19 test of any type should be evaluated for treatments.”

All of this means that, as a patient, when it comes to Paxlovid: Assume you could be eligible until you’re told otherwise, and seek out that prescription, urges UCSF’s Chin-Hong.

“People aren’t great about determining whether or not they’re the highest risk or not” says Chin-Hong. “I think the assumption [should be], you qualify.”

You may also not 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 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.

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.

You no longer need a positive test to get a prescription

Previously, if you wanted to get a prescription for Paxlovid, you’d need to provide proof of a positive COVID test.

But as of Feb. 1, you no longer need to provide this positive test to get a Paxlovid prescription, removing another obstacle between you and a potential course of this antiviral treatment.

Your closest pharmacy may not have supplies of Paxlovid

Paxlovid supply can vary, and if you obtain a prescription for Paxlovid and ask for it to be filled at your closest pharmacy or the pharmacy you regularly use, you may find that this location does not in fact have any current supply. In that case, your provider could ask you to call other nearby pharmacy locations yourself, to check whether they have supply.

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. 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.

But Chin-Hong stresses that you shouldn’t let fear of the “Paxlovid rebound” dissuade you from seeking out Paxlovid when you might greatly benefit from it, because people can sometimes “rebound” with COVID anyway — even without taking Paxlovid.

Chin-Hong says he’s “seen so many studies now” at this stage of the pandemic that show swabs of COVID patients both with and without Paxlovid with “very similar rates of the virus coming back, with and without symptoms.” In short, “we don’t have any evidence at this point that Paxlovid causes more rebound than natural infection, when you study people systematically,” says Chin-Hong.

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

The state says that “COVID-19 medications are free in California” and you “don’t need to have insurance or be a U.S. citizen” to receive them. But if you’re uninsured, finding a Paxlovid prescription can still feel complex — and you could potentially still be navigating hidden costs.

Make sure you have a list of any medications you’re currently taking on hand, 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.

You’ll be asked about your personal health circumstances, to determine your eligibility for Paxlovid. Be aware that a host of conditions and circumstances could qualify you as having higher risk of severe illness or complications from COVID, and therefore make you a good candidate for Paxlovid. Before talking with a provider, consider briefly familiarizing yourself with the CDC’s list of possible risk factors — which includes mental health conditions and mood disorders like depression, the amount of physical activity you get and being a current or former smoker — so you’re prepared to answer their questions.

Also, since you may not be 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 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.

Paxlovid supply can vary, and if you obtain a prescription for Paxlovid and ask for it to be filled at your closest pharmacy, or the pharmacy you regularly use, you may find that this location does not in fact have any current Paxlovid supply to give you. In that case, your provider could ask you to call other nearby pharmacy locations yourself, to check if they have supply. If this happens, you may find that sometimes the only way to be able to speak directly to a pharmacist when you call a location’s phone number is to select the option for prescribers or doctors.

If you live in San Francisco or Contra Costa County, your county is providing additional assistance on finding COVID treatments like Paxlovid, especially if you’re uninsured. Jump to information for uninsured San Francisco or Contra Costa County residents.

1. Use Sesame Care, the state’s official telehealth service

If you don’t have health insurance and want Paxlovid, the California Department of Health advises that you use Sesame Care, California’s COVID-19 telehealth service. (Previously, the state’s COVID care services were provided by Optum Serve.)

The California Department of Public Health says it’s providing this free service “to support uninsured and underinsured individuals within the State of California who cannot connect with a healthcare provider within 24 hours of receiving a positive test result.” Even though you technically no longer require proof of a positive COVID test to receive a Paxlovid prescription, Sesame Care asks that you only request an appointment if you have a positive COVID test and symptoms of COVID.

Visit sesamecare.com/covid to make a free phone or video appointment through Sesame Care, or alternatively call (833) 686-5051 (6 a.m. to 4 p.m PT, seven days a week). When you speak to a provider through Sesame Care, they’ll prescribe you Paxlovid “if appropriate,” and it will either be mailed to you or made available at a pharmacy near you.

This Sesame Care consultation and the Paxlovid prescription should be free. Sesame Care’s site says that if you are asked to pay for any of these services, you should call Sesame Care at (888) 897-1244 so they “can follow up with the pharmacy.”

Be careful only to use Sesame Care’s free COVID care webpage at sesamecare.com/covid and not click away to other parts of Sesame Care’s website. Sesame warns that if you enter Sesame Care’s regular website, you’ll be charged for its services.

2. Visit a CVS pharmacy (but be aware of the consultation cost)

CVS pharmacies offer a range of testing and treatment options for COVID, where you can get a prescription for Paxlovid without insurance — but you’ll have to pay a $60 consultation fee out of pocket.

To start the process to be prescribed Paxlovid, you can complete the online screening, which will then prompt you to schedule a call with a CVS pharmacist.

Please be aware that there are several key things to know about getting Paxlovid through a CVS pharmacist:

• You will be charged $60 for a consultation with a CVS pharmacist, which you can pay by cash.
• You will be charged this $60 fee even if the CVS pharmacist does not prescribe you Paxlovid. 
• You must have had blood work completed within the last 12 months, including blood work that looks at your liver and kidney function, for the CVS pharmacist to refer to in order to prescribe you Paxlovid.
• You must not have kidney or liver disease.

If you are ineligible for Paxlovid because of any of these factors, remember that CVS will still charge you $60 for the consultation, and you’ll still have to find a Paxlovid prescription somewhere else.

3. Live in San Francisco or Contra Costa County? 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, at (415) 682-1740. Read more about getting COVID treatment in San Francisco, especially if you’re uninsured.

