Disparities in Latinx patients receiving COVID-19 treatment ‘blatantly appalling’ says NC health official

Dr. Shannon Dowler

Latino residents of North Carolina are likely not getting access to a COVID-19 treatment promoted as preventing hospitalization and death.

Dr. Shannon Dowler, chief medical officer for the state Medicaid program, called the disparity between Latinx patients and others receiving monoclonal antibody treatment “so blatantly appalling.”

DHHS officials presented information that showed that not all residents have the same access to the therapy, and Latinx patients likely being underserved.

Dowler spoke to LATIN-19, a group of Latinx doctors, other medical professionals, community outreach workers, and health program managers who aim to improve access to COVID-19 information, testing, and treatment in Latino communities. Dowler and Angela Cullicutt, a public health nursing manager with the state Department of Health and Human Services, asked those in the meeting for ideas to improve access to monoclonal antibodies.

Monoclonal antibodies are made in labs and work like antibodies the body makes. Monoclonal antibodies attach to viral particles and prevent them from infecting cells.

Monoclonal antibodies are not a substitute for COVID-19 vaccinations, health officials say. The treatment is available to people 12 and older and who are at high risk of serious illness. It is given by IV or injection. The treatment must start within 10 days of the onset of symptoms. It is used for people who have mild to moderate symptoms.

The patient data Dowler presented covered the first half of this year and applied only to people who used Medicaid.  About 25% of the state’s population, or about 2.6 million people, use the government health insurance. Information on people who used private insurance or were uninsured was not presented.

A chart Medicaid of claims for monoclonal antibody treatment showed more than 700 were submitted for non-Hispanic patients, while Hispanic patients represented a small fraction of the claims.

Dowler said one of the Medicaid managed care providers supplied updated numbers that were better, with Latinx patients representing about 25% of the claims.

The numbers were closer for Black and white Medicaid patients. Between 400 and 450 Medicaid claims were filed for white Medicaid recipients, and between 350 and 400 were filed for Black recipients.

Dowler called it “a small disparity… but pretty close.”

The disparity for Native Americans was “significant,” and consistent with the lack of access to testing and vaccines, she said.

Policy Watch reported last month on significant gaps in information about monoclonal antibodies and lack of access in some parts of the state. No federally-qualified health centers in the state, which are important in providing healthcare in rural areas and to marginalized populations, were offering the therapy.

Not all counties have providers offering the treatment, according to a DHHS map presented Wednesday.  Most counties have at least one or two. Large counties have more. Wake has six, according to the DHHS map, and Mecklenburg has 16. But about 20 counties have none.

Dowler said, for example, there is no place in Madison County to get the treatment, the closest location is an hour’s drive, and the wait is more than 10 days. There’s a “real need” for geographic equity, she said.

Information about the therapy has been slow to get to patients and healthcare providers.

A map derived from Medicaid claims data showed that no residents in some western counties, no residents of counties surrounding Rowan County, in a cluster of five counties in the south-central part of the state, and a few other others, had residents using Medicaid who had received monoclonal antibody treatment.

DHHS was preparing a big plan to get monoclonal antibodies to more locations that included using vendors at rural health care centers, Callicutt said. But the federal government changed the rules for distribution last week in the face of sudden high demand. Medical centers and states can no longer put in their own orders. The federal government determines how much each state receives.

“We realize there is a vast need out there,” Callicutt said.

There can be financial hurdles, too. The monoclonal antibodies themselves are free to patients, but providers can charge fees for administration. Medicaid and Medicare pay those fees, but uninsured people or insured people with high deductibles could be billed around $500, Callicutt said.

“It’s a costly service to provide,” she said.

Patients must be observed for an hour afterward after the infusion.

Federally-qualified health centers aren’t paid soon after they provide the service, but are reimbursed once a year. The health centers cannot afford the upfront costs involved with offering the therapy, Dowler said. DHHS is trying to think of a way to help with those expenses, she said.

“We think it’s a critical tool,” she said.

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