How Will Biden’s ‘Test to Treat’ Initiative Work for COVID-19?

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Lara Antal / Verywell

Key Takeaways

  • People with a variety of health conditions can decrease their chance of severe COVID-19 by getting early treatment with a COVID medication.
  • Test to Treat, an initiative just announced by the White House, will allow for quicker administration of COVID-19 antiviral pills.
  • Those who are eligible will be able to take a test at a pharmacy and receive medication right away if they test positive.
  • COVID-19 antivirals are currently only authorized for people with confirmed mild-to-moderate COVID-19 who are at high risk of developing a severe case.

President Biden announced a new COVID-19 strategy plan in his March 1 State of the Union address, including a “Test to Treat” initiative. As a part of this initiative, people will be able to get tested for COVID-19 at a pharmacy, and receive free antiviral pills on the spot if they are positive.

Even though cases are dropping in the U.S., easier access to COVID-19 drugs is crucial. Right now, getting treatment can be a lengthy process, since it requires a positive test and a prescription. Both of the antiviral pills authorized in the U.S.—Pfizer’s Paxlovid and Merck’s molnupiravir—should be taken within five days of symptom onset.

In an email to reporters sent while President Biden was still delivering his State of the Union address, a White House official shared specifics on the Test to Treat plan, explaining that the goal was “to minimize the time between a positive test result and receiving an effective COVID-19 treatment, including antiviral pills and monoclonal antibodies.”

In his speech, President Biden referred only to Pfizer’s antiviral drug, Paxlovid. However, treatments authorized by the Food and Drug Administration (FDA) to treat the currently-circulating Omicron variant also include monoclonal antibodies, an antiviral pill from Merck, and the drug remdesivir, given as an infusion, according to treatment guidelines from NIAID.

According to the White House official, “under this program, people can get tested at local pharmacies and community health centers and receive antiviral pills right on the spot. The Administration will be launching these one-stop shops this month, with hundreds of sites opening nationwide including at pharmacy clinics at places like CVS, Walgreens, and Kroger.”

Who Can Take Antiviral Pills for COVID-19?

Paxlovid is available for people 12 and older with confirmed mild-to-moderate COVID-19 who are at high risk of developing a severe case of the disease—meaning they could become hospitalized, need intensive care, or die. Molnupiravir is authorized for people 18 and older with the same same risk, but only when other FDA-authorized COVID-19 treatments are inaccessible or inappropriate.

According to the Centers for Disease Control and Prevention (CDC), conditions and factors that may place someone at high risk for severe COVID include, but are not limited to:

  • Cancer
  • Chronic kidney disease
  • Chronic liver disease
  • Chronic lung disease
  • Cystic fibrosis
  • Dementia or other neurological conditions
  • Diabetes
  • Down syndrome
  • Heart conditions
  • HIV
  • Immunocompromised state
  • Mental health conditions
  • Obesity
  • Pregnancy
  • Sickle cell disease
  • Smoking
  • Organ or blood stem cell transplant recipient
  • Stroke
  • Substance abuse disorders
  • Tuberculosis

When Will the Test to Treat Program Start?

Don’t expect every corner drugstore to suddenly be a source of COVID treatment. At least for now, pharmacists cannot prescribe treatments for COVID-19.

“I’d refer you to each drug’s EUA (emergency use authorization) fact sheet which lists current prescriber authority…and does not currently include pharmacists,” Matt Blanchette, manager of retail communications for CVS Pharmacy, told Verywell via email. The fact sheets currently only authorize physicians, advance practice nurses, and physician assistants, to prescribe COVID-19 treatments.

Ilisa Bernstein, PharmD, JD, senior vice president of pharmacy practice and government affairs at the American Pharmacists Association, told Verywell that her organization is in discussions with the FDA to allow pharmacists to do the prescribing, too.

Rollout Details Remain Vague

The Department of Health and Human Services (HHS) did not return calls to Verywell about Test to Treat specifics on Wednesday, and information remains paltry even for professionals who will be involved.

“We will provide additional details regarding rollout in our stores as it becomes available,” Walgreens spokesperson Alexandra Brown told Verywell.

“We’re still reviewing the new initiative and don’t have a lot of details on how the program will be structured,” Michael Ganio, PharmD, senior director of pharmacy and practice at the American Society of Health-System Pharmacists (ASHP), told Verywell. 

Leana Wen, MD, an emergency physician and professor of health policy and management at George Washington University in Washington, DC, is concerned that Paxlovid, currently in short supply, won’t be prioritized sufficiently under the new initiative for those most likely to need it.

“Right now, there are such limited supplies of Paxlovid that these doses need to be reserved to those who are most likely to become severely ill, like the immunocompromised or elderly and medically vulnerable,” Wen told Verywell. “In the future, oral antivirals for the coronavirus should become like Tamiflu for influenza—if people test positive, they should be able to immediately access an antiviral that dramatically reduces their risk of severe illness. It benefits the individual, and also prevents straining hospitals.”

The White House said that Pfizer will deliver a million courses of treatment in March and double that amount in April. How much is needed, of course, will depend on whether there’s a new surge or variant of COVID-19. And if there is, it remains to be seen whether Paxlovid remains effective.

Prescriptions Requires Review of Patient’s Health Record 

Getting and taking Paxlovid isn’t quite as easy as President Biden made it seem in his State of the Union speech.

The treatment consists of 40 pills over five days. Paxlovid interacts with a long list of other drugs, including two statins to treat high cholesterol and several epilepsy drugs. It isn’t indicated for people with some serious health conditions, such as severe liver disease.

In some cases, patients can simply stay off their other drugs while they take Paxlovid, Amesh Adalja, MD, a senior scholar at the Johns Hopkins Center for Health Security, told Verywell. But he said some drugs can’t be paused and others take a long for the body to clear.

If Paxlovid isn’t an option for a patient, Merck’s antiviral pill, molnupiravir, be be an alternative, but it is only about 30% effective at reducing hospitalizations, compared to Paxlovid's 89%. Monoclonal antibody treatments are an option for most patients, but require an infusion at a treatment center.

Test to Treat Could Be Your Fastest Route to Treatment 

Once it’s up and running, the White House Test to Treat program may be the fastest route to treatment.

“I think the priority is getting the pills in your hand as soon as possible,” Adalja said. “Even for those with primary care providers, Test to Treat may be more rapid than their [own doctor] prescribing antivirals.”

No primary care doctor and no Test to Treat clinic near you yet? Adalja recommends these options:

What This Means For You

It may take time for the Test to Treat program to reach your area. If you have COVID-19 symptoms or test positive and have a primary care physician, reach out right away. If you don’t have a personal doctor and think you may have been exposed or test positive, local urgent care centers and community health clinics can help you access testing and—if you need it—care.

The information in this article is current as of the date listed, which means newer information may be available when you read this. For the most recent updates on COVID-19, visit our coronavirus news page.

By Fran Kritz
Fran Kritz is a freelance healthcare reporter with a focus on consumer health and health policy. She is a former staff writer for Forbes Magazine and U.S. News and World Report.