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Evusheld Guide

01/2023 NOTE: Evusheld is no long effective against current Covid variants as of 01/2023 FDA announces evusheld not currently authorized (fda.gov)

Tips and information to help immunocompromised get the covid protection they need.

About This Guide

We wrote this guide to help people who need Evusheld or think they might. The guide explains how Evusheld works and who needs it, and gives you some relevant background on immunity and on what causes people to be immunocompromised. And it gives practical advice on figuring out whether you qualify for Evusheld, finding a supplier and convincing a doctor to prescribe it for you.

At the end of the guide are links to some scientific and medical articles that explain these matters in more detail, for those who are interested. The articles there are some of the ones we read in order to write this manual. While we are not scientists or doctors ourselves, we do have training in statistics and research design, and read up on Evusheld, COVID-19 and immunity so that we could give you accurate information. And we consulted with an oncologist, a biologist who is herself taking immune-suppressing drugs, and a person who has a PhD in pharmacology. The information here is good. If you have suggestions or questions about the content, please email: evusheld-data@relyeas.net

ABOUT EVUSHELD

What is Evusheld?

Evusheld is a medication that gives people whose immune system isn’t working well some extra protection against covid. Most people’s immune systems produce antibodies when they get the covid vaccine, and the antibodies, along with some other blood cells, work to fight off the virus if the person gets infected. But people with suppressed immune systems do not make antibodies, or do notmake enough of them when they are vaccinated. Evusheld gives them a supply of long-lasting antibodies. It is given as 2 injections right in a row on the same visit. You need to have a prescription from a doctor to get it.

Evusheld gives protection that lasts for about 6 months. It depends partly on which new COVID variants are dominant. Evusheld reduces the chance of hospitalization for COVID by about 80%. Most doctors recommend that Evusheld should be given in addition to COVID vaccinations and boosters. (Evusheld can’t be given at the same time as a vaccination. You need to wait at least 2 weeks after a vaccination or booster to get the Evusheld shots.) The combination of Evusheld and vaccination can often make an immunocompromised person about as protected as a normal person from becoming severely ill if they become infected with COVID.

Evusheld was initially given an Emergency Use Authorization on December 8, 2021. On June 29, 2022 it revised its recommendation to include repeat dosing of Evusheld every 6 months for those who qualify for the drug. The FDA is monitoring the performance of Evusheld against new variants, and believes it is currently still effective against the COVID variants that are circulating.

Evusheld sometimes has side effects, and it may not be a good idea for people with certain medical conditions to receive Evusheld. Here is a link to more information about Evusheld from the FDA (Food and Drug Administration).

Who needs Evusheld?

Two kinds of people need Evusheld: people who are unable to get the COVID vaccines because of allergic reactions, and people who are immunocompromised. If you are in the first group, a lot of this manual does not apply to you. You can skip ahead to the “How Do I Get Evusheld” section, and look through our site’s information about places in your state with available Evusheld. When it comes to convincing a doctor to give you Evusheld, the doctor may or may not agree. If you are young and in good health, the doctor may feel that your chance of severe illness from COVID is low, even if you are unvaccinated. Older people, and younger ones with risk factors (asthma, obesity, diabetes, etc.) who are allergic to the vaccine may have an easier time getting a doctor to give them Evusheld.

Most people who need Evusheld are not allergic to the vaccine, but are immunocompromised. “Immunocompromised” means their immune system does not work well. It doesn’t do a good job at fighting real infections, and does not make enough antibodies when the person gets vaccinated against an illness. (Sometimes people use the terms “immunosuppressed” or “immunodeficient.” They all mean pretty much the same thing.) There are two main things that can lead to someone being immunocompromised. They can have a disease or condition that keeps the immune system from working right. Or, they can be having treatment for another disease, and the treatment itself suppresses the immune system.

For more info about being immunocompromised, have a look at this Wikipedia article.

Wouldn’t my doctor have told me if I needed Evusheld?

Not necessarily. There have been a lot of things about the way Evusheld has been introduced that have led to doctors not offering it to some people who need it. It was shipped out in a hurry, and not well-publicized. And Evusheld was not shipped directly to doctors — your doctor does not have any at the office. Some doctors do not know a lot about exactly who qualifies for Evusheld and how much is available. Some doctors are so busy they have not had time to contact all the patients they have who qualify for Evusheld. So we recommend that you do your best to figure out on your own whether you qualify, then contact your doctor if you think you do. If your doctor has told you in the past that you are unusually likely to get infections, that probably means that the doctor thinks you are immunocompromised. If the doctor has not said that, we recommend that you read what follows to try to get an idea whether you are.

