The Debate Over the COVID-19 Test to Treat Program
Key takeaways:
The Test to Treat initiative was launched by President Joe Biden’s administration to create one-stop centers where patients could be tested for COVID-19 and be prescribed antivirals.
The position of the American Medical Association (AMA) is that allowing antivirals to be prescribed without a primary care physician’s input oversimplifies the decision-making process and is a threat to patient safety.
The American Pharmacists Association (APhA) feels it is a positive step forward, but believes that all pharmacies, and not just those with an on-site clinic, should be able to provide both testing and treatment services.
The Test to Treat initiative was launched in March 2022 in an effort to provide Americans with immediate access to COVID-19 treatments. It allows someone who tests positive for COVID-19 to receive treatment at select pharmacies, long-term care facilities, and Federally Qualified Health Centers (FQHC).
In response, the American Medical Association (AMA) and American Pharmacists Association (APhA) both issued statements taking a stance on the initiative. Here, we’ll look at the details of the Test to Treat program and also the opinions of the AMA and APhA.
What is the Test to Treat program?
The Test to Treat initiative was announced by the Biden administration on March 8, 2022, as part of their National COVID-19 Preparedness Plan. It identifies one-stop Test to Treat locations, where patients can be tested and prescribed antivirals for COVID-19. One of those sites is pharmacies with an on-site clinic that is staffed by a provider, like a physician’s associate or nurse practitioner.
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The federal government, through the Department of Health and Human Services, will allocate and distribute the antiviral medications to all sites participating in the Test to Treat program. The two treatments being provided through the program are molnupiravir (Lagevrio), which is made by Merck, and nirmatrelvir (Paxlovid), which is made by Pfizer.
In addition to treatment being provided for those who test positive on site, people who use at-home testing or go to a different testing site will also be able to get COVID-19 treatments at participating locations. (If a person uses an at-home testing kit, they can bring in the kit with the positive result to receive treatment.) Testing and treatment under the program are free of charge.
Finally, this program does not change prescribing privileges for any healthcare provider. Any provider with prescribing authority can write a prescription for the antivirals, which can be filled at any pharmacy, including those participating in Test to Treat. Pharmacists are still not able to prescribe the antivirals; they dispense the medication prescribed by other providers.
Telehealth is also available through some Test to Treat sites.
The goals of the Test to Treat program
A major goal of the Test to Treat program is to remove barriers to treatment. That includes giving people access to testing locations near their home.
In removing barriers to testing and treatment, the administration’s aim is to give people the chance to self-isolate more quickly and slow the spread of the virus.
One key to this plan is that people will be able to take the antivirals early, which is crucial to their effectiveness. Both antivirals must be started within 5 days of the onset of symptoms.
What is the debate about?
The Test to Treat initiative sparked a range of responses, the most notable of which came from the AMA and the APhA.
The AMA perspective
In their formal response, the AMA wrote that the initiative's approach oversimplified prescribing decisions and was a risk to patient health. According to the statement, leaving out a primary care physician oversimplifies these decisions “by omitting knowledge of a patient’s medical history, the complexity of drug interactions, and managing possible negative reactions.”
The statement emphasizes these reasons for the AMA’s position against the one-stop Test and Treat sites:
Numerous drug interactions
Age restrictions
Adverse effects
Warnings and precautions
The AMA writes that expanding antiviral prescribing to on-site pharmacy clinics is extremely risky because these clinics typically treat simple infections, but COVID-19 is a complex disease.
The APhA perspective
The title of the APhA statement declares that the Test to Treat initiative “recognizes pharmacists, but barriers should be removed.”
In the statement, the APhA applauded the inclusion of pharmacies with on-site clinics in the Test to Treat program. However, they also argued that the plan does not go far enough because it does not allow all pharmacies to participate, only those with an on-site clinic.
From the APhA’s perspective, pharmacists should be allowed to prescribe and be reimbursed for antivirals in order to expand access, especially in underserved areas.
What comes next?
The Test to Treat program already has hundreds of participating locations all over the country. So far, the federal government has not responded to either association’s statements or the ensuing debate.
Instead, since launching in March, the administration has worked on expanding access to antivirals by making it easier for pharmacies to order them. It has also tried to make distribution of the medication more equitable, by expanding the number of Test to Treat sites, educating providers about the medications, and providing more resources for those who are immunocompromised.
In May, the program was further expanded to improve access in hard-hit, high-risk, and underserved areas. These new federally funded Test to Treat sites are required to provide same-day or next-day services at no charge to the patient and are located in areas that fit specific criteria.
The new sites area located in areas that:
Previously had few participating locations
Currently have a medium to high community level of COVID-19
Are socially vulnerable
Are in a county or parish that has a large racial or ethnic minority population.
The bottom line
The Test to Treat initiative was launched to increase access to COVID-19 testing and treatment services. A major part of the initiative was the creation of one-stop Test to Treat centers, where patients can get tested and prescribed antivirals during the same visit.
The AMA and APhA have come out against different aspects of the program, but the government has not issued a response to either organization. It has, however, implemented multiple initiatives to expand the program since it was first instituted.
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