The federal “test-to-treat” program, announced in March, is supposed to scale back covid hospitalizations and deaths by rapidly getting antiviral tablets to individuals who take a look at optimistic. However whilst circumstances rise once more, many Individuals don’t have entry to the program.

Pfizer’s Paxlovid and Merck’s Lagevrio are each designed to be began inside 5 days of somebody’s first signs. They’re for people who find themselves at excessive threat of growing extreme sickness however are usually not presently hospitalized as a result of of covid-19. Thousands and thousands of chronically ill, disabled, and older Individuals are eligible for the remedies, and Dr. Anthony Fauci of the Nationwide Institutes of Well being said April 11 that extra individuals could qualify quickly