EVP/CEO LETTER
TEST-TO-TREAT:
SCOPE CREEP OR
INCREASING CARE?
Jon R. Roth, MS, CAE
April 2022 • DALLAS MEDICAL JOURNAL | 7
On March 8, 2022, the Biden
Administration announced
the launch of an initiative
with the stated goal of
“ensuring rapid ‘on the spot’
access to lifesaving COVID treatments.” As
stated in the US Health and Human Services
(HHS) press release, “People who test positive
for COVID-19 will be able to visit hundreds of
local pharmacy-based clinics and federally
qualifi ed community health centers (FQHCs),
and residents of long-term care facilities will
in one stop, be assessed by a qualifi ed health
care provider who can prescribe antiviral pills
on the spot. This ensures that, if people who
are at high risk for developing severe disease
test positive and if administration of an antiviral
is appropriate, they can get treatment
quickly and easily.”
After two long years of facing the impact
of COVID-19 in communities and physician
practices alike, many of us welcome just
about any innovative means to reduce the
burden of this disease. With the continuous
evolution of therapies to combat COVID-19,
it is incumbent upon all of us to maximize
the resources we have at hand to improve
the health of the nation. However, with every
idea and innovation proposed, it is imperative
to look at how the benefi ts outweigh any
potential risks. This is also true for the Test-to-
Treat program.
Buried in the press release from HHS are
the fi ner details that specify the terms under
which this program will roll out. While the
press release headline conjures images of
a patient walking into any neighborhood
pharmacy, receiving a COVID-19 test, and
walking out with their prescription for PAXLOVIDTM,
this is not how the program will be
implemented. In fact, only the few pharmacies
that have health clinics inside their stores
and health care providers not physicians
that can prescribe these COVID-19 therapies
will be eligible to dispense the medication to
people who need them.
Although the HHS program is being celebrated
by some as a vast improvement of
access to care for COVID-19 patients, there
are relatively few pharmacies with clinics
and prescribing providers who will be able to
participate in the program. For example, the
national pharmacy chain CVS has roughly
10,000 pharmacies across the US, but only
10% of those stores have Minute Clinics that
would be eligible to participate in this program.
Not exactly the barn-burner expansion
of care
that is
envisioned
in the
headlines.
But that’s
actually
good news
given the
questions
this
program
raises as
it moves
patients
out of their
primary
care physicians’
offi ces
and into
neighborhood pharmacy clinics.
Test-to-Treat is one of the latest examples
of the health care delivery system utilizing
pharmacies to “expand access to care.” The
convenience and accessibility of pharmacies
along with the training of pharmacists are
the primary reasons that more delegation
of primary health care services is being allowed
in a pharmacy. We have witnessed this
expansion with health interventions such as
vaccinations, birth control, and smoking cessation
occurring in pharmacies in a number
of states. In some cases, this expanded use
of pharmacists can indeed be benefi cial.
Pharmacists are medication experts and
have the knowledge to screen and initiate
important conversations with patients about
subjects such as medication interactions,
polypharmacy, and medication management.
But there is a delicate balance
between the stated goal of expanding access
to care against the important need to
maintain the primary relationship between a
patient and their physician.
Physicians and pharmacists routinely
collaborate on the care of patients as do
physicians with a host of other allied health
providers. When working as a team, physicians
and allied providers can improve the
care of patients. The slope turns slippery
when an allied profession pivots away from
collaboration and attempts to intervene in
the relationship between the physician and
their patient. Call it professional expansion,
scope creep, or economic opportunity; it
must be acknowledged that patient care is
not being optimized when the care team is
fragmented.
Physicians, and organized medicine in
general, often get blamed for “protecting
turf” when a proposal to expand scope of
practice by an allied health group is objected
to in legislative or regulatory arenas. That
is not a fair portrayal of medicine’s viewpoint.
In fact, I would suggest that physicians are
protective of the integrity of their position
on the care team because they have either
fi rsthand experience or fear of untoward
outcomes that patients may receive if the
team is broken apart. Their concern is about