WADA Statement on the Test to Treat Initiative

The AMA opposes pharmacy clinics as an entry point for COVID-19 treatments.

Members of Drug Topics® The Editorial Advisory Board met to respond to the recent statement1 published by American Medical Association (AMA) President Gerald E. Harmon, MD, criticizing the Biden administration’s plan to include pharmacists as entry points into the Test to Treat initiative.2

“While the administration has outlined promising plans…to combat COVID-19…the clinical pharmacy component of the test plan to treat flaunts patient safety and risks significant negative health outcomes. “, said Harmon. “This approach, while well-intentioned…simplifies difficult prescribing decisions by omitting knowledge of a patient’s medical history, the complexity of drug interactions, and the management of possible adverse reactions.”1

Responses to this statement from our Editorial Advisory Board are collated below.

We know that there is a significant inequality in terms of access to health care, and many people in rural areas or city centers simply do not have access to doctors, but they have access to their pharmacy. . These COVID-19 antivirals are time sensitive, with a need for prompt administration after diagnosis. Delays between testing and doctors’ access to treatment have the potential to lessen the impact of these drugs.

The AMA’s statement that “Paxlovid is 88[%]effective in preventing hospitalization and death. But it also contains 6 pages of drug interactions, including interactions that may require a patient to hold, change, or reduce doses of other medications.”1 implies that family physicians would be better resources than clinical pharmacists to better address the issue of drug interactions. A clinical pharmacist has much more training in pharmacology than a family doctor and probably has experience with many more of these drugs on this 6-page list! As the American Society of Health-System Pharmacists (ASHP) states, “Pharmacists are clinically trained medication experts and are the primary healthcare professionals responsible for ensuring the safe use of medications, including the identification and mitigation of drug interactions associated with oral antiviral medications for COVID-19.”3

The position that physicians have a more complete medical history of the patient than a pharmacist also assumes that all patients see the same provider and provider organization, which is not the case. Patients can access instant care locations, emergency rooms, [or] unknown service providers who no longer have access to a [patient’s] medical history than a pharmacist. It also overlooks the fact that on average a physician has 15 minutes to spend with a patient trying to get as much information as possible in order to make the most informed decisions, whereas a clinical pharmacist can spend a lot more time with a patient.

I also find it absurd that we have a known health risk with reported deaths (over 950,000, with actual deaths likely much higher due to lack of reporting), we have a treatment option that is 88% effective % but which has a narrow window to treat, and yet the AMA is more concerned with the theoretical, unproven impact of pharmacist prescribing than the potential expansion of access to viable treatment. There is always risk associated with any new program, but the risk must be carefully weighed against the reward, and the time to treatment would clearly seem to outweigh the concern about managing drug interactions.

—James A. Jorgenson, RPH, MS, FASHP
CEO, Vante

Jim eloquently took the words out of my mouth! I completely agree with all of your feelings. During COVID-19, many medical clinics reduced their hours of operation and decided to simply do telehealth. Only pharmacies remained open. We are also the main source of vaccinations in the community, not the doctors, due to our access and availability. The reasoning put forward by the AMA, against access by pharmacists, is simply unfounded.

—Ken Thai, PharmD, APh
CEO, 986 Degrees Corporation
Past President of the California Pharmacists Association
University of Southern California School of Pharmacy, Adjunct Assistant Professor of Clinical Pharmacy Practice
Western University of Health Sciences School of Pharmacy, Clinical Assistant Professor of Pharmacy Practice

I am concerned that the AMA is so adamantly opposed to a measure that would limit access to critical treatments for COVID-19. The AMA’s main argument is about medical complexity, but there’s really nothing to argue about: we agree that pharmacists are not qualified to make complex medical decisions. But that’s not what’s on the table here. What’s on the table allows pharmacists to follow simple, protocol-based medical decision-making guidelines that would expand access to this urgent treatment to millions more Americans. And when the medical decision-making is more complex, the pharmacist refers the patient to a doctor. So what are we discussing? Let’s do this!

—David Pope, PharmD, CDE
Chief Innovation Officer, OmniSYS

To add, pharmacists have already implemented a similar “test to treat” program for another recently forgotten epidemic: HIV. For example, in California or New York, pharmacists are allowed to dispense anti-HIV drugs for post-exposure prophylaxis (PEP) without a prescription. .4 Patients are tested for HIV and hepatitis C at baseline and usually 28 days after completing PEP treatment. This current model is essentially identical to the test proposed to address the Paxlovid prescription program.

Additionally, pharmacists in California are already licensed to prescribe naloxone, contraceptives, smoking cessation agents, and travel health agents to provide the best patient care.5 Allowing pharmacists to ensure that patients have access to Paxlovid would essentially add a single drug to the growing list of drugs that pharmacists can already provide to patients.

—Mohamed A. Jalloh, PharmD, BCPS
Touro University California College of Pharmacy, Assistant Professor, Department of Clinical Sciences
OLE Health, Ambulatory Care Clinical Pharmacist

Do you have a response to the AMA statement? Email your thoughts to Lauren Biscaldi, Managing Editor, at [email protected]

The references

  1. WADA statement on the administration’s COVID-19 test-to-treat plan. Press release. American Medical Association. March 4, 2022. Accessed March 11, 2022. https://www.ama-assn.org/press-center/press-releases/ama-statement-administration-s-test-treat-covid-19-plan
  2. National COVID-19 Preparedness Plan. The White House. Published March 2022. Accessed March 11, 2022. www.whitehouse.gov/wp-content/uploads/2022/03/NAT-COVID-19-PREPAREDNESS-PLAN.pdf
  3. Pharmacist groups are calling on the Biden administration to remove prescribing limits on COVID treatments. Press release. American Society of Healthcare Systems Pharmacists. March 9, 2022. Accessed March 11, 2022. https://www.ashp.org/news/2022/03/09/pharmacist-groups-call-on-biden-administration-to-remove-limits-on-prescribe-covid-treatments
  4. Statement of emergency. Independent provision of HIV pre-exposure and post-exposure prophylaxis. California State Board of Pharmacy. Published April 10, 2020. Accessed March 11, 2022. www.pharmacy.ca.gov/laws_regs/1747_nifer.pdf
  5. Pharmacist services. California State Board of Pharmacy. Updated August 2021. Accessed March 11, 2022. https://files.medi-cal.ca.gov/pubsdoco/publications/masters-mtp/part2/pharmserv.pdf

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