You could try just skipping the research and asking your doctor whether you are immunocompromised and need Evusheld. However, we have heard a lot of stories from people who did that and were told by their doctor that they did not qualify or that there was no Evusheld available. So we think it is better to be prepared in advance with information about why you may qualify, and how much Evusheld is available near you, so that when you talk to your doctor you are all set to make a good case if you meet opposition.

How do I know whether I am immunocompromised enough to need Evusheld?

The truth is, there is a lot of uncertainty among doctors regarding this exact question. Some are not clear about the guidelines the CDC (Center for Disease Control) and FDA (Food and Drug Administration) have given regarding Evusheld. Others are, but see that there are a lot of judgment calls to be made regarding who, exactly, qualifies for Evusheld. If a doctor has told you you do not qualify for Evusheld they may or may not be right. Then again, they may be uninformed about the guidelines, or informed but just making a different judgment call than another doctor would. In this section we are going to fill you in as well as we can about the guidelines and some of the judgment calls involved. Unless you already know for sure that you are quite immunocompromised and qualify for Evusheld, you should look at them. We are sorry to be giving you all this medical information to wade through, but if you are going to advocate for yourself you need to have it.

The FDA Criteria:The FDA states that Evusheld is to be given to people who are “moderately or severely immunocompromised.” It then spells out in some detail who these people are. Table 1, below, shows the current FDA criteria.

TABLE 1: QUALIFYING FOR EVUSHELD - FDA CRITERIA

Active treatment for solid tumor and hematologic malignancies
Receipt of solid-organ transplant and taking immunosuppressive therapy
Receipt of chimeric antigen receptor [CAR-T-cell] or hematopoietic stem cell transplant (within 2 years of transplantation or taking immunosuppression therapy)
Moderate or severe primary immunodeficiency (e.g., DiGeorge syndrome, Wiskott-Aldrich syndrome)
Advanced or untreated HIV infection (people with HIV and CD4 cell counts <200/mm3 , history of an AIDS-defining illness without immune reconstitution, or clinical manifestations of symptomatic HIV)
Active treatment with high-dose corticosteroids (i.e., ≥20 mg prednisone or equivalent per day when administered for ≥2 weeks), alkylating agents, antimetabolites, transplant-related immunosuppressive drugs, cancer chemotherapeutic agents classified as severely immunosuppressive, tumor-necrosis (TNF) blockers, and other biologic agents that are immunosuppressive or immunomodulatory (e.g., B-cell depleting agents) (Added in a later publication: Patients receiving Bruton’s tyrosine kinase inhibitors)

Quoted from www.fda.gov/media/154703/download as of 6/15/2022.

We believe the FDA guidelines are the information you should show to your doctor. Doctors take government guidelines seriously. However, these guidelines are not very user-friendly, so Table 2, below, presents the guidelines broken down a little bit more for you, and with some further details about the illnesses and treatments on the list. The FDA guidelines also have a footnote adding that qualifying conditions “are not limited to” those on the table, and Table 2 also adds to the FDA list three additional conditions that we believe likely qualify people.

Finally, Table 2 contains information from an NIH (National Institute of Health) publication that gives criteria for who among the moderately and severely immunocompromised should be given priority if there was very little Evusheld available. There is not, currently, a shortage of Evusheld – in fact one third or less of the supply has been given to people in the six months the drug has been available. But we think it is useful for you to have information regarding which immunocompromising conditions the government regards as most serious.

TABLE 2: QUALIFYING FOR EVUSHELD - FDA CRITERIA (DETAILS AND EXTRA CRITERIA ADDED BY US)

Details in Bold identify conditions that appear on the NIH “short list” of conditions that give people extra priority if the supply of Evusheld is extremely limited.

Anything in italics was added by us.

A solid tumor. That means you have a cancerous mass in your body somewhere. In our research, many sources stated that tumors themselves do not suppress the immune system, or do not suppress it much. However some treatments for it do (and then again, quite a few do not).

A hematologic malignancy. That means some kind of blood cancer. Common kinds are leukemia, multiple myeloma and lymphoma. It appears that these blood cancers themselves interfere with the functioning of the immune system. Additionally, many treatments for blood cancer suppress immune functioning quite a lot. Patients with hematologic malignancies who are on active therapy receive highest priority if there is a shortage.

A solid organ transplant and are receiving immunosuppressive therapy.A “solid organ” basically means any organ — for example, a heart or kidney or liver transplant. Everyone who receives an organ transplant is given immunosuppressive drugs to prevent their body’s attacking the unfamiliar organ. Usually high doses of these drugs are given soon after the transplant. After a while, people can move to lower-dose, maintenance drug regimens, but since the FDA guidelines don’t say anything about time frames, it appears that having had an organ transplant even quite a while ago qualifies you for Evusheld. Highest priority given to lung transplant recipients,patients who are within 1 year of receiving a solid organ transplant, and solid organ transplant recipients who had recent treatment with T-cell or B-cell depleting agents (e.g. Rituximab) for acute rejection.

