How the try-to-treat bill of the U.S. Covid Strategy is failing patients

The federal “test-to-treat” program, announced in March, is intended to reduce covid hospitalizations and deaths by quickly administering antiviral drugs to those who test successfully. But as cases escalated, Americans did not have access to the program.

Pfizer’s Paxlovid and Merck’s Lagevrio are scheduled to launch within five days of each other’s first orders. For those who have had serious problems developing serious illness but have not been treated at this time due to covid-19. Millions of sick, disabled, and elderly Americans have access to care, and Drs. Anthony Fauci of the National Institutes of Health said April 11 so that more people will choose quickly.

The program allows people with covid symptoms to be tested, prescribed antiviral medications, and complete a comprehensive prescription in a single visit. The federal and state and local health agencies are leading citizens to an online map where people can find test-to-treat sites and other medications where they can access them. they fill out the order forms.

But most parts of the country have no prescription drugs or health centers listed as of April 14.

People who always see a doctor may not be able to find the medication on time, and that’s where the program comes in. Prior to the disease, 28% of Americans did not have access to a standard source of health care, with higher rates for black and Hispanic Americans.

“Our overall health response relies on lowering the barrier to accessing medications to the right people,” said Drs. Kirsten Bibbins-Domingo, director of the Department of Epidemiology and Biostatistics at the University of California-San Francisco.

He said in public, state, and local health systems, the U.S. Department of Health and Human Services relies on employees who are paying high prices for options, and the lack of knowledge prevents action. “The best tools we have are not available to the people who really want them,” he said.

Bibbins -Domingo is a medical doctor at Zuckerberg San Francisco General Hospital, who not only tests patients for covid and prescribes them antivirals, but also gives them medications – everything. of try-to-treat. But the hospital, which treats the most low -income and non -reported patients, is not listed on the federal map. There are three locations in San Francisco: two community health centers and one CVS.

Ninety -one percent of the sites listed on the map are federal partners: drug chains such as CVS, federally critical health agencies, and military and Indian agencies. HHS asked state and national health agencies to identify other participants, such as San Francisco General Hospital, that could be integrated. Most of those friends were not counted.

Nationwide, more than half of CVS MinuteClinics are trial-to-treat, according to federal data. About 1,200 hospitals, in 35 states and Washington, DC, will be housed under the same CVS treatment facility, where patients will be able to get medications for covid antivirals. . Walgreens drug stores and Kroger retail companies run about 400 additional sites.

The federal government has allocated nearly 400,000 classes of antivirals for its federal medical partners – about a quarter of the total supply since the program began in March.

Although the cost of the medications is covered by the federal government, the availability of the medication in the medications that control the program can be costly. While CVS does not charge undocumented individuals for covid tests online, MinuteClinics offers over $ 100 per person or telehealth options to screen patients and prescribe an antiviral. , if necessary. Those without insurance, health plans do not cover visits to medical clinics, or high-deductible programs have to take the full cost of the option.

Even if they can be found, the cure is not available.

KHN hopes to find out how easy or difficult it is to schedule a try-to-treat meeting at a CVS. Advertisers searched online and in person for covid testing and treatment options in April.

A KHN advertiser in Washington, DC, took a three -hour drive between stores to see if the test and antivirals were available for price at four MinuteClinic locations – the time available to people. little is available in general, let alone during illness.

Each store offers try-to-treat services, which can be booked through a kiosk. But three of the stores did not have the same available dates and did not have antiviral drugs available during the day.

A KHN broadcaster also tried to write polls online at medical clinics in some states, counting high respiratory symptoms. After the publisher signed a positive covid test on the screening document, a message came out – “For the safety of our patients and staff, we cannot allow you in. of the current office ” – then the patient is instructed to book a medical visit.

KHN also searched the CVS website for testing options at all of the MinuteClinics listed on the federal map in the District of Columbia, Maryland, and Virginia, with more than 100 offices. . Only half counted on the upcoming trial options.

Amy Thibault, a CVS spokesperson, said MinuteClinics all offer human testing services and found a glitch program they didn’t have. He said CVS was working to fix that. Thibault said covid patients are “encouraged” to use telehealth.

Some Americans, especially the elderly, do not have the gadgets, internet connection, or technical skills necessary for virtual visits. The program needs people like CVS to provide options for people’s choices, said HHS spokeswoman Suzanne Sellman.

KHN also searched the internet for options at Kroger and Walgreens offices in the states and found several options available.

Another problem: The FDA requires physicians, registered nurses, or physician assistants to write prescriptions. Medicine can’t work. Many of the nation’s major pharmaceutical companies have asked the Biden administration to open the border, expanding the program to different parts of the country and its communities.

According to this rule, the project requires medical and pharmaceutical clinics to live under the same roof – an arrangement that is not available in many places, especially in rural areas.

The federal map does not show areas in Wyoming or other South Dakota that have military bases and do not serve the public. People in other locations will have to drive more than 100 miles to get to the nearest office, according to the KHN survey of entry points.

The Wyoming Department of Health is working to register providers for the program, Kim Deti said.

There are four testing agencies maintained in Montana, including the federal network and Jon Ebelt, spokesman for the Montana Department of Health and Human Services. He said seven Defense and Indian Health Service departments would also provide trial-and-care services, but it was not open to the majority of the population.

Billings, the state’s largest city, is less than a three -hour drive from the nearest station shown on the map. Ebelt said the company is working with a primary care agency to get more people to sign up.

We need to have this right, says Bibbins-Domingo, a San Francisco doctor. He said as the U.S. moves away from drugs like mask prescriptions, the health system needs to make sure everyone has access to these new drugs, which can be returned to those who are work, prevent serious illness, and save lives.

For those far away from clinics, people with disabilities, and critically ill patients leaving home, telehealth is the easiest way to be managed. Several local governments, including Los Angeles County and New York City, have begun conservation efforts.

Truepill, a company that provides telehealth and medical technology, offers online covid assessments through its website for a fraction of the cost of CVS ’in-person or services. telehealth. The company has completed more than 10 million orders in the past five years.

Services are available in 50 states and Washington, DC, for $ 25 to $ 55. Although insurance is not allowed, the cost is comparable to insurance copies for medical appointments. Prescriptions can be sent to a local pharmacy for free and shipped home overnight via FedEx for a $ 20 fee.

HHS has not responded to requests for information about antiviral use and has repeatedly refused to allow KHN to watch virtual wiki meetings about the program held with health officials. state, departmental leaders, and other health care providers.

Bibbins-Domingo said that in order for the federal government to be trained to test and maintain, the program is more targeted at people with the highest levels of covid-related injury complaints.

“If you’re a normal person trying to drive this,” he said, “it’s just impossible.”

KHN writers Katheryn Houghton and Rachana Pradhan gave the presentation.

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