Dear Colleague,
It's just been a couple of weeks since President Biden delivered his State of the Union address and announced, "And we're launching the ‘test to treat' initiative so people can get tested at a pharmacy, and if they're positive, receive antiviral pills on the spot at no cost." If perfect is the enemy of good, then this statement was really good.
Unfortunately, the "test to treat" program is drastically limited because of the FDA's myopic decision to prohibit pharmacists from being able to prescribe oral antivirals—a complete 180 from the authorization pharmacists have to prescribe other COVID-19 treatments which they have been doing with a great deal of success. How limited? The "test to treat" program might as well have been called the "Minute Clinic program" because it appears to target CVS Minute Clinics. There are more than 1,100 CVS Minute Clinics in 33 states, fewer than 100 Walgreens' VillageMD programs and a handful of other pharmacy sites (including a few independents) where a prescriber is on-site. Altogether, it's likely that less than 3 percent of pharmacies could do "test to treat" as described by the White House. Not exactly a convenient way for consumers to access a COVID-19 treatment—especially one where timely treatment is of the essence.
The solution to this would have been for the FDA to include pharmacists as prescribers when they granted emergency use authorization for the current two antivirals, molnupiravir and Paxlovid, to treat COVID-19. FDA has told us about concerns they have with pharmacists having access to lab values such as renal function that are important considerations when prescribing these drugs. It's true that pharmacists don't always have ready access to the patient's latest lab values, but neither do some urgent care clinics or convenient care clinics. There are ways to identify patients who may have compromised renal function and protocols that could be put in place for pharmacists to refer patients if they have concerns. FDA could still do a course correction but, at least for now, the public health good they could have done in this area has been unrealized.
Speaking of missing an opportunity, NCPA has been critical in the press and with CMS of health plans paying insultingly meager dispensing fees for oral antivirals—citing Prime Therapeutics, the PBM for many BlueCross/Blue Shield plans, as one of the worst offenders for initially paying pharmacies only a dollar for the pharmacist to perform drug and disease interaction checks and to work with the physician on the proper prescribing.
(Let me break in here for an important announcement. We all know how ridiculous these reimbursements are, and we have to let legislators, the public, and the media know too. NCPA has launched an advocacy and public awareness effort by creating a website that will post your story. This strategy localizes the narrative to specific legislative districts and the public can relate to a story that's in their own back yard. Lots of pins on a map are a great way to get a legislator's attention. Please take a few minutes to tell your story – multiple times with multiple cases if you like. Remember: this kind of effort only works if hundreds of you participate. Tell your story here.)
This week, Express Scripts finally decided to boost their anemic dispensing fee to $12 - two months after the omicron surge peaked in the U.S. Likewise, Prime Therapeutics now offers $8. That's like showing up to put out a forest fire with a garden hose. Too little, too late.
The Biden administration needs to do better in this area. Make sure that patients have convenient access to COVID-19 treatments to help keep them alive and out of the hospital. Open up "test to treat" to all pharmacies and add oral antivirals to the list of COVID-19 treatment options that pharmacists have the authority to prescribe. During his speech, the president said the government has ordered more than a million "pills" from Pfizer (Paxlovid). That's wonderful. But if those "pills" can't get to the patients in a timely manner to all parts of the country, they can't work their magic. Mr. President, don't limit "test to treat." Expand it to include pharmacists so they can work theirs.
Best,
B. Douglas Hoey, Pharmacist, MBA
NCPA CEO
