AMA Test-to-Treat Initiative Statement

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

members of Drug Topics® Editorial Advisory Board has joined forces 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 in the Test to Treat initiative.2

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

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

We know there are significant inequalities in access to healthcare, and many people in rural or inner-city areas simply don’t have direct access to doctors – but they do have access to their pharmacy. These COVID-19 antiviral drugs are time-sensitive and must be administered quickly after diagnosis. Delays from testing to doctor access for treatment can reduce the effects of these drugs.

The AMA statement that “Paxlovid is 88[%]effective in preventing hospitalizations and deaths. But it also has 6 pages of drug interactions, including interactions that may require a patient to keep, change, or reduce the dose of other drugs.”1 implies that primary care physicians would be better resources than clinical pharmacists to best address the problem of drug interactions. A clinical pharmacist has far more pharmacological training than a general practitioner and is likely to have experience with many more of the drugs on this 6 page list! As stated by the American Society of Health-System Pharmacists (ASHP), “Pharmacists are clinically trained medication experts and the primary health care professionals responsible for ensuring safe medication use, including identifying and mitigating drug-drug interactions associated with oral antiviral drugs versus COVID-19.”3

The position that physicians have a more complete patient history than a pharmacist also assumes that all patients seek the same provider and provider organization, which is not the case. Patients can access insta-care facilities, emergency rooms, [or] unknown providers who no longer have access to a [patient’s] Medical history as a pharmacist. It also neglects the fact that a doctor has an average of 15 minutes to spend with a patient trying to gather as much information as possible in order to make the best possible decisions, while a clinical pharmacist can spend much more time with a patient .

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

– James A Jorgenson, RPH, MS, FASHP
Managing Director Visate

Jim eloquently took the words out of my mouth! I totally agree with all your feelings. During COVID-19, many medical practices reduced clinic hours and decided to simply go telemedicine. Only the pharmacies remained open. We are also the primary source of immunizations in the community – not doctors – due to our access and availability. The rationale put forward by the AMA against pharmacist access is simply unfounded.

—Ken Thai, PharmD, APh
CEO, 986 Degrees Corporation
Immediate Past President of the California Pharmacists Association
University of Southern California School of Pharmacy, Associate Associate Professor of Clinical Pharmacy Practice
Western University of Health Sciences School of Pharmacy, clinical assistant professor of pharmaceutical practice

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

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

What’s more, pharmacists have already established a similar “test to treat” program for another recently forgotten epidemic: HIV. For example, in California or New York, pharmacists are authorized to dispense HIV medication for post-exposure prophylaxis (PEP) without a prescription.4 Patients will be tested for HIV and hepatitis C at baseline and typically 28 days after completion of PEP therapy. This current model is essentially identical to the proposed Paxlovid test-to-treat prescribing program.

In addition, pharmacists in California are already permitted to prescribe naloxone, birth control, smoking cessation and travel health products to provide the best patient care.5 Allowing pharmacists to ensure patients have access to Paxlovid would essentially add a single drug to the growing list of drugs that pharmacists can already offer patients.

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

Do you have an answer to the AMA statement? Email your thoughts to Lauren Biscaldi, Editor-in-Chief at [email protected]

references

  1. AMA Statement on Administration’s Test-to-Treat COVID-19 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 lift restrictions on COVID treatment prescriptions. press release. American Society of Health-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- prescribing -Covid treatments
  4. determination of the emergency. Independent institution for HIV pre- 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. Pharmacy 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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