You are here

On the Spot

Test to treat COVID plan in development

By Karen Kier, Pharmacist on behalf of the ONU HealthWise team

The idiom “on the spot” means at the very moment or right away. Interestingly, another source defined this idiom as having to answer or decide without warning or preparation. This is exactly what came to mind when I heard the President’s State of the Union speech on March 1, 2022.  The theory for the “test to treat” is excellent and if planned appropriately, could be an essential way to continue to control SARS-CoV-2 within our country. However, many news sources are critical of the ability to accomplish a standardized program across the country by the end of March 2022.

President Biden’s plan would allow pharmacies, community health centers, long-term care facilities and Veterans Affairs facilities across the country to test for COVID-19 infections and if the test returns positive, the patients could be provided antiviral medication to reduce the risk of serious infection and hospitalization.  

Pharmacists are reported to be the most accessible healthcare professional to the general public. You do not need an appointment to go to the pharmacy and most individuals live close to a pharmacy even in a rural area. Often pharmacies have extended hours to serve the public and some offer 24-hour service. A survey by the National Association of Chain Drug Stores found that 9 out of 10 Americans are within five miles of a pharmacy. A January 2022 study published in the Journal of Managed Care and Specialty Pharmacy found that patients visit their community pharmacies almost twice as often as their physician or other primary care provider.  This study emphasized the accessibility of the community pharmacist and the ability for them to improve patient engagement and health outcomes. This accessibility would be based on all pharmacies in the country participating in the proposed plan. The current Biden plan would be to have CVS and Walgreens be the providers for the “test to treat” by the end of the month.  Unfortunately, this plan will leave many without a pharmacy provider for antiviral pills especially in the rural and underserved communities.  Small, independent community pharmacies like ONU HealthWise Pharmacy will be left out of the mix for March.  

President Biden’s “test to treat” would include Pfizer’s antiviral Paxlovid. This combination of two drugs (nirmatrelvir and ritonavir) was given emergency use authorization (EUA) on December 16, 2021. The EUA was issued for evidence that the combination antiviral could decrease the risk of hospitalization by 90% when started early after testing positive for COVID-19. Paxlovid is a five-day treatment involving six tablets each day.  The healthcare provider would dispense 20 tablets of nirmatrelvir and ten tablets of ritonavir.  The individual would take two nirmatrelvir tablets in the morning with or without food plus one ritonavir tablet at the same time.  The same three tablets would be repeated in the evening for a total of six pills per day. The regimen should be started as soon as possible upon testing positive in those 12 years and older and weighing more than 88 pounds who are at high risk of progressing to a severe COVID-19 infection including hospitalization. The medication is not to be used in an existing severe COVID-19 or for pre-exposure or postexposure prophylaxis if exposed to an infected person.  The combination should not be used in those who have kidney or liver disease.  Healthcare providers need to check a patient’s medication list including nonprescription medication, as well as herbal products due to significant drug-drug interactions that can occur with Paxlovid. Some who have been critical of the President’s plan cite that additional training, as well as treatment maps or algorithms need to be established to make sure that only those who need the combination will receive it. In addition, healthcare providers need to make sure that the drugs can be used safely. The combination has some side effects including a change in taste often referred to as metallic, a potential increase in blood pressure, and muscle pain.

The government would offer the pill combination for free for those who would require it. The United States ordered 20 million doses of Paxlovid in January and Pfizer will provide three million doses in the next two months.  

With COVID-19 cases dropping dramatically throughout most of the country and mask mandates being lifted, this might provide more time for a “test to treat” plan to become functional and practical for all Americans no matter where they live.  The plan could become essential if other variants become dominant as was seen with omicron.

Feel free to call the ONU HealthWise Pharmacy for the science on COVID-19. ONU HealthWise is offering COVID-19 and flu vaccines Monday through Friday from 4 pm to 6 pm. Call the pharmacy for an appointment for other time slots. The ONU HealthWise pharmacy offers Moderna, Pfizer, Janssen and flu shots and high-dose flu vaccines. Pediatric Pfizer vaccines (5 to 11-years) are available by appointment through the state Vaccine Management Solution (VMS) system.  Call the pharmacy to get more information.