Inequity to COVID-19 Test to Treat Access — Pharmacists can help if permitted
APhA’s analysis of COVID-19 Test to Treat locations, as of June 22, 2022, demonstrates that underserved and vulnerable communities do not have equitable access to care in the current program.
As hospitalization rates and deaths from COVID-19 persist, the need to quickly connect high-risk patients who test positive for COVID-19 to lifesaving treatments remains essential.
Pharmacists have long been considered one of the most accessible health care professionals. Nearly 90% of the population lives within 5 miles of a pharmacy. According to our analysis, there are over 28,000 community pharmacies located in federally recognized underserved communities today, yet there only 838 Test to Treat sites have been established in those communities. Tapping the pharmacies in these areas could increase access to treatments by about 3200%.
At Test to Treat locations, patients who test positive for COVID-19 and have a high risk for progression to severe COVID-19 disease can receive a prescription for an oral COVID-19 medicine and conveniently fill that prescription at the same site of care. Throughout the COVID-19 pandemic, pharmacists have expanded access to testing and vaccination services but currently cannot prescribe these medicines because of limits by FDA despite being authorized to prescribe oral COVID-19 therapies. By allowing pharmacists to order oral COVID-19 treatments, access to prescriptions for these products could expand far beyond the 2,654 Test to Treat sites available nationwide at the time of the analysis.
As seen through the lens of social vulnerability, under-represented minority communities continue to experience barriers to achieving equitable access to patient care services. A recent study in The Lancet found that communities with a high social vulnerability can experience higher COVID-19 test positivity and risk of hospitalization. The CDC/Agency for Toxic Substances and Disease Registry Social Vulnerability Index (SVI) can be used to identify areas that would benefit from more resources to maintain the health of the community. According to APhA’s analysis, the least vulnerable areas nationwide have access to 75% of Test to Treat locations, limiting the most vulnerable communities to only 25% (666) of these locations. However, these areas—which fall in the top 30% of the social vulnerability index—have an estimated 24,000 community pharmacies, most of which are not points of care for oral COVID-19 medications.
Allowing pharmacists to order oral COVID-19 antivirals will open up significantly more community pharmacies as one-stop points of care and increase equitable access to those who need it most.
A Nationwide Look at Test to Treat Programs
Analysis Summary
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Test to Treat locations as of May 6, 2022
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Percent of overall Test to Treat locations
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Total # of pharmacies in area
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Potential # of pharmacies that could become Test to Treat locations
|
|
Bottom 70% of Social Vulnerability Index (SVI) areas
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Test to Treat locations as of May 6, 2022
1988
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Percent of overall Test to Treat locations
75%
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Total # of pharmacies in area
>47,000
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Potential # of pharmacies that could become Test to Treat locations
>45,000
|
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Top 30% of SVI areas
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Test to Treat locations as of May 6, 2022
666
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Percent of overall Test to Treat locations
25%
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Total # of pharmacies in area
>25,000
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Potential # of pharmacies that could become Test to Treat locations
>24,000
|
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Top 20% of SVI areas
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Test to Treat locations as of May 6, 2022
460
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Percent of overall Test to Treat locations
17%
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Total # of pharmacies in area
>16,000
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Potential # of pharmacies that could become Test to Treat locations
>16,000
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Top 10% of SVI areas
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Test to Treat locations as of May 6, 2022
240
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Percent of overall Test to Treat locations
9%
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Total # of pharmacies in area
>8,500
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Potential # of pharmacies that could become Test to Treat locations
>8,200
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Top 5% of SVI areas
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Test to Treat locations as of May 6, 2022
130
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Percent of overall Test to Treat locations
5%
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Total # of pharmacies in area
>4,600
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Potential # of pharmacies that could become Test to Treat locations
>4,500
|
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Locations in medically underserved areas/populations
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Test to Treat locations as of May 6, 2022
838
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Percent of overall Test to Treat locations
32%
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Total # of pharmacies in area
>28,000
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Potential # of pharmacies that could become Test to Treat locations
>27,000
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Locations in primary care health professional shortage areas
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Test to Treat locations as of May 6, 2022
982
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Percent of overall Test to Treat locations
37%
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Total # of pharmacies in area
>34,000
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Potential # of pharmacies that could become Test to Treat locations
>33,000
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© American Pharmacists Association
Methodology & References
COVID-19 Test to Treat location addresses (as of May 6, 2022) were determined using public domain data from HealthData.gov.1 Pharmacy location addresses (as of June 22, 2021) were determined using public domain data from the CMS National Plan and Provider Enumeration System National Provider Identifier (NPI) Registry.2 A program was written to extract all rows that included the Taxonomy code 3336C0003X (which designates a community or retail pharmacy) from the comprehensive NPI publication.3 Non-U.S. entities, provider (type 1) NPIs, and duplicate phone numbers and addresses were then excluded. All remaining addresses were geocoded using a Google Maps platform application programming interface (API) key except for 121 addresses that were manually geocoded because of errors in the Google Maps platform API key. Duplicate coordinates were excluded.
Medically underserved areas (MUAs), medically underserved populations (MUPs), and health professional shortage areas (HPSAs) were gathered through public data provided by the Health Resources Services Administration as keyhole markup language (KML) files.4 SVI locations were gathered through public data provided by CDC and ATSDR as shapefiles.5 Depictions of the U.S. states and territories were gathered through public data provided by the U.S. Census Bureau as KML files.6 Addresses, KML files, and shapefiles were analyzed and mapped using the geographic information software QGIS. (QGIS is a free geographic information system that was developed by the QGIS Development Team.) A series of maps depicting the location of all MUAs, MUPs, Primary Care HPSAs, Primary Care HPSA facility locations, SVIs, Test to Treat locations, and community pharmacy locations in the U.S. were then created. Dental health and mental health HPSAs were excluded. These maps were overlayed, and intersection geoprocessing tools were used to create the images and analysis.