News & Analysis

Debating the Role of Pharmacy in Healthcare Transformation

A nighttime view into a dimly lit pharmacy|A map shows that vast swaths of America have no pharmacies with test-to-treat capability

In March, President Joe Biden announced a new test-to-treat initiative that allows some pharmacies to prescribe life-saving Covid antivirals for patients who walk in and test positive – a policy that begins to recognize the role of pharmacy in healthcare transformation.

No more shuttling between a doctor’s office and pharmacy? That seems like a commonsense solution, especially for vulnerable populations without a primary care provider, good transportation options, or reliable Internet.

The initiative is perfectly aligned with our Healthytown model of healthcare transformation, which emphasizes each patient receiving the right care at the right time in the right place by the right provider.

Many experts praised the test-to-treat program. “All of our public health response relies on lowering the barrier to getting treatments to the right people,” Dr. Kirsten Bibbins-Domingo, chair of the Department of Epidemiology and Biostatistics at UCSF, told Kaiser Health News.

But there are caveats, as we’ve consistently seen with the evolution toward patient-centered, value-based care. The biggest problem is that vast swaths of the country don’t have a single test-to-treat pharmacy, according to this KHN map, based on data as of April 14:

To illustrate the role of pharmacy healthcare transformation, a map shows that vast swaths of America have no pharmacies with test-to-treat capability

It’s clear from the map that millions of Americans – primarily in rural areas – would have to drive hours to find their nearest test-to-treat location. That’s because pharmacists can dispense the antivirals but not actually prescribe them. Test-to-treat only applies to pharmacies with an on-site clinic staffed by advanced providers such as a physician assistant or nurse practitioner. Those pharmacies – think CVS/MinuteClinic – are largely unknown in rural America.

In other words, the role of pharmacy in healthcare transformation is limited by current public policy.

“FDA’s limitation undermines the intent of your announcement and patient access to pharmacies as a one-stop shop for COVID-19 testing and treatment with antivirals,” the major pharmacy organizations wrote to President Biden in a March 9 letter. “Pharmacists are clinically trained medication experts and are the primary healthcare professionals responsible for ensuring safe medication use, including identifying and mitigating drug interactions associated with oral antiviral medications for COVID-19.”

As experts in healthcare strategic planning, we’ve written often that one key to lower healthcare costs is allowing providers to practice at the top of their license – and it’s a principle that applies to pharmacists, as well.

Allowing pharmacists to prescribe Covid antivirals would instantly make the drugs available to millions more Americans, especially in more remote parts of the country. (And it might help overcome low prescription rates in urban and suburban areas, as well.) That would mean fewer hospitalizations, fewer deaths, and lower system costs, even if pharmacists were paid more for the time-consuming task of taking patient histories to check for drug interactions.

However imperfect and controversial, the test-to-treat initiative is just one more sign of the transformation that’s occurring in US healthcare – signs that hospitals and health systems cannot afford to ignore.

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