Untie Pharmacists’ Hands to Address COVID-19 Health Inequities
According to CDC data, as of June 8, 2022, the current average of daily new cases and hospitalizations increased 8.0%, with over 1 million deaths in our country. Given the length of time we as a society have had to deal with this deadly pandemic, the risks of inertia could significantly increase, thus having a negative impact on the cases and death rates associated with COVID-19.
Throughout this pandemic, we’ve been fortunate to have new diagnostic tests, vaccines, and therapeutics added to our toolbox to combat COVID-19. But despite these breakthroughs, COVID-19 has exposed the negative impact of long-standing health inequities in our communities. As seen through the lens of social vulnerability, under-represented minority communities continue to experience barriers to achieving equitable access to patient care services. In fact, studies in some of the most prestigious academic journals, The Lancet and JAMA, found that racial/ethnic minority groups and residents in neighborhoods with higher social vulnerability were at a greater risk of acquiring COVID-19 and had an increased risk of hospitalization and death. The social vulnerability of our communities is also showing us that the Test-to-Treat program is falling short in many ways.
As a pharmacist and pharmacy owner, I have been on the front lines administering COVID-19 tests and vaccinations as well as providing support care to my patients. My pharmacy is in an area of Florida that has a moderate level of social vulnerability and that has been identified by the federal government as medically underserved with designated health professional shortage areas. My patients rely on me, but the federal government is currently preventing me from doing more to keep them from being hospitalized if they test positive for COVID-19.
Oral antiviral medicines taken within 5 days of testing positive have been unquestionably shown to reduce mortality and hospitalizations. To increase use of these life saving medications, the Biden Administration created a Test-to-Treat program which allows pharmacies to be one-stop shops for patients who test positive and qualify for oral antivirals. For patients who live in medically underserved areas, the potential impact of this program could be game-changing.
However, an updated analysis by the American Pharmacists Association (APhA) found that only 32% (<850) of Test-to-Treat sites are in medically underserved areas of the U.S. Additionally, in the most vulnerable areas in the country as defined by the Social Vulnerability Index, only 17% (460) of Test-to-Treat sites are located in these areas. Currently, there are over 2,600 Test-to-Treat sites, but there are over 70,000 community pharmacies in the country. A new analysis by the Centers for Disease Control and Prevention (CDC), confirmed APhA’s earlier findings, stating "dispensing rates were lowest in high vulnerability zip codes, despite these zip codes having the largest number of dispensing sites.” Simply put, when it comes to social vulnerability, the Test-to-Treat program is not providing accessible or equitable access to care to those who are the most vulnerable.
Although the U.S. Department of Health and Human Services has recognized the high level of training pharmacists receive by authorizing pharmacists to prescribe COVID-19 therapeutics on the spot, FDA’s emergency use authorizations for these medications specifically exclude pharmacists as prescribers. As a result, these medications are being underutilized and sitting on pharmacy shelves, which unnecessarily increases health care costs and puts lives at risk.
Identifying patients who qualify for these medications can be time-consuming and requires a thorough evaluation for potential drug–drug interactions. As medication experts, pharmacists are well-equipped to perform the patient assessments necessary to prescribe and dispense these medications, including identifying potentially dangerous drug–drug interactions. Despite this, FDA fails to recognize pharmacists’ expertise, thereby effectively denying patients’ access to these lifesaving therapeutics.
In mid-March, my pharmacy received 20 treatment courses of the oral antiviral Paxlovid. Two months later, we had only dispensed 9 courses because of low prescribing by prescribers. In early May, a patient who qualified for Paxlovid could not find a prescriber and the closest Test-to-Treat pharmacy was over 40 miles away. Looking at the social vulnerability nationwide tells us a powerful story about the need to disrupt the status quo in this pandemic. As APhA’s analysis clearly demonstrates, including pharmacists as prescribers of oral antivirals would open the door for Test-to-Treat pharmacies in our communities that need them the most.
Like the successful administration of COVID-19 vaccine by pharmacists—in which pharmacists were granted both the authority and sustainable payment for success—the federal government now needs to follow a similar, common-sense approach to COVID-19 oral antivirals. They need to untie our hands and remove these restrictions on pharmacists so that we can reach our nation’s vulnerable and underserved patients, eliminate unnecessary hospitalizations, and lead this country out of the pandemic.
Theresa Tolle, BPharm, FAPhA, owner of Bay Street Pharmacy in Sebastian, FL, and president of the American Pharmacists Association
