San Diego Union-Tribune (Sunday)
‘TEST TO TREAT’ DRAWS PRAISE, QUESTIONS
Plan aims to get treatment to those who need it quickly
Consumers will be able to walk into a clinic at a CVS or Walgreens, get tested for the coronavirus and, if the results come back positive, go home with a free course of antiviral medicine under a “test to treat” program announced by President Joe Biden this past week as part of his new pandemic road map.
The one-stop approach has been hailed as a potential breakthrough by some doctors, who say it will make it far easier for people at heightened risk of severe disease to get the lifesaving drugs quickly — especially for those who don’t have regular doctors. But the American Medical Association came out strongly critical of the plan Friday afternoon, saying prescribing decisions should be made “under the guidance and supervision of physicians with expertise to deal with complex medications.”
And many puzzle pieces — including having adequate supplies of antiviral drugs and rapid tests — must fall into place for the program to scale up quickly as envisioned in the president’s plan.
“The overall goal of the program is to increase access to lifesaving treatments that need to be given quickly to be effective,” said Tom Inglesby, senior adviser to the White House coronavirus response team.
The program aims to streamline the process for people with underlying conditions to obtain either Pfizer’s Paxlovid or Merck and Ridgeback Biotherapeutics’ molnupiravir. Both drugs significantly reduce the risk of hospitalization and death if they are taken within five days of the onset of symptoms. In clinical trials, Pfizer’s pill was shown to be nearly 90 percent effective at keeping high-risk patients from developing severe illness. Merck’s drug reduced the risk of hospitalization or death by 30 percent.
“I’m rooting for this,” said Eric Topol, a molecular medicine professor and executive vice president of Scripps Research, calling the program “the bold type of move we need. This is what we want to have in place to be ready for a surge.”
But he also had questions about the challenges ahead. “We need a much better supply of ANTICOVID pills, accurate tests, and solid coordination with pharmacists to pull this off,” he tweeted last week after the announcement.
Administration officials said in interviews that they are confident they have sufficient supplies of both the pills and test kits to launch the program in hundreds of pharmacy locations, as well as in community health centers and long-term-care facilities, beginning this week. They say the antiviral drugs have already been bought by the federal government and will be provided free.
“At this point, we have enough Paxlovid and molnupiravir to provide the medications,” Inglesby said.
The debate over who is best positioned to prescribe the drugs stems in part from concerns the medications are inappropriate for some people. Pfizer’s pill cannot be taken alongside several common medications, including some that treat heart conditions and control cholesterol. Molnupiravir does not have known drug interactions, but it is not recommended during pregnancy or for those younger than 18 because it could affect bone and cartilage growth.
The AMA said Friday that the administration’s plan, “though well intentioned ... oversimplifies challenging prescribing decisions by omitting knowledge of a patient’s medical history, the complexity of drug interactions, and managing possible negative reactions.”
But White House officials countered that the program is primarily focused on the quarter of Americans who do not have a primary care provider.
People who can meet with a family physician shortly after testing positive should do so, said Cameron Webb, senior adviser for equity on the White House coronavirus task force and a physician. But the test-to-treat locations will boost access to the lifesaving treatments for those who do not have such doctors. “Now they have a path,” he said.
Other officials noted that the health care providers in pharmacies, usually advanced practice registered nurses and physician assistants, are equipped to screen patients for possible contraindications, just as primary care physicians would, before prescribing the pills.