Let’s Do This! A Call to Action for Test to Treat in Pharmacy

I’ve long been an advocate for pharmacists’ ability to evaluate and prescribe, so hearing President Biden announce a pharmacy test to treat initiative for COVID-19 during his State of the Union address was a thrill! The COVID-19 pandemic brought national attention to pharmacy and what we can do to serve our communities, and this felt like a great continuation of that narrative in the national spotlight.

Pharmacists are ready for test to treat, but there are a few steps that need to happen before this can become a reality:

• The FDA must update emergency use authorizations (EUA’s) to allow pharmacists the authority to prescribe.
• Payers must allow pharmacists to be reimbursed for the act of prescribing through the medical benefit. A positive test doesn’t necessarily mean Paxlovid should be administered. Therefore, pharmacists need to be reimbursed for their efforts as a provider to evaluate patients based on the outlined protocols and either prescribe directly or refer the patient if more complex medical decision making is necessary. Medicare will lead the way here with reimbursement guidelines, and other payers will generally follow what Medicare does. This is significant as it will reimburse pharmacists as medical providers on the medical benefit (aka provider status).
• The Health Resources and Services Administration needs to allow pharmacists to submit office visit codes when there isn’t coverage elsewhere.

Right after the State of the Union, the steps above felt like a formality. But, now we’re seeing pushback from those outside of our community about whether or not pharmacists should have the ability to prescribe and it’s possible that one or all of the steps I’ve outlined above won’t happen. What a disappointment. Yet again, pharmacists are left to advocate for our seat at the health care table.

The biggest issue I have with the argument against allowing pharmacists to prescribe is that it’s already happening today. For example, in Idaho, pharmacists are prescribing a statin to patients with diabetes through a protocol. And in Florida, pharmacists are prescribing Tamiflu based on positive flu test results. Pharmacists are qualified to make basic medical necessity determinations based on the clearly defined protocols; it is well within our abilities and training as doctors of pharmacy. If the medical decision making becomes more complex, we can refer the patient to their PCP for follow up.

The cost of not allowing pharmacy to prescribe is too great and will prevent access to Test to Treat pathway for many Americans. Let's do this!

David Pope, PharmD, CDE, is the Chief Innovation Officer at OmniSYS and a member of the Drug Topics® Editorial Advisory Board.