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How Biden's new 'test to treat' COVID plan works — and why it might not be enough


This week, the Biden administration is launching a test to treat COVID program. High-risk patients with COVID symptoms will be able to walk into hundreds of pharmacies for a free COVID test and walk out with a free course of pills. But as NPR's Pien Huang reports, the program is limited in scope.

PIEN HUANG, BYLINE: COVID pills help keep people with mild symptoms from getting worse. Dr. Celine Gounder, an infectious disease specialist and senior fellow at Kaiser Health News, says if taken early, they can prevent hospitalization and death.

CELINE GOUNDER: It's really important to start treatment within three to five days or so of the onset of infection if you really want to have the impact of that treatment.

HUANG: The pills are antivirals, which means they stop the virus from making copies in your cells.

GOUNDER: And that treatment should also reduce their infectious period and thereby also reduce the risk of onward transmission to others.

HUANG: Dr. Cam Webb, senior adviser to the White House COVID Response Team, says right now, getting COVID pills can be kind of complicated.

CAMERON WEBB: They have to identify that they have symptoms. They have to then get a test, get a test result, contact a provider, someone who can prescribe, get that prescription and then go pick up that prescription. That's six different steps.

HUANG: The test to treat program will streamline by matching patients with places that can test for COVID and prescribe treatments on the spot. Natalie Quillian with the White House COVID Response says they're starting with a few hundred sites this week, and they'll grow the program from there. Still, she says, there's a limited number of pharmacies that can participate.

NATALIE QUILLIAN: Right now, these pills must be prescribed by a prescribing authority. And so we're really targeting those clinics and locations where you have a prescribing authority that can actually prescribe you the pills.

HUANG: Prescribing authorities include nurse practitioners, doctors and physician's assistants, and most pharmacies don't have them on site. CVS is the nation's largest pharmacy chain, and across the nation, just 10% of their locations contain MinuteClinics that are even capable of becoming test to treat places.

COVID pills are new, and they come with prescribing challenges. Pfizer's Paxlovid can interfere with many commonly prescribed drugs and cause health problems. Merck's molnupiravir comes with precautions due to reproductive risks. Independent pharmacies say they can help. Susan Davis is a pharmacy professor at Wayne State University in Michigan.

SUSAN DAVIS: Pharmacists are medication experts. We have been managing drug interactions and dose adjustments routinely for decades. We could handle this.

HUANG: Davis and her colleagues say if pharmacists could prescribe these pills, these one-stop shops can be everywhere. That would require some changes at the state level and also from the FDA, and the suggestion is controversial. The American Medical Association, which represents physicians, says the pills should be prescribed by a doctor who knows a person's full medical history.

Even as it stands, health experts say the program needs public buy-in and funding from Congress to succeed. As COVID cases recede, Dr. James Hildreth, president of Meharry Medical College, says it's not a time to be complacent.

JAMES HILDRETH: The virus is not done with us yet, right? And if we do have another surge, having a system like this in place can have a huge impact on controlling it.

HUANG: Hildreth says the program has a lot of promise, so long as it expands its outreach to rural communities, Indigenous groups and other marginalized, high-risk people that need it the most.

Pien Huang, NPR News. Transcript provided by NPR, Copyright NPR.

Pien Huang is a health reporter on the Science desk. She was NPR's first Reflect America Fellow, working with shows, desks and podcasts to bring more diverse voices to air and online.

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