Chimeric antigen receptor T cell therapy(often called CAR-T) within the last 2 years. CAR-T is a cancer treatment in which immune cells called T cells are removed from the blood, engineered to fight the cancer, and returned to the body. It leaves the person quite immunocompromised for a period. Note that anyone who received this treatment within the last 2 years is given highest priority.

A hematopoietic cell transplant within the last 2 years. A hemopoietic cell transplant, also called a bone marrow transplant or a stem cell transplant, is a procedure used in treating cancer and a few other conditions. The patient is given extremely high doses of chemotherapy and/or radiation to kill the cancer cells. Such an aggressive cancer treatment also kills the patient’s bone marrow, and the bone marrow cells are later replaced with cells from the patient’s own bone marrow or with donor cells. The procedure leaves the patient profoundly immunocompromised. Note that highest priority is given to post-hematopoietic cell transplant recipients who have chronic graft-versus-host disease or who are taking immunosuppressive medications for another indication.

A moderate or severe primary immunodeficiency (e.g., DiGeorge syndrome, Wiskott-Aldrich syndrome). Primary immunodeficiency diseases are diseases where your immune system is profoundly malfunctioning. We believe these are mostly diseases that people are born with. They are not very common, and if you have one you would probably know by now. Highest priority is given to patients with severe combined immunodeficiencies.

Advanced or untreated HIV infection (defined as people with HIV and CD4 T lymphocyte counts <200 cells/mm3, or a history of an AIDS-defining illness. This means you have HIV and the disease is actively doing damage to your immune system. That damage might show up as a low CD4 T lymphocyte count, or as an illness that people without AIDS rarely get, such as Pneumocystis pneumonia. If you are HIV-positive and are receiving treatment, it is unlikely that the HIV is active enough to do this sort of damage. Note that anyone with this condition is given highest priority.

Active treatment with high-dose corticosteroids (i.e., ≥20 mg prednisone or equivalent per day when administered for ≥2 weeks), alkylating agents, antimetabolites, transplant-related immunosuppressive drugs, cancer chemotherapeutic agents classified as severely immunosuppressive, tumor-necrosis blockers, or other immunosuppressive or immunomodulatory biologic agents (e.g., B cell-depleting agents). The FDA list here is naming several classes of drugs that suppress the immune system. There are several drugs in each of these drug classes., and in Table 4 we give you a list of them. These drugs are used mainly in the treatment of cancer and of autoimmune-diseases. (Table 3 gives you more information about autoimmune diseases.). If you do not have cancer or an autoimmune disease, it is unlikely that you are taking one of these immune-suppressing drugs. Highest priority given to Patients who are within 1 year of receiving B cell-depleting therapies and patients receiving Bruton’s tyrosine kinase inhibitors.

Some criteria we have added

• Liver cirrhosis. See this qxmd.com article, which found that people who have liver cirrhosis respond poorly to vaccinations, and do not develop much immunity from vaccinations for covid.

A condition that requires you to receive immunoglobulin replacement therapy (IgG). The purpose of immunoglobulin replacement therapy is to boost a person’s antibody levels. It is given to people whose immune systems are not working properly. It seems to us that anyone who needs this treatment must be quite immunocompromised.

Lung transplant recipients. Lung transplant recipients appear on the NIH list of conditions that move people to the top of the list if there is a shortage of Evusheld. While other people who have received an organ transplant have to be receiving immunosuppressive therapy to qualify for the short list, lung transplant recipients do not. We don’t know why — perhaps lung transplant recipients are especially immunocompromised for some reason, or are almost certain to be on an aggressive immune-suppression regimen? Note that lung transplant recipients are on the list of people who receive highest priority.

Sources:

Notice that aside from a few illnesses (blood cancer, immune deficiency diseases, advanced HIV) a lot of what qualifies people is drugs that suppress the immune system. Cancer treatment qualifies people because many (though not all) of the drugs used in treatment suppress the immune system. Recent stem cell procedures or organ transplants qualify people because both require the use of particularly powerful immune-suppressing drugs. And the final item on the FDA list of qualifying conditions is a list of classes of drugs that suppress the immune system. So let’s talk about these drugs, and whether the drugs you are taking suppress your immune system enough so that you need Evusheld.

Using drugs that suppress the immune system: It might seem like a bad idea to give somebody a drug that suppresses the immune system, but there are situations where the advantages are bigger than the disadvantages. People who have had organ transplants take immune-suppressants to keep their body from rejecting the new organ. Some cancer treatments suppress the immune system, but are needed to fight the cancer. And some people with auto-immune diseases do better if they take a drug to damp down their immune system. Auto-immune diseases are diseases where the body attacks some of its own cells the way it would attack such enemies as viruses and bacteria. Immune-suppressing drugs slow down the body’s attack on its own cells, but also make the immune system less able to fight off real enemies, such as COVID.

