Biden’s test to treat plan pits pharmacists against doctors

March 14, 2022 – The Biden Administration new test program to treat is simple on the surface: if you think you have COVID-19, go to a pharmacy, get tested, and if you test positive, get treated right away with an antiviral drug.

But the program is not so straightforward for groups representing physicians and pharmacists.

A large group of doctors are concerned that the program leaves doctors on the margins and could put patients at risk if there are side effects from the drugs. Pharmacist groups, on the other hand, say the program is too restrictive, according to an article by the Advisory Board research group.

The White House announced last week that more than 1,000 pharmaceutical clinics across the United States have signed up to participate in the initiative, according to CNN.

In addition to retail clinics at chain pharmacies, the antivirals will also be available at community health centers, long-term care facilities and Veterans Health Administration clinics, according to the Department of Health. Health and Social Services.

The two FDA-cleared antiviral pills include Pfizer’s Paxlovid, for people age 12 and older, and Merck’s Molnupiravir, for adults. Either drug should be taken within 5 days of the onset of symptoms to prevent serious illness.

The need for speed is one of the main reasons the government has chosen to work with retail clinics that are more accessible than most primary care offices. However, the American Medical Association (AMA), National Community Pharmacists Association (NCPA), and American Pharmacists Association (APhA) have criticized the administration’s approach.

Pharmacist groups are concerned that the program will be limited to pharmacies with on-site clinics, thus limiting the number of pharmacies qualified to participate. Fourteen pharmacy groups have also urged the White House to make it easier for pharmacies to order the drugs.

The groups also want permission as “clinically trained drug experts” to prescribe the drugs and ensure their safe use.

The AMA on March 4 challenged with the prescribing component, saying that “the pharmacy-based clinical component of the test-to-treat plan violates patient safety and risks significant negative health outcomes.”

In the AMA’s view, prescribing one of the newer antiviral drugs without the patient’s physician present poses a risk of drug interaction issues, because neither the nurse practitioners at retail clinics nor the pharmacists who dispense the drugs don’t have full knowledge of a patient’s medical history. .

The next day, the AMA published another statementsaying he was reassured by comments from administration officials “that patients who have access to a regular source of care should contact their doctor soon after testing positive for COVID-19 to assess their treatment options.”

“Traditional approach reserved for doctors”

Having patients call their doctors after testing positive for COVID-19 at a pharmacy “seems unnecessary to me in the vast majority of cases, and it will delay treatment,” said Robert Wachter, MD, professor and department chair. of Medicine from the University. from California to San Francisco, says. “In this case, it looks like the AMA is taking a very traditional, doctor-only approach. And the world has changed. It’s much more of a team sport than an individual sport, as it was a years old.”

Wachter said he has the utmost respect for pharmacists’ ability to screen prescriptions for adverse drug interactions.

“We are required to do medication reconciliation when patients see us,” he says. “And in many hospitals we delegate that to pharmacists. They are at least as good if not better than doctors.”

While it’s essential to know what other medications a patient is taking, he says, pharmacies have computer records of all the prescriptions they’ve filled for patients. In addition, pharmacies have access to complete medication history through Surescripts, the company that enables electronic prescription transactions between prescribers and pharmacies.

“Not insignificant” drug interactions

Preeti Malani, MD, chief medical officer and professor of medicine at the University of Michigan, says potential interactions between antiviral drugs and certain other medications are “not trivial.”

However, she says, “The really dangerous drugs are those for people who have had organ transplants and such. These are not individuals who go shopping at a pharmacy.”

Besides anti-rejection drugs, Wachter says, there can be serious interactions with cholesterol-lowering drugs. If a person takes Lipitor, for example, “someone should decide if I can stop for a while or reduce the dose. But I trust the pharmacist to do it as well as anyone else . “

Barring these potential drug interactions, antiviral drugs are “pretty safe,” he says, adding that being able to immediately treat people who test positive for COVID-19 is a big advantage of the test program to treat , given how difficult it is for many people to get access to a doctor.

This delay could mean that antivirals are not prescribed and taken until they are no longer effective.

Wachter and Malani say the widespread distribution of pharmacies and their extended opening hours are other important benefits, especially for people who cannot easily leave work or travel far to see a doctor.

Malani warns that there are still some issues in the test program to deal with. It will be some time before retail clinics have all the antiviral drugs, and many pharmacies do not have clinics on site.

Still, she says people can still go to their doctors to get tested, and presumably those doctors can also write antiviral prescriptions. But it’s unclear where the antivirals will be available in the near term.

“Right now we’re playing catch-up,” Malani said. “But pharmacies are an important piece of the puzzle.”

Looking at the bigger picture, she says, “We know that neither vaccination nor natural infection provides lasting immunity, and so there will be a role for antivirals to make this a manageable disease. And when you talk about millions of cases, like we had a few months ago, the health care system can’t accommodate all those patients so we need a system where I can go to a pharmacy and get a test and a treatment.