White House plan eases access to COVID-19 pills – but potential roadblocks loom

March 11, 2022

Kobi Wolf/Bloomberg via Getty Images

(NEW YORK) — Inside hundreds of pharmacies across the country, high-risk Americans who test positive for COVID-19 have been told they will soon be able to find and fill a prescription for oral medication directly at the store.

The new White House “test to treat” program, touted as a one-stop shop for antiviral pills from Pfizer and Merck, aims to create a free and streamlined approach to get sick people the lifesaving care they need, when they need it.

Although Pfizer and Merck’s COVID-19 pills were authorized in December, scarce supply has made them difficult to access.

Major pharmacies have already begun ordering their new “test to treat” supply directly from the federal government, and anticipate being able to start as early as this week. CVS will offer end-to-end access to the pills at their nearly 1,200 MinuteClinic locations as soon as this week, spokesperson Matthew Blanchette told ABC News, while a Walgreens spokesperson said patients will be able to get the antiviral pills at “select stores” where provider partners are available to assess and prescribe medication.

The idea is for everyday Americans to be able to visit their local pharmacy for a rapid test, and if positive, “you can be treated right there on the spot,” said Dr. Simone Wildes, an infectious disease expert from South Shore Health.

As clinic doors open to this new initiative, however, numerous puzzle pieces must align to ensure the smooth rollout the president has hoped for.

“We’re leaving no one behind or ignoring anyone’s needs as we move forward,” President Joe Biden said of the plan during his State of the Union address last week, emphasizing his administration has “ordered more pills than anyone in the world has.”

The program’s promised scope hinges on sufficient participating locations and drug supplies.

And in a development that could jeopardize the program’s future, House Speaker Nancy Pelosi announced this week that COVID-19 funding would be stripped from an upcoming government funding and Ukraine emergency aid package — an element hotly contested by some members.

Without this additional pandemic funding, the White House has warned there could be “dire” consequences: the U.S. could run out of pill supplies by the end of the summer.

The government has so far purchased 20 million doses of Pfizer’s COVID-19 pill, Paxlovid, although it’s not expected to be widely available until later this spring.

And there are other hurdles. Test to treat’s reach is bounded by the requirement that there must be a prescribing health care provider on site, a feature at a fraction of the tens of thousands of pharmacies in the country.

Some pharmacy groups have chafed against the required authority, like a nurse practitioner or physician’s assistant, who must prescribe the pills on-site.

“We were anticipating something that would really have an impact on the pandemic and on patients being able to access medications and instead we’re underwhelmed with the missed opportunity of what this could have been,” said Michael Ganio, American Society of Health-System Pharmacists’ senior director of pharmacy practice and quality.

While the plan is a step in the right direction, “further action is needed” to enhance equity and access, National Association of Chain Drug Stores’ President and CEO Steven Anderson said, adding that the current test-to-treat plan “does not leverage fully the health and wellness professionals and access points in America’s pharmacies.”

Conversely, the American Medical Association called the plan “well-intentioned” but that it “oversimplifies challenging prescribing decisions by omitting knowledge of a patient’s medical history, the complexity of drug interactions, and managing possible negative reactions.”

The drugs are not appropriate for everyone. Merck’s Molnupiravir, for example, is not recommended during pregnancy or for minors, while Pfizer’s Paxlovid runs the risk of negatively interacting with other commonly prescribed drugs, including medicines that manage heart conditions and cholesterol, and those with severe kidney or liver problems.

Another issue, doctors say, is that patients will need to start taking the pills within days of developing symptoms, which means participating stores need to be convenient enough to access quickly, and with enough rapid tests to diagnose in time.

To connect patients with convenient pickup sites, the government is developing a website to help people find a site near them, set to launch later this month.

“The biggest issue is making sure that you get seen and diagnosed rapidly because you’ve got a five-day window of opportunity for Paxlovid to be optimally effective,” said Dr. Amesh Adalja, senior scholar at Johns Hopkins Center for Health Security and an infectious disease physician.

“If you’re a high-risk individual, you want to make the diagnosis as quickly as possible,” said Dr. Todd Ellerin, director of infectious diseases at South Shore Hospital. “And then make contact with a health care provider.”