Test and Treat Sparks New Healthcare Debate

AMA raises concern about pharmacists providing antiviral therapy.

In President Joe Biden’s State of the Union address, he announced the launch of a Test and Treat Initiative, where consumers testing positive for COVID-19 at certain pharmacies will be given antiviral therapy by an on-site provider on the spot and at no cost

However, there’s already a debate about who should be able to prescribe these antiviral pills as the U.S. Department of Health and Human Services (HHS) began distributing them in the last few weeks.

The American Medical Association (AMA) expressed concern about the initiative allowing a provider without an established patient-doctor relationship with the consumer to prescribe the pills.  In other words, the AMA is uncomfortable with pharmacists or anyone else without an ongoing and well-established medical relationship with the patient prescribing anything under the initiative.  According to the AMA, one of the antivirals to be prescribed has over six pages of drug interactions that would require patients to modify or even stop other prescriptions they are taking.  The organization stated that prescribing these without full patient history and ongoing monitoring sets a very dangerous precedent because while these pharmacy-based clinics are equipped to treat simple conditions, COVID-19 and the antiviral medications that treat it are too complicated for this on-site service.

On the flip side, pharmacists believe they should be able to prescribe the antivirals if the initiative hopes to meet its stated goal of providing the most vulnerable and underserved Americans with access to lifesaving treatment.  Pharmacists believe that expanding the power to prescribe these pills beyond just on-site providers would not only expand access to the initiative but also would be an obvious and safe choice considering pharmacists’ extensive knowledge of medication and side effects. 

When asked about the reach of the initiative, pharmacists say that not only should the program be expanded to include a lot more pharmacies nationwide, but that the best way to do that would be to allow them to prescribe the antiviral pills. However, currently the Test and Treat initiative limits participating pharmacies to just those with onsite clinics with a provider.

These types of pharmacies are far less likely to be found in rural and sparsely populated areas.  For example, CVS Minute Clinics, which would be eligible to prescribe antivirals under the initiative, make up only 10 percent of all CVS Pharmacies. By limiting the ability to prescribe the antiviral pills to these pharmacies with on-site providers, thousands of other pharmacies across America are ineligible to participate, many in areas that serve some of the hardest hit populations and populations without insurance.   

Additionally, pharmacists also believe they would be the perfect prescribers of the antiviral pills.  In fact, they say they have already been prescribing some COVID treatments since last year under other federal statutes. Pharmacists also have extensive knowledge about medication, of course, and understand potential interactions and side effects.  When asked about the issue, one professor of pharmacy even called pharmacists “medication experts”.

After the AMA issued a statement about their concerns, the Biden administration encouraged people who do have a regular health care provider to continue seeing that provider for testing or when they’ve received a positive COVID-19 test at a treatment site.  This appears to have pacified the AMA and other physicians’ worries for the time being. However, there is still a very real concern for Americans without insurance and without access to a primary care physician.

As antiviral pills have begun arriving at pharmacies that signed up for the initiative, a federal website to search and find locations has yet to fully launch but is expected by months end. 

With COVID-19 cases falling, increased vaccine and testing availability, and now increased treatment options, Americans are rapidly moving towards a new normal as we hit the two-year anniversary of COVID-19 lockdowns.

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