But molnupiravir is a much less effective drug, and many doctors have been reluctant to prescribe it. "It's an alternative rather than a first-line drug, and I think that's why the utilization is lower," says Dr. Rajesh Gandhi, of Mass General Hospital in Boston, who helps develop COVID-19 treatment guidelines for the NIH and the IDSA, a medical society.
An ICER committee voted (PDF) 11-2 that the evidence on molnupiravir was inadequate to demonstrate a net health benefit over symptomatic care alone. Paxlovid, for its part, won all panelists’ favor with 13 votes, while a slight majority of panelists (7 to 6) found current evidence on fluvoxamine acceptable to demonstrate benefit over symptomatic care.