Testing program to deal with Covid-19 is stalled by lack of services and technical issues


But large swaths of the country had no pharmacies or health centers for testing to treat listed as of April 14. And the largest participant’s website, CVS, has significant technical issues that make it difficult to book appointments.

“Our whole public health response hinges on lowering the barrier to getting treatments to the right people,” said Dr. Kirsten Bibbins-Domingo, chair of the University’s Department of Epidemiology and Biostatistics. from California to San Francisco.

She said the fragmentation of federal, state and local public health systems, the US Department of Health and Human Services’ reliance on partners who charge high prices for appointments, and the lack of clear information hinders the effort. “The best tools we have won’t reach the people who need them most,” she said.

Bibbins-Domingo is also a practicing physician at Zuckerberg San Francisco General Hospital, which she says not only tests patients for covid and prescribes antivirals, but also provides them with drugs — all the elements of the test to treat. But the hospital, which largely treats low-income and uninsured patients, does not appear on the federal map. It shows just three locations in San Francisco: two community health centers and one CVS.

Ninety-one percent of the sites listed on the national map are federal partners: pharmacy chains like CVS, federally licensed health centers and military clinics and Indian Health Services. HHS has asked state and local health departments to identify other potential participants, such as San Francisco General Hospital, so they can be added. Most states have not yet listed these partners.

Nationally, CVS MinuteClinics account for more than half of all test-to-treat sites, according to federal data. The roughly 1,200 clinics, in 35 states and Washington, DC, are housed under the same roof as CVS pharmacies, where patients can get prescriptions for covid antivirals. Walgreens pharmacies and Kroger-affiliated grocery stores operate approximately 400 additional locations.

The federal government has set aside nearly 400,000 courses of antivirals for its federal pharmaceutical partners – about a quarter of total offer since the start of the program in March.
Although the cost of the pills is covered by the federal government, getting a prescription from pharmacies that dominate the program can be expensive. Although CVS does not charge symptomatic uninsured people for on-site covid testing, MinuteClinics does charge over $100 for in-person or telehealth appointments to examine patients and prescribe antiviral medication, if needed. People without insurance, whose health plans don’t cover clinic visits, or who have high-deductible plans must pay the full cost of the appointment.

Even if they can afford it, finding a treatment may be impossible.

KHN aimed to find out how easy or difficult it would be to book a test appointment to treat in a CVS. Journalists searched online and in person for covid testing and treatment appointments in April.

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It took a KHN reporter in the Washington, D.C. area, three hours to drive between stores to determine if tests were available and antivirals were in stock at four MinuteClinic locations — time few can afford in general, let alone when they are sick.

Each store provided test-to-treat services, which could be booked through a kiosk. But three of the stores either didn’t have same-day appointments or didn’t have the antiviral pills in stock that day.

A KHN reporter also attempted to book appointments online at clinics in several states, listing upper respiratory tract symptoms. After the reporter marked a positive covid test on the screening form, a message appeared – “For the safety of our patients and staff, we cannot allow you into the clinic at this time” – and the patient was then prompted to book a telehealth visit.

KHN also searched the CVS website for testing appointments at all of the MinuteClinics listed on the federal map in the District of Columbia, Maryland and Virginia, just over 100 clinics in total. Only half listed future testing appointments available.

Amy Thibault, spokesperson for CVS, said all MinuteClinics provide in-person testing services and a software glitch made it appear they weren’t. She said CVS is working to fix this issue. Thibault said covid patients are “encouraged” to use telehealth.

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Some Americans, especially older people, do not have the devices, internet connection or technology skills needed for the virtual tours. The program requires participants like CVS to provide options for in-person appointments, HHS spokeswoman Suzanne Sellman said.

KHN also searched online for appointments at participating Kroger and Walgreens clinics in several states and found many in-person appointments available.

Another complication: The FDA requires physicians, advanced practice registered nurses, or physician assistants to write prescriptions. A pharmacist cannot do this. Many of the nation’s leading pharmaceutical organizations have asked the Biden administration to remove the restriction, which would expand the program to dozens of rural and underserved communities.
Because of this rule, the program requires clinics and pharmacies to be under the same roof – a setup that does not exist in many regions, especially in rural areas.

The federal map shows no sites in Wyoming or South Dakota other than military clinics, which do not serve the public. Residents of dozens of other areas would have to travel more than 100 miles to reach the nearest clinic, according to a KHN survey of participating sites.

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The Wyoming Department of Health is working to enroll providers in the program, spokesperson Kim Deti said.

According to the federal website and Jon Ebelt, spokesperson for the Montana Department of Public Health and Human Services, Montana has four test-to-treat clinics for the public. He said seven Ministry of Defense and Indian Health Service establishments are also providing testing services to treat, but these are not open to most people.

Billings, the most populous city in the state, is more than a three-hour drive from the nearest site shown on the map. Ebelt said the agency was working with a local primary care nonprofit to find more facilities to enroll.

We have to get it right, said Bibbins-Domingo, a professor in San Francisco. She said as the United States moves away from restrictions like mask mandates, the public health system must ensure everyone can get these new treatments, which can get people back to work sooner. , prevent serious illnesses and even save lives.

For people far from clinics, people with disabilities, and people too sick to leave home, telehealth might be the easiest way to get treatment. Some local governments, including Los Angeles County and New York Citylaunched virtual care initiatives.
Truepill, a company that provides telehealth and pharmacy technology, is offering online covid assessments through its website findcovidcare.com for a fraction of the cost of CVS in-person or telehealth operations. The company has filled more than 10 million prescriptions over the past five years.

The service, available in all 50 states and Washington, DC, costs $25 to $55. Although insurance is not accepted, the cost is comparable to insurance copayments for in-person medical appointments. Prescriptions can be sent to a local pharmacy at no additional cost or shipped overnight via FedEx for a $20 fee.

HHS has not responded to requests for data on antiviral use and has repeatedly refused to allow KHN to observe weekly virtual meetings on the program organized with state health officials, clinic directors and other health care providers.

Bibbins-Domingo said that to be effective, the federal government must facilitate testing and treatment, especially when the program is for those most at risk for devastating complications from covid.

“If you’re just an average person trying to figure it out,” she said, “it’s actually completely impossible.”

KHN correspondents Katheryn Houghton and Rachana Pradhan contributed to this report.
KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism on health issues. Along with policy analysis and polls, KHN is one of the three main operating programs of the KFF (Kaiser Family Foundation). KFF is an endowed non-profit organization providing information on health issues to the nation.


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