If you have any friends in the medical community, cocktail parties may be a little awkward right now. The pharmacy community and the American Medical Association have been at odds about provider status for pharmacists. When President Biden announced pharmacy test to treat during the State of the Union address in March, this issue was thrust into the national spotlight once again.
Last fall, as COVID-19 antivirals were close to being authorized, the Prep Act stated that pharmacists would be eligible to prescribe during the national emergency once FDA approval was granted. However, in a surprise move by the FDA, pharmacists were specifically carved out from prescriptive authority. This was particularly unusual, as the FDA does not generally specify which types of providers can prescribe when approving new medications.
When the program was announced, many assumed the long-anticipated prescriptive authority for pharmacists on COVID-19 antivirals would quickly follow. But it didn’t take long to realize that there were some very important nuances in the announcement, and test to treat may only apply to existing pharmacy-based clinics run by physicians and nurse practitioners. While medical practices inside pharmacies are on the rise, they’re not at a scale that involves the pharmacy community in any broad sense.
Once it became clear that there was some room for debate, the conversation really heated up. At the end of the day, it all comes down to medical decision-making. Not all medical decision-making is created equal; in fact, it’s far from it. Complex medical decision-making involves a review of multiple systems, diagnostic tests, lab results and more. Straightforward medical decision-making is applying clearly defined protocols to a patient who has already received a diagnosis.
When pharmacists finally receive prescriptive authority for COVID-19 antivirals, they will undoubtedly follow a straightforward, protocol-based decision-making process. As part of those protocols, patients with certain conditions or drug interactions will be referred to a physician.
What’s particularly important to note here is that this exact process is already happening successfully in a number of states: statin prescribing in Iowa for diabetic patients, flu and strep prescribing in Florida, hormonal contraceptive prescribing in 19 states, and countless other ambulatory care protocols in hospitals across the country. In other words, this isn’t new. Pharmacists know when to prescribe and when they need to refer the patient for more complex medical decision-making.
So why is it so important for pharmacists nationwide to have prescriptive authority for COVID-19 antivirals? Time to treatment for COVID-19 antivirals is essential. These medications need to be taken as early as possible after diagnosis to maximize their effectiveness. Allowing pharmacists to prescribe and dispense is the quickest pathway to reaching a scale that reduces the time between diagnosis and treatment of COVID-19, ultimately leading to fewer hospitalizations.
Health equity is also a critical part of the equation. For many rural and underserved communities, pharmacists are the most accessible healthcare provider for miles. By enabling pharmacists as providers, the lifesaving test-to-treat pathway will be available to millions of more patients.
The path to empowering pharmacists for the test to treat program is straightforward:
- FDA: Update EUAs to allow pharmacists the authority to prescribe;
- CMS: Allow pharmacists to be reimbursed for the encounter through the medical benefit; and
- HRSA: Allow pharmacists to submit office visit codes when there isn’t coverage elsewhere.
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Allowing pharmacists to leverage their education, skills and training to make the basic medical necessity determination to prescribe COVID-19 antivirals will make the test-to-treat pathway more effective and more accessible for millions of Americans. And who can argue with increasing access to lifesaving medications? This is an important time in the history of our nation and, yes, of pharmacy. Make our voices heard. Let’s do this!