If you are reading this manual, it’s likely you are someone who is being treated for cancer or for an auto-immune disease. Below is a table listing the most common auto-immune diseases, including information about the drug classes most commonly used to treat them. There are many autoimmune diseases besides the common ones appearing on our table. If you have an auto-immune disease, a doctor has probably told you that you do.

TABLE 3: COMMON AUTOIMMUNE AND INFLAMMATORY DISEASES AND DRUGS USED FOR TREATMENT

Diseases often treated with B cell-depleting agents or steroids are in *bold with a star next to them. Diseases often treated with other immune-suppressing drugs, but not with B cell depleters or with steroids are in bold.

*Addison’s Disease

Autoimmune Vasculitis

*Celiac Disease

*Crohn’s Disease

Dermatomyositis

Diabetes, Type 1

Grave’s Disease

Hashimoto’s thyroiditis

*Lupus

*Multiple Sclerosis

*Myasthenia Gravis

Pernicious Anemia

*Psoriasis/psoriatic arthritis

*Rheumatoid Arthritis

Scleroderma

Sjogren’s syndrome

*Ulcerative Colitis

Sources:

Notice that some of these conditions are commonly treated with immunosuppressive drugs, and others, such as Type 1 Diabetes, are generally not. (Of course, there are exceptions to this generalization. There may be doctors who try treating something like Type 1 Diabetes disease more aggressively, using immunosuppressants rather than the usual approach.) If you have an autoimmune disease that is not treated with immune-suppressing drugs, there is no reason to think your immune system is working less well than anyone else’s. You probably are as able to benefit from the COVID vaccines as someone who does not have your condition. It is also good to keep in mind that there are certain autoimmune diseases for which doctors often use particularly aggressive immune-suppressing treatments. Our impression is that Multiple Sclerosis, Rheumatoid Arthritis and Lupus generally get the most aggressive treatment.

Like treatment of autoimmune diseases, cancer treatment sometimes uses immunosuppressive drugs and sometimes does not. If you have cancer but are not taking an immune-suppression drug, your body can probably do a good job of building immunity to covid when you were vaccinated.

Different classes of immune-suppressing drugs: Table 4, below, lists drugs in all of the drug classes mentioned in the FDA guidelines. The first three classes on the table, Bruton Tyrosine Kinase Inhibitors, B cell-depleting drugs and high-dose steroids seem to be the ones the makers of the government guidelines see as most immunosuppressive – each is singled out in some way in the guidelines. Because of their special importance, we made an effort to include in the table every single drug in these classes. As for the other classes, we went with some lists we found online. These lists may not be complete. If you are taking a drug that does not appear on our list, you can google it and the information you find about the drug will likely tell you what class it falls into.

TABLE 4: DRUGS THAT SUPPRESS THE IMMUNE SYSTEM

Bruton Tyrosine Kinase Inhibitors:Especially powerful immunosuppressants used for treating some forms of leukemia and lymphoma

Acalabrutinib (Calquence)
Ibrutinib (Imbruvica)
Zanubrutinib (Brukinsa)

B Cell-depleting Agents:Powerful immunosuppressants used for cancer and autoimmune disease

Atacicept (Serono)
Fingolimod (Gilenya)
Glatiramer acetate (Copaxone)
Ibritunimab (Zevalin)
Leflunomide (Arava)
Natalizumab (Tysabri)
Obinutuzumab (Gazyva)
Ocrelizumab (Ocrevus)
Ofatumumab (Kesimpta, Arzerra)
Rituximab (Rituxin, Truxima, Riabni)
Teriflunomide (Aubagio)
Tositumomab (Bexxar)
Veltuzumab (Empliciti)

Steroids:Used for inflammatory and autoimmune disease to reduce inflammation or to suppress the immune system

Dexamethasone, 3 mg or more per day (Decadron, Intensol, Dexasone, Solurex, Baycadron)
Hydrocortisone 80 mg or more per day (Cortef)
Methylprednisolone, 16 mg or more per day (Medrol, Duralone, Medralone, M-Prednisol)
Prenisolone, 20 mg or more per day (Millipred)
Prednisone, 20 mg or more per day (Deltasone, Orasone)

Alkylating Agents:Used in cancer treatment.

