Kaiser Health Foundation: How the Test-to-Treat Pillar of the US Covid Strategy Is Failing Patients
The federal “test-to-treat” program, announced in March, is meant to reduce covid hospitalizations and deaths by quickly getting antiviral pills to people who test positive. But even as cases rise again, many Americans don’t have access to the program.
Pfizer’s Paxlovid and Merck’s Lagevrio are both designed to be started within five days of someone’s first symptoms. They’re for people who are at high risk of developing severe illness but are not currently hospitalized because of covid-19. Millions of chronically ill, disabled, and older Americans are eligible for the treatments, and Dr. Anthony Fauci of the National Institutes of Health said April 11 that more people may qualify soon.
The program allows people with covid symptoms to get tested, be prescribed antiviral pills, and fill the prescription all in one visit. The federal government and many state and local health departments direct residents to an online national map where people can find test-to-treat sites and other pharmacies where they can fill prescriptions.
But large swaths of the country had no test-to-treat pharmacies or health centers listed as of April 14. And the website of the largest participant, CVS, has significant technical issues that make booking an appointment difficult.
Even people who regularly see a doctor may be unable to get a prescription in time, and that’s where the program comes in. Before the pandemic, 28% of Americans didn’t have a regular source of medical care, with rates even higher for Black and Hispanic Americans.
“All of our public health response relies on lowering the barrier to getting treatments to the right people,” said Dr. Kirsten Bibbins-Domingo, chair of the Department of Epidemiology and Biostatistics at the University of California-San Francisco.
She said the fragmented federal, state, and local public health systems, the U.S. Department of Health and Human Services’ reliance on partners that charge high prices for appointments, and the lack of clear information are stymieing the effort. “The best tools that we have are not going to reach the people who most need them,” she said.
Bibbins-Domingo is also a practicing physician at Zuckerberg San Francisco General Hospital, which she says is not only testing patients for covid and prescribing them antivirals, but also delivering them medications — all the elements of test-to-treat. But the hospital, which largely treats low-income and uninsured patients, doesn’t appear on the federal map. It shows just three locations in San Francisco: two community health centers and one CVS.
Ninety-one percent of the sites listed on the national map are federal partners: pharmacy chains like CVS, federally qualified health centers, and military and Indian Health Service clinics. HHS has asked state and local health departments to identify other potential participants, like San Francisco General Hospital, so they can be added. Most states have none of those partners listed yet.