As two new antiviral pills for Covid-19 are approaching emergency clearance, experts fear that a lack of public health infrastructure – especially easy access to rapid tests and quickly filled prescriptions – will prevent them from make a significant dent in the pandemic.
“We know that these antivirals are going to have a window of opportunity where they are most effective, and it can be difficult to get an appointment and get a prescription,” said Amesh Adalja, infectious disease specialist, researcher. principal at the Johns Hopkins Center. for health security.
Virtual care companies believe they could speed up the process of giving antivirals to patients within three to five days of symptom onset, when they are most effective. This week, digital health company Truepill announced that it will soon launch a platform to support telehealth consultations, prescriptions and overnight delivery of new drugs, from Merck and Pfizer, when they are authorized. . Carbon Health, which has both physical clinics and virtual care, plans to expand its Covid acute care program to include oral antivirals. And the direct-to-consumer company Ro says it has the ability to prescribe and deliver the drugs and expects to make them available through its platform.
“I think there might be a great opportunity here to take advantage of all the telehealth that has developed during the pandemic, and was going on even before the pandemic, to be able to put prescriptions in people’s hands. much faster than the traditional route. ” said Adalja.
But that opportunity depends on getting all the other pieces in place at the right time. For the pills to reach their full potential, people need to be able to procure and pay for tests, receive their results quickly, and immediately connect with a healthcare provider if they test positive for Covid.
If all of these steps go as planned, online platforms, due to their distributed workforce of virtual providers, could get prescriptions faster while still allowing HIV-positive patients to self-quarantine. When a patient registers online for Carbon Health’s Covid-19 program, “we make sure they receive a thorough virtual assessment within 24 hours of symptom onset,” said the medical director of program development Aaron Weinberg, also national director of Carbon for Research. “The clock starts as soon as someone contacts us.”
Once patients meet with a Carbon Health provider and receive a positive test result, they may be given a prescription for monoclonal antibodies, a pulse oximeter to self-monitor their symptoms, or soon, a prescription for antivirals.
Truepill offers an even more explicit speed guarantee, with the intention of offering its teleconsultation and delivery services as a plug-and-play tool for existing healthcare systems, providers and payers, said Andy Rink, vice president of telehealth at Truepill. “We will essentially allow any patient who has tested positive for Covid and qualifies for these drugs under the [emergency use authorization] guidelines for getting the drug within 24 hours, ”he said.
How quickly digital pharmacies can get antivirals to a patient’s door will depend greatly on supply. Drugs, like vaccines and other Covid-19 therapies, will be distributed state by state as needed. To ensure prompt delivery after a telemarketer has prescribed the medication, Truepill will arrange for access in one of two ways: dispatching them overnight via one of the company’s own pharmacy centers, or arranging the pickup or delivery to a retail pharmacy, using publicly available information to determine which locations have drugs in stock. “We can take that information and pass it on to the supplier at the time of that visit, so that we can send it to the right place, the first time,” Rink said.
Truepill plans to complete its platform within two weeks and is in discussions with groups that may implement it. “We have groups of vendors who are interested in taking our existing solution and using it for their patients, even patients who already have a primary care physician,” said Rink – primarily with the benefit of securing a supply. reliable in medicine. They also talk to payers, employer groups and existing direct-to-consumer businesses.
Until these partnerships are solidified, it is unclear what the impact will be on increasing access in underserved patient groups – particularly the elderly and low-income people, who are less likely to have access to or use telemedicine. Telehealth has also been used less among non-white, uninsured and rural patients.
“I’m concerned that we have this tendency to herald breakthroughs in technology, while really preparing for a disruption in delivery to those who will need it most,” said Alyssa Bilinski, public health policy expert at the University. Brown.
It is possible that telehealth companies could, if not increase access for the most underserved patients, ease the burden on some providers in person, or reduce wait times for some patients. Direct-to-consumer drug companies like Ro, Nurx, and Hims & Hers – many of whom began by providing convenient online prescriptions for erectile dysfunction or birth control drugs – have increasingly expanded their offerings, including Covid-19 testing and added telehealth services. These companies could capitalize on their own network of telemarketers to support access to antivirals, or deploy a platform like Truepill’s.
“The companies that have been able to do it with other drugs, lifestyle drugs, I think they’re perfectly ready to do it,” Adalja said.
But each of these pathways to digital prescription and delivery could face obstacles. Not all virtual care networks have licensed telemarketers in every state; a person looking for a quick prescription may find themselves in a bind when they realize that a platform is not serving them. And while the platforms typically require users to complete an intake survey that asks about indications for antiviral drugs, patients with complex medical histories should be especially careful to ensure that a new telemarketer is taking. take into account any contraindication or potential drug interaction.
“Given their potential advantage in terms of access, one might see direct-to-consumer telemedicine companies playing a bigger role,” Mehrotra said. “However, I suspect the vast majority of people will still go to their regular PCP or go to a local emergency care or retail center.”
Primary care offices are also able to write prescriptions after virtual visits, of course. In a study led by Michael Anne Kyle, a postdoctoral researcher in the Department of Health Care Policy at Harvard Medical School, researchers found that many primary care offices offered testing and virtual visits during the pandemic. “But the wait times to get an appointment were usually out of the window… needed to start the antivirals,” Kyle wrote in an email.
Rink said that Truepill’s platform will allow users to order a home test online, but acknowledged that “given the five-day window, it will be difficult to do all of that – take the test, do it. deliver, have the visit, get the drug. So patients who turn to virtual care companies for an antiviral prescription will likely have had an antigen test at home. This means that the biggest beneficiaries of virtual platforms could be the ones who had the means and the capacity to stock up on these tests. “We see a lot of people ordering tests in advance to have them at home,” Rink said.
In a bid to increase access to testing, the Biden administration has said it will soon require private insurers to reimburse Americans for the cost of rapid home antigen testing. But access can still present a challenge for patients who don’t have the $ 30 or so to pay for a test up front, or for those who can’t find tests on the shelves.
If telehealth is to play a role, then it should only be part of a systemic effort to enable access to rapid testing, diagnosis and treatment with new antivirals.
“So much less attention was paid to the full stunt of stages,” Bilinski said. “It starts with educating people to get tested, and then take the test and the quick turnaround time of the test, but then knowing that you want to ask for a prescription, have some sort of consultation with someone who can prescribe, and then have this prescription filled. . “Any break in this chain of events could be the one preventing the pills from reaching their full impact.