The Biden administration last week introduced a new "Test to Treat" initiative that would allow individuals who test positive for Covid-19 at pharmacies to also receive antiviral pills free of charge. And while some praise the program for expanding quick access to potentially life-saving drugs, industry groups are voicing concerns.

The Biden administration's 'Test to Treat' initiative

During his State of the Union address last week, President Joe Biden introduced a new "Test to Treat" initiative that will allow people who test positive for Covid-19 at a pharmacy to receive antiviral pills "on the spot at no cost."

How to improve access to Covid-19 treatments

According to Jeff Zients, the White House Covid-19 response coordinator, hundreds of "One-Stop Test to Treat" locations will open this month around the United States. These locations include pharmacy chains with onsite clinics, such as CVS, Walgreens, and Walmart, as well as long-term care centers, community health centers, and veterans' health centers.

Cameron Webb, a senior policy advisor for equity on the White House Covid-19 response team, said the new initiative helps streamline the process of getting antiviral pills, particularly for those at high risk of severe Covid-19 outcomes.

"[A high-risk person with Covid-19 would] have to identify that they have symptoms. They have to get a test, get a test result, contact a provider who can prescribe the medication, get that prescription sent over, and then go pick up that prescription. That's six different steps," Webb said, but the "Test to Treat" initiative would "compress that timeline" by allowing patients to get tested, prescribed, and receive the pills in one visit.

Separately, Michael Ganio, a senior director at the American Society of Health-System Pharmacists, agreed, saying, "I think it's a step in the right direction in trying to make the process more seamless for patients."

Industry groups voice concerns, push for expansion

In response to the initiative, the American Medical Association (AMA) expressed concerns that it would bypass the expertise of primary care physicians, who the organization argues are the most suited to prescribe treatments.

"Leaving prescribing decisions this complex in the hands of people without knowledge of a patient's medical history is dangerous in practice and precedent," AMA wrote in a statement. "We urge patients who test positive for Covid-19 to contact their physician to discuss treatment options."

However, a quarter of Americans do not have primary care providers, and Webb noted that they are the ones who would likely benefit the most from the "Test to Treat" program. He added that the administration recommends people with easy access to primary care providers consult them about treatment first—which AMA said was "reassur[ing]."

On the other hand, the National Community Pharmacists Association (NCPA) and the American Pharmacists Association (APhA) both said the program was too restrictive.

Currently, only pharmacies with onsite clinics are eligible to participate in the program, which are often only available in certain areas. For example, CVS has almost 10,000 pharmacies nationwide, but just 10% of them have Minute Clinics with on-site prescribers.

Rural areas in particular are less likely to have access to eligible pharmacy-based clinics, according to Theresa Tolle, president-elect of APhA.

In addition, NCPA and APhA said they believe pharmacists should prescribe Covid-19 antivirals themselves, instead of relying solely on clinic providers for prescriptions. Under FDA's authorization for the antiviral pills, only "physicians, advanced practice registered nurses, and physician assistants that are licensed or authorized under state law to prescribe drugs" are allowed to prescribe the drugs.

However, NCPA president Michele Belcher said pharmacists have already acted as prescribers during the pandemic. Under an amendment to the PREP Act made by the Biden administration last fall, pharmacists were authorized to order and administer certain Covid-19 treatments, including monoclonal antibodies.

Pharmacists are also well-qualified to handle any prescribing challenges that come with the antiviral pills, including potential drug interactions and negative effects.

"Pharmacists are medication experts," said Susan Davis, a pharmacy professor at Wayne State University and former president of the Society of Infectious Disease Pharmacists. "We have been managing drug interactions and dose adjustments routinely for decades. We could handle this."

According to Belcher, NCPA has written to FDA about expanding the "Test to Treat" program to include pharmacists. "With the appropriate guardrails in place, I think that we could certainly get to a place where the FDA, the AMA, feel comfortable with a similar type of ability for pharmacists to be able to test and treat," she said. (Putka, MedPage Today, 3/8; Huang, "Shots," NPR, 3/8)