Altretamine (Hexalen)
Bendamustine (Bendeka)
Busulfan (Myleran)
Carmustine (Gliadel Wafer)
Chlorambucil (Leukeran)
Cisplatin (Platinol)
Cyclophosphamide (Nerosar)
Dacarbzine (DTIC-Dome)
Diaziquone (Proglycem)
Ifosfamide (Ifex)
Iomistine (Gleostine)
Mechloretthamine (Valchor)
Mephalan (Evomela)
Mitomycin C
Oxaliplatin (Eloxatin)
Procarbazine (Matulane)
Temozolomide (Temodar)
Thiotepa (Tepadina)

Antimetabolites:Used for both cancer and autoimmune disease

Cytarabine (Cytosar-U)
5-Flourouracil (Carac)
Gemcitabine (Gemsar)
Mercaptopurine (Purinethol)
Methotrexate (Oxtrexup, Trexall, Rasuvo)
Pemetrexed (Alimpta)

Transplant-related immunosuppressive drugs:Used for transplants and for autoimmune disease

Azsathioprine (Imuran)
Basiliximab (Simulect)
Belatacept (Nulojix)
Cyclosporine (Gengraf, Neoral, Sandimmune)
Everolimus (Zortress)
Mycophenolate mofetil (CellCept)
Mycophenolic acid (Myfortic)
Sirolimus (Rapamune)
Tacrolimus (Protopic, Emvarsus)

TNF Blockers:Used for autoimmune disease

Adalimumab (Humira)
Certolizumab (Cimzia)
Etanercept (Enbrel)
Golimumab (Simponi)
Infliximab (Remicade)

Other immunosuppressive drugs:

Abatacept (Orencia)
Anakinra (Kineret)
Baricitinib (Olumiant)
Hydroxychloroquine (Plaquenil)
Ixekizumab (Taltz)
Natalizumab (Tysabri)
Secukinumab (Cosentyx)
Tofacitinib (Xeljanz)
Ustekinumab (Stelara)
Vedolizumab (Entyvio)

Sources

How much immunocompromise is too much? There has been a lot of research into how effective covid vaccination is for people who are immunocompromised for various reasons. We read some of it, and also two excellent, very thorough summaries of the literature. They are:

Here are the three main takeaways

Many immunocompromised people have a surprisingly decent response to Covid vaccination when compared to people with normal immune systems, 99% of whom develop antibodies after their covid vaccination.

These people responded pretty well to the vaccine, with 60% or more of them developing antibodies: People with chronickidney disease; with HIV but with normal CD4 counts; with immune-mediated inflammatory diseases; with no spleen; and with cancerous tumors.
These people responded moderately well to the vaccine, with 40-60% of them developing antibodies: People with blood cancers; and with HIV and low CD4 counts.
These people responded poorly, with less than 40% of them developing antibodies: People treated with B-cell-depleting agents; people who have had hematopoietic stem-cell transplant or organ transplant; and people with liver cirrhosis.

If people in these groups are given extra vaccinations beyond the usual series, their response rate improves to a moderate degree. People whose initial response was 70% or so of normal may benefit so much that they become as well-protected as someone with a normal immune system. People whose initial response was less good than that will become more protected against covid, but still not as protected as people who are not immunocompromised.
B cell-depleting therapies and Bruton Tyrosine Kinase Inhibitorsseem to be in a class by themselves among immune-suppressing drugs. In general people with autoimmune diseases and cancer respond pretty well to vaccination (though not as well as normals) despite the fact that many are taking immune-suppressing drugs. But those taking B cell-depleting drugs or Bruton Tyrosine Kinase Inhibitors respond poorly. It may be that people who take high-dose steroids are also more likely to be immunosuppressed than people on other drugs in Table 4. Since the FDA in its criteria went to the trouble of spelling out what constitutes a substantial dose of various steroids, that may mean that they, too, are more immunosuppressive than other drugs,

We hope that all this information, taken together, helps clarify for you whether you are immunocompromised, and if so how badly. Here’s a summary: You are likely to be significantly immunocompromised if you have a primary immunodeficiency disease, if you have some form of blood cancer, if you have untreated or advanced HIV, or if you had CAR-T, an organ transplant or a stem cell transplant in the last couple of years. For everyone else, it depends on what drugs you are taking. If you are taking Bruton Tyrosine Kinase Inhibitors orB-cell depleting drugs (those are the ones in the top two groups in Table 4) you are probably significantly immunocompromised. If you are taking high-dose steroids, you may also be. If you are taking anything else, you may have some degree of immunocompromise, but it is not as likely to be severe. If your degree of immunocompromise is not severe, you may be adequately protected just by getting an extra vaccination on top of the usual series, although for that too you need to qualify. Here are the government recommendations for vaccination schedules for the moderately and severely immunocompromised.

