5 reasons 'test to treat' is off to a rocky start

In March, the White House launched its "test-to-treat" initiative, a program allowing high-risk patients with COVID-19 symptoms to get tested at pharmacies and receive free antiviral pills on the spot. But the rollout has not been going as smoothly as many hoped.

Here are five challenges the initiative is struggling to address:


HHS' Office of the Assistant Secretary for Preparedness and Response started distributing COVID-19 antiviral pills — Pfizer's Paxlovid and Merck's Lagevrio — to participating pharmacy-based clinics March 7, supplying the pills for Americans with mild or moderate COVID-19 who are at risk of severe disease.

However, many Americans are unaware of the test-to-treat program, and many who test positive for COVID-19 are unsure whether they qualify for Paxlovid or Lagevrio. Some people are also confused by healthcare providers' interpretation of the eligibility guidelines, as some define them more narrowly than others.

"Test to treat is exactly what we should be doing at this point," Mara Aspinall, a biomedical diagnostics professor at Arizona State University in Tempe, told Forbes. "But the implementation simply has not worked. Lots of pharmacists don’t even know it exists."

Finding a location

Availability remains a challenge for many Americans trying to utilize test-to-treat centers, especially for those who live in rural areas or other healthcare deserts. In these areas, test-to-treat locations are scarce, according to HHS' finding tool.

Ninety-one percent of the test-to-treat locations included on HHS' national map are federal partners, meaning they are mostly pharmacy chains such as CVS, federally qualified health centers, and military and Indian Health Service clinics, according to Kaiser Health News. HHS has asked state and local health departments to add participants that provide testing and antivirals under one roof, such as local hospitals and clinics, but most states do not have those partners listed yet.

Some users of CVS' online appointment booking system said they were met with this message after submitting their positive COVID-19 test: "For the safety of our patients and staff, we can't allow you into the clinic at this time." Patients who received this message were encouraged to book a telehealth visit.

A CVS spokesperson told Kaiser Health News that all MinuteClinics provide in-person test-to-treat services and the company is working to fix the glitch that makes it seem as if they do not.


Pharmacy chains such as CVS are the largest participants in the test-to-treat program. Their clinics serve as a place where many Americans without a primary care physician go to receive diagnoses and treatment.

CVS MinuteClinics do not charge uninsured patients for COVID-19 testing, but the appointment required to obtain an antiviral prescription can cost upward of $100. The cost would be even higher if an uninsured patient got their prescription from an urgent care clinic or hospital, according to Forbes.

Legal and safety concerns

Pharmacists can dispense COVID-19 antivirals, but most states do not allow them to write prescriptions for the pills. Many pharmacists send patients to physicians for follow-up tests, which often cause patients to miss the window when COVID-19 antiviral pills are most effective (about three days since the onset of symptoms), according to Financial Times.

The American Medical Association has been against the test-to-treat program since its inception, calling the initiative "extremely risky" on March 4.

"COVID-19 is a complex disease, and there are many issues to consider when prescribing COVID-19 antiviral medications," the AMA said. "Leaving prescribing decisions this complex in the hands of people without knowledge of a patient's medical history is dangerous in practice and precedent."

Additionally, many Americans are apprehensive about taking a new medication. The White House is finalizing plans to ensure Paxlovid is available at every pharmacy in the U.S., but the drug has the disadvantage of adverse reactions to common medications such as statins, according to Forbes.

Less testing

Many Americans are learning to live with COVID-19, so testing numbers are much lower than they were in the winter. The average number of tests being done every day in the U.S. is 600,000, down from a peak of 3.5 million earlier in 2022, according to Financial Times.

Ezekiel Emanuel, MD, PhD, a medical professor at the University of Pennsylvania in Philadelphia and former COVID-19 adviser for President Joe Biden, told Financial Times that the way Americans are testing has shifted quickly since the start of the year.

In addition to testing taking place less frequently, those who do test are largely doing so at home rather than in medical settings, Dr. Emanuel said.


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