Contra Costa County residents can call the Contra Costa Health Services Advice Nurse line for a potential referral to a doctor at (877) 661-6230. Read more about getting COVID treatment in Contra Costa County, especially if you’re uninsured.

4. Contact a community health center near you

Use the U.S. Department of Health and 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.

How to get Paxlovid if you have health insurance

What to know before you begin

Make sure you have the following on hand:

• A list of any medications you’re currently taking, as COVID antiviral drugs can have dangerous interactions with other drugs.
• Your insurance details.

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.

You’ll be asked about your personal health circumstances, to determine your eligibility for Paxlovid. Be aware that a host of conditions and circumstances could qualify you as having higher risk of severe illness or complications from COVID, and therefore make you a good candidate for Paxlovid. Before talking with a provider, consider briefly familiarizing yourself with the CDC’s list of possible risk factors — which includes mental health conditions and mood disorders like depression, the amount of physical activity you get and being a current or former smoker — so you’re prepared to answer their questions.

Also, be very clear with whomever you speak 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.

Paxlovid supply can vary, and if you obtain a prescription for Paxlovid and ask for it to be filled at your closest pharmacy or the pharmacy you regularly use, you may find that this location does not in fact have any current supply. In that case, your provider could ask you to call other nearby pharmacy locations yourself, to check whether they have supply. If this happens, you may find that the only way to speak directly to a pharmacist is to select the option for prescribers or doctors.

If you have insurance, be aware that if you ask for a Paxlovid prescription to be sent to a pharmacy that turns out not to have any, you’ll likely have to cancel the order at that pharmacy before another location can fill it for you. That’s because if you don’t, your insurance will think you’re trying to fill the prescription again.

1. Call your health care provider to get your prescription

If you have health insurance, the first thing you should do is contact your health care provider — or, if you’re able to, your regular primary care provider.

Tell your health care provider that you’ve tested positive for COVID, and that you’re interested in Paxlovid or another COVID antiviral drug. Having access to your health care records, your provider will be able to judge whether you’re eligible for these drugs, and weigh your risk factors with your symptoms.

Tell your provider about any other medications you’re taking, as COVID antiviral drugs can have dangerous interactions with other drugs. Be clear with your 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.

If your provider believes you should receive Paxlovid or another COVID antiviral drug, they will give you a prescription, which you can then go fill at a location in the Bay Area that has supplies of that drug available.

Ask your provider whether they’re able to assist you in finding a location to fill your prescription — some providers may make calls to local pharmacies and suppliers on your behalf. You can also try using the Test to Treat site locator map to find locations that are filling Paxlovid prescriptions: Input your location, then look for the “Locations to fill a prescription” section.

2. Find a Test to Treat site 

If making contact with your regular health care provider is proving difficult, you could try a Test to Treat site.

Test to Treat sites are places where you can get tested for COVID and potentially treated for it by being prescribed COVID antivirals on-site. 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.

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 have health insurance, you can visit any Test to Treat site near you. You can call the Test to Treat call center at (800) 232-0233 (TTY 888-720-7489) — assistance is available 5 a.m. to 5 p.m. PT Monday–Friday, and 5 a.m. to 2 p.m. Saturday–Sunday, 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. PT, or email DIAL@usaginganddisability.org.

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.

3. Use Sesame Care, the state’s official telehealth service

Sesame Care‘s COVID services are provided in collaboration with the California Department of Public Health to support people without insurance — but it’s also available to you if you have insurance but are having difficulty connecting with their health care provider within 24 hours of getting a positive COVID test.

Even though you technically no longer require proof of a positive COVID test to receive a Paxlovid prescription, Sesame Care asks that you only request an appointment if you have a positive COVID test and symptoms of COVID.

Visit sesamecare.com/covid to make a free phone or video appointment through Sesame Care, or alternatively call (833) 686-5051 (6 a.m. to 4 p.m PT, seven days a week). When you speak to a provider through Sesame Care, they’ll prescribe you Paxlovid “if appropriate,” which will either be mailed to you or made available at a pharmacy near you.

This Sesame Care consultation and the Paxlovid prescription should be free. Sesame Care’s site says that if you are asked to pay for any of these services, you should call Sesame Care at (888) 897-1244 so that they “can follow up with the pharmacy.”

Be careful only to use Sesame Care’s free COVID care webpage at sesamecare.com/covid and not click away to other parts of Sesame Care’s website. Sesame warns that if you enter Sesame Care’s regular website, you’ll be charged for its services.

4. Visit a CVS pharmacy (but be aware of the potential cost)

CVS pharmacies offer a range of testing and treatment options for COVID. To start the process to be prescribed Paxlovid, you can complete the online screening, which will then prompt you to schedule a call with a CVS pharmacist.

Please be aware that there are several key things to know about getting Paxlovid through a CVS pharmacist that will complicate this process:

• • You will be charged $60 for a consultation with a CVS pharmacist, which you can pay by cash or out of your health savings account (HSA) or with your flexible spending account (FSA) card. Your insurance may cover this cost, but it’s not guaranteed.
  • You will be charged this $60 fee even if the CVS pharmacist does not prescribe you Paxlovid. 
  • You can’t get Paxlovid through CVS if you are using Medicare or Medicaid, which CVS says is due to federal regulations.
  • You must have had blood work completed within the last 12 months, including blood work that looks at your liver and kidney function, for the CVS pharmacist to refer to in order to prescribe you Paxlovid.
  • You must not have kidney or liver disease.

If you are ineligible for Paxlovid because of any of these factors, remember that CVS will still charge you $60 for the consultation, and you’ll still have to find a Paxlovid prescription somewhere else.