But bear in mind that the summary we just gave is actually much more conservative than the FDA guidelines. According to the FDA guidelines regarding drugs, people taking any of the drugs on Table 4 qualify for Evusheld. So if you would like to err on the side of caution and get Evusheld, even though the immune suppressants you are taking are not among the most aggressive ones, it certainly appears that you qualify. It is, though, our impression from talking to doctors that some might turn you down for Evusheld even though you are taking certain of the immune suppressants. They might, for example, say you are taking too small a dose of the drug to be very immune suppressed, or that you have not been taking it long enough. They might recommend that you simply stop taking the immune-suppressing drug for 2 weeks before getting vaccinated, and not resume it until your body has had time to respond to the vaccine by building immunity. (And that, in fact, is a perfectly valid strategy, if it is safe for you to just discontinue your immune-suppressing drug for that period.) We think, though, that doctors are much less likely to turn you down if you are taking Bruton Tyrosine Kinase Inhibitors, B cell-depleting drug, or steroids at the doses given in the table.

Is there a shortage of Evusheld?

A lot of people are immunocompromised. Of course, some might not want to get the Evusheld shot. If we use a conservative estimate of how many immunocompromised people there are, and aim to protect half of them with Evusheld, we would need 4 million doses of the drug. The US government has about 875,000 doses of Evusheld from the manufacturer. Thatis only enough for one person in 5 out of the 4 million we’d hope to protect with Evusheld. So yes, there is nowhere near enough to go around. On the other hand, the amount that’s available is being given to the public very slowly. Pharmacies and other sites have received a total of 361K doses since January of this year. Even though the drug has been available for almost six months, only about 150K doses of the supply had been given to patients as of this writing, at the middle of June 2022. The rest is on shelves waiting to be used. So few patients know about Evusheld, and so few doctors are well-informed about it, that the supply we have is in danger of going to waste.

Here are 2 articles about the problems with getting Evusheld to the people who need it. (The second one also covers distribution problems with other COVID drugs, but gets to the subject of Evusheld in the second half.)

Under the circumstances we think it is legitimate and not selfish to try to get Evusheld if you are immunocompromised. You will not be taking it away from somebody else. You will be taking it out of storage.

How much does Evusheld cost?

The drug itself is free. There often is a charge for administering it, which most insurance should cover.

HOW DO I GET EVUSHELD?

Look over the sites near you that have it

Our website is set up to help you locate all the Evusheld providers near you. You will be able to see how much Evusheld each one currently has. We think the site is pretty user-friendly, but here are some instructions. If you don’t feel like you need help using the site, go ahead and use the dropdown menu on the main page (covidsafe.fyi/evusheld) to look at providers in your state.

To start, go to the main page of this site: covidsafe.fyi/evusheld. To see info for your state, click on the bar at the top of the page that says <state>. A list of all the states will appear, and you can select yours. Or, you can click on your state in the US map on the main page.

Here’s the information you’ll see at the top of the page after you pick your state. We picked New Jersey for our example.

If you click on one provider you get taken to more information about it.

You can see from the graph that Hackensack U Medical Center got a shipment of 200+ doses of Evusheld on 2/15 and another 60 or so on 2/22. Their inventory dropped over the next couple weeks, then on 3/8 they restocked. If you want to see how much they had on one particular day, hover the cursor over the graph at any point. Above, we hovered it over the graph on 3/31. In the future, we hope to be able to give you a clickable link to the website of each provider, and also a phone number. Unless that info appears on the page, though, you will have to google Hackensack U Medical Center yourself to get the information.

There is also a questionnaire at the bottom of the page where you can tell about your experience with this provider, to help other searchers. We hope you will fill it out! We will not share your name or your email address.

Figure out the lay of the land in your state

Look over all the sites in your state. Evusheld was shipped to a lot of different kinds of places. Some of those are more likely than others to be willing to give you a dose. Most hospitals and outpatient clinics have Evusheld, but they often give it out only to people who are already patients at their institution. Many pharmacies and infusion centers have it, and those places are usually more willing to give doses to anyone who walks in, provided their doctors send them a prescription for you to get it. And there are some sites with odd names and it is not clear what sort of place they are. If you have an affiliation with a hospital or outpatient clinic, they are likely to be your best bet. But if you do not, pharmacies and infusion centers are the most promising.

Call some sites near you

If, wherever you call, you reach someone who seems never to have heard of Evusheld, ask to speak with the pharmacist or the person who handles medications. If you call a hospital’s main number, ask for the pharmacy or the infusion center. If you call a drug store, ask for the pharmacist.

We suggest you say something like this: “I have learned that I am eligible for Evusheld. I am calling around to help my doctor locate a place that will give it to me. Would it be possible to come to your site to get the shots?”

