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Limitations to the program include limited supply of the drugs and pharmacies lack of ability to prescribe.

Pharmacies were key to rolling out vaccines to millions of Americans quickly, and under a new pandemic response plan promoted by President Joe Biden, drugstores will be deployed once again to deliver a powerful tool against COVID-19 — an antiviral pill that can reduce the chances of hospitalization and death by 88%. But the new initiative, called Test-to-Treat, will not work as easily as Biden made it sound during the State of the Union address last week, when the president described pharmacies as one-stop shops where, “People can get tested … and if they’re positive, receive antiviral pills on the spot at no cost.” Unlike the vaccines, antiviral pills require a doctor’s prescription. That means only pharmacies with an on-site clinic and doctor can test and treat patients as envisioned in the White House plan, which also proposes using community health centers, long-term care facilities and Department of Veterans Affairs centers for Test-to-Treat.

The federal initiative will face other limitations, including a scarce supply of antivirals, inadequate testing and a significant number of uninsured Americans who do not have a regular doctor.

Biden said in his address to the nation that the federal government has “ordered more of these pills than anyone in the world,” and that the drug manufacturer, Pfizer, is working on delivering 1 million pills in March and 2 million in April — two to four times more than the 500,000 that have been distributed to all states to date. according to the U.S. Department of Health and Human Services, Kansas has received a combined 3,488 doses of Paxlovid and Molnupiravir and Missouri has received a combined 4,774 does of the two drugs.

But without giving pharmacists the authority to prescribe antivirals to COVID-positive patients, the White House will not be able to deliver on the promise of faster, easier access to potentially lifesaving treatments, said Michael Jackson, CEO of the Florida Pharmacy Association, told the Miami Herald. “We’ve literally put millions and millions of vaccines into the arms of patients,” he said. “That distribution system made a huge difference and we can make a difference here.”

Which Pharmacies Will Participate?

While Test-to-Treat is less than a week old and regulators and eligible providers are already registering to participate and order antiviral drugs directly, Biden administration officials said the government will launch a website in mid-March where patients can find locations participating in the program, along with information on where they can get free masks, tests and vaccines. Walgreens and CVS Health issued statements when asked about plans for participating in Test-to-Treat, and neither pharmacy company would say exactly how many or which of their stores will offer testing and treatment for COVID-19 on site.

Doctor’s Perspective

A CVS Health spokesman said the company’s pharmacies with walk-in clinics, known as MinuteClinic, are “uniquely positioned to help support the Government’s Test-to-Treat initiative.”

But doctors, Florida’s health department and the manufacturers of the new COVID-19 antiviral pills, which received the Food and Drug Administration’s emergency use authorization in December, said the drugs pose a greater safety risk for patients than the vaccines. One pill, called Paxlovid and manufactured by Pfizer, has significant risk of adverse effects due to interactions with other drugs, including analgesics, anti-HIV medications, and even St. John’s Wort, an herbal product. A second pill, called Molnupiravir, is not authorized for patients who are younger than 18 or pregnant or breastfeeding. Both drugs must be taken within the first five days of symptom onset.

The American Medical Association, the largest group representing physicians in the United States, issued a statement soon after the White House unveiled its Test-to-Treat initiative last week warning against allowing pharmacists to prescribe antivirals. “The pharmacy-based clinic component of the test-to-treat plan flaunts patient safety and risks significant negative health outcomes,” said Gerald E. Harmon, a physician and AMA president, in a prepared statement.

Pharmacists Want Power to Prescribe

Yet pharmacists are not only one of the most accessible healthcare providers, they’re also one of the most knowledgeable about drug interactions and their potential adverse effects on patients, said Dr. Timothy Loftus, a physician and attorney who leads the University of Miami’s Health Disparities Project, an initiative to address the pandemic’s disproportionate impact and ongoing toll on low-income and minority communities.

“I can’t think of anybody better to watch out for drug interactions than a pharmacist,” he said. “People trust their pharmacist.”

States or the federal government could authorize pharmacists to prescribe COVID-19 antiviral medications through a standing order from a State’s Surgeon General or through a declaration by the federal government using the Public Readiness and Emergency Preparedness or PREP Act, which was invoked in March 2020 for COVID-19 tests, vaccines and other drugs and preempts state requirements on who can prescribe, dispense or administer therapeutics.  

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