President Joe Biden’s plan to expand access to covid-19 pills through “Test to Treat” programs at pharmacies faces a major limitation: Only doctors can prescribe the drug.
“We’re launching the ‘Test to Treat’ initiative so people can get tested at a pharmacy, and if they’re positive, receive antiviral pills on the spot at no cost,” the president said Tuesday in his State of the Union address.
The announcement sparked excitement and praise from experts, since the medicine — Pfizer’s Paxlovid — reduces the risk of hospitalization or death by 88 percent when taken early in the course of disease. “My first reaction was one of optimism,” said Julie Ann Justo, an infectious disease clinical pharmacist at the University of South Carolina.
She and other clinicians assumed the Biden administration would use its emergency powers to allow pharmacists to prescribe the pills, as it did for some covid antibody treatments. But that is not the case — meaning that for now, “Test to Treat” is limited to pharmacies that have on-site medical clinics.
To Justo, that’s a missed opportunity. What’s being rolled out “is different than what a lot of us clinicians initially assumed ‘Test to Treat’ would be,” she said. “It’s still helpful, but a lot more scaled back.” CVS, one of the drugstore chains Biden said would participate in “Test to Treat,” has nearly 10,000 locations in the United States. But only about 1,100 have on-site clinics.
Only a couple hundred pharmacy-based clinics will initially participate in the program, along with select community health centers, long-term care facilities and Department of Veterans Affairs locations, federal officials told public health and healthcare stakeholders on a call Tuesday. Currently, only doctors and — in some states — physician assistants and nurse-practitioners can prescribe the drugs.
“Based on what I’ve heard so far, I’m not sure [the program] is much of an advance,” said Susan Davis, a professor of clinical pharmacy at Wayne State University, since pharmacy-based clinics can already administer tests and treatments. While it’s good to raise awareness that such “one-stop shops” for testing and treatment exist, she said, “I don’t think it expands access. It’s not giving another pathway, it’s just emphasizing one that already exists.”
Throughout the pandemic, pharmacies have been crucial in expanding access to testing and vaccines. Adding treatments to the arsenal of community pharmacies would go a long way toward closing access gaps, Davis said. “Pharmacists are the most accessible healthcare providers,” she said, and are often the easiest point of contact for medical care in many rural and underserved communities.
But allowing pharmacists to prescribe medications is a controversial issue, and only a handful of states allow it under certain conditions. The federal government can step in during public health emergencies and override the normal limitations, using powers outlined in the Public Health Readiness and Emergency Preparedness Act.
It last did so in September, when the department of Health and Human Services used its PREP Act authority to allow pharmacists to prescribe certain covid therapeutics, including monoclonal antibodies.
Many health experts suspect the government has not expanded the pool of prescribers for Paxlovid and another, less-effective, covid antiviral — Merck’s molnupiravir — because the drugs interact in potentially harmful ways with many common medications. Some people may not be able to safely take the covid drugs because of drug interaction concerns; others may need to have dosages of their regular medications adjusted.
“To me, pharmacists are the medication experts; we’re the profession most qualified to make those assessments and adjustments,” Davis said. In response to Biden’s plan, the American Pharmacists Association said it will continue to work with the federal government to make it easier for pharmacists to prescribe these drugs and “unleash the power of our nation’s pharmacists to provide this needed care, particularly in underserved communities.”
Another issue that could limit Biden’s “Test to Treat” initiative is the relatively limited supply of Paxlovid. The U.S. has ordered 20 million courses from Pfizer, but so far only about 513,830 have been distributed to pharmacies. During his speech Tuesday, Biden said a million more Pfizer pills will be coming in March — enough to treat about 50,000 people.
Although the number of new infections is falling across much of the nation, health experts say that fast and equitable access to covid treatments will be especially important as the U.S. shifts away from collective coronavirus protections, like masking, toward those focused on individuals — including antiviral pills for the sick.
Providing access at pharmacies with doctors is a good first step but not enough, said KJ Seung, a senior technical adviser to Partners in Health, a global health nonprofit organization. “The people at high risk for death from covid-19 are the elderly, the non-English speakers, the poor,” he said, “these are exactly the ones who are least likely to access such a system.”