If they ask where you learned that they have Evusheld, it is better to tell them that you used the government site, the Covid Therapeutics Locator. It has exactly the same data as our site regarding how much Evusheld each place has available. The person you’re speaking to may not have heard of our site, and may claim that it is not accurate. They will know about the government site, though, and will not be able to wiggle out of being identified as a site with Evusheld.
If they say they do not have any Evusheld, tell them the number of doses our site shows you they are holding, and politely ask them to double-check to see how much they have. (But if they ask where you got the number, tell them you got it from the government Covid Therapeutics Locator. They are obligated to make regular, accurate reports to the government about how much they have on hand, and they are not going to want to lie to someone who has seen the number from their latest report to the government.)
If they say they do not give Evusheld to the public, only to people who qualify in some special way, ask them whether there is a way to qualify. For instance, if they are an outpatient clinic and you register as a patient with the clinic and make an appointment for some date in the future, will you then qualify?
If you try all that and there’s clearly no way you are going to get Evusheld from the place, ask them if they know a site that does give the drug to members of the public whose doctors send them with a prescription.

Try to keep going until you find a place that says they will give you Evusheld. If you absolutely cannot find one, you can go to the next step, contacting your doctor, and hope the doctor knows of a place to send you. Some do. But it is better to go to the doctor with the name and contact information of a place that will give you the med. It makes things easier for the doctor, and it also serves as proof that it actually is possible to get Evusheld (some think there is almost none available, or that it’s all in hospitals being saved for transplant patients).

Contact your doctor

The ideal thing would be to meet with your doctor in person to discuss Evusheld. If it is possible to get an appointment some time in the near future, we recommend that you do that. If not, you need to speak with your doctor directly. If your doctor uses a patient portal, or has given you their email address, you can send them a detailed message (we give a sample one below.) If you need to contact them by phone, tell the receptionist that you have an important question having to do with your ability to withstand infection. (If you must, you could even sort of imply you are ill now — though not with Covid — and feel like you are not fighting off the bug.) If you get connected to the office nurse, tell her the same, but you can add that you are interested in getting Evusheld. Unless she says “fine we’ll give you some,” push to speak with the doctor.

Sample Letter to Doctor

Dear Dr. ___________,

I recently learned that I may qualify for Evusheld. I know that it is only given to those who are moderately and severely immunocompromised, but I did not know what illnesses and medications make people immune compromised. But it appears from what I have read that I do qualify, because of [name the illness or immunosuppressive drug you think qualifies you]. Here is a bulletin from the FDA that lists the thing that qualifies me: www.fda.gov/media/154703/download. There is also an FDA site with detailed information for providers about Evusheld, covering dosage, handling, storage, contraindications, special populations, etc. It is here: https://www.fda.gov/media/154701/download The government has also set up another page for providers that allows doctors to order a si ngle dose of Evusheld, and gives them the number of a provider helpline where they can ask AstraZeneca any questions they have. (The provider page is at https://aspr.hhs.gov/COVID-19/Therapeutics/updates/Pages/important-update-27July2022.aspx. The phone number for the helpline is 1-833-388-7453.)

Also, I had heard that there is almost no Evusheld available, and that it is being saved for the sickest of the sick. However, it looks like Evusheld is being distributed very slowly, and there is quite a bit of it currently available. Here is an article about that: As New Variant Spreads, a Crucial Drug to Protect the Most Vulnerable Goes Vastly Underused (statnews.com)

Then, if you have located a site that will give you Evusheld, say this: I have searched on the government’s Covid-19 Locator and found a place that will give me the injections. It is [name & address of the place].

If you have not located a site that will give you Evusheld, say this: I have searched on the government’s Covid-19 Locator but have not yet found a place that will give me the injections. I am hoping you know of a place that provides injections. If you do not, I will keep looking until I find one, to spare you the trouble.

Either way, end the letter or email in some friendly way, saying you hope to speak with the doctor soon, and giving a phone number and times when you are reachable.

Talking with your doctor

When you speak with your doctor, start by just saying you believe you qualify for Evusheld, and asking the doctor about getting the injections. Don’t sound irritable and resentful, even if you feel that way — be polite and friendly. Hopefully your doctor will agree. If they do not, their objection will probably be one of three things: You are not immune compromised enough; there is not enough Evusheld available; or they are not comfortable prescribing Evusheld because they are not very familiar with it and have not used it before.

If they say you are not immune compromised enough, show them the FDA pageand point out the part that gives the guidelines for who qualifies for Evusheld. The page is here: www.fda.gov/media/154703/downloadDo not show the doctor our table – it will have more impact to show them a bulletin from the FDA. Tell them what condition or medication you believe makes you immunocompromised. Have the article ready to show them if they ask to see it. It is much better to have the article printed out, ready to hand to them. If you start trying to get your doctor to go look at sites online, they may refuse.

If they say there is not enough Evusheld available, tell them that you have learned that actually two thirds of the amount the government has shipped since January is sitting on pharmacy shelves, and that there is a fair amount available. Tell them about this article: As New Variant Spreads, a Crucial Drug to Protect the Most Vulnerable Goes Vastly Underused Try to have a copy of it printed out to give to the doctor. You can also tell the doctor the information from the government Covid-19 Therapeutics Locator. If you know how to do it, you can use the Therapeutics Locator at home to get a listing of all the locations in your state that have Evusheld, and how much they have, and take a screenshot of that information (it will be on the left side of the screen). Then bring that to the doctor. If you cannot do that, you can try to get the doctor to look at the locator on their computer. It’s web address is https://covid-19-therapeutics-locator-dhhs.hub.arcgis.com. Or you can show them our website. However, since they may not be familiar with our site they may distrust it.

If they say they do not know enough about Evusheld to be comfortable prescribing it, you can tell them the government has detailed online information for presribers about Evusheld. It is here: www.fda.gov/media/154701/download. You can also tell them about the provider page put up by ASPR (Administration for Strategic Preparedness and Response). It’s here: https://aspr.hhs.gov/COVID-19/Therapeutics/updates/Pages/important-update-27July2022.aspx. You can tell your doctor that the page lists a helpline to Astra Zeneca, the manufacturer of Evusheld, that providers can call if they have questions or concerns. The page also allows the doctor to order a single dose of Evusheld for you.

The information at the FDA site (www.fda.gov/media/154701/download) really does cover all the things a doctor would want to know. There are many pages of details. It covers dosaging, dosing schedules, special dosages for certain populations, possible bad reactions to it, whether and how to use it with certain populations (pregnant, elderly, people with kidney disease, etc etc.), how to store and handle Evusheld, and so on. You could even consider printing out the whole thing and presenting it to your doctor. The unusual thing about Evusheld is that doctors did not hear about it the way they do about other new drugs. Usually there are presentations and mailings by the pharmacy companies for doctors to attend where they learn about new drugs. That did not happen with Evusheld, and so for many doctors it’s kind a spooky unknown – they feel uneasy about prescribing it. Handing the doctor a sheaf of pages telling them everything they might want to know about Evusheld might just do the trick. (On the other hand, it might irritate them . . . You make the call, taking into consideration what your doctor is like.)

Fallbacks if your doctor says no

If your doctor says that you do not qualify for Evusheld, listen carefully to their explanation and make notes on it. You need to consider the possibility that the doctor is right. For instance, even if you are taking one of the immunosuppressive drugs listed on Table 4, it may be that you are taking an unusually small dose, so small that it is unlikely to make any difference in your ability to develop COVID immunity from the vaccinations. They are other valid reasons, as well, why you might not qualify.

But if you are sure you qualify, here are some further steps to take:

If you have more than one doctor, go see the other doctor and ask them to prescribe Evusheld. Tell them the truth: that the other doctor refused, but you believe you qualify. Doctors aren’t necessarily all that scared of disagreeing with each other.

Make an appointment to see an immunologist or an infectious disease specialist. Someone who specializes in either of these fields is pretty much guaranteed to know about Evusheld. Explain when you make the appointment that you want a consult to be evaluated to see if you should take Evusheld. Only make an appointment with a doctor whose office says they are willing to do that.

Contact walk-in clinics – urgent care places that take all comers, such as Minute Clinics, etc. Describe the situation and tell them you can bring documentation of the condition or medication that makes you immunocompromised. Ask if they will give you Evusheld.

Contact pharmacies near you that give Evusheld and ask if they have a doctor on staff who will evaluate you and prescribe Evusheld if you qualify. Tell them you can bring documentation.

Google “Covid hotline for [your state]”. Call them and explain the situation. We know of at least one person who got Evusheld this way.

Call your local state legislator. You can find out who they are at https://openstates.org/find_your_legislator/ A lot of these people have staff whose job it is to help out people in their district with problems like housing discrimination, unfair school practices, etc. State legislators care a lot about being seen as caring and effective, and their staff are often surprisingly helpful with the problems of an individual in their district. Your goal should not be to get your doctor in trouble — the legislator is not going to want to get involved in that, because they will lose the doctor vote! Contact them with the goal of getting Evusheld.

LET US KNOW HOW IT WENT

We hope our information and suggestions helped you get Evusheld, and we would like to hear how it went. We will pass any information you give us on to other patients (but we will not share your name or email address). We would especially like to know what worked and what did not work for you, and any suggestions you have for people in addition to the ones we give. You can send the information to:covid-data@relyeas.net

GOOD SOURCES OF INFORMATION

Here are some articles and websites where you can get further information. They include all the places we linked to in the manual, and some additional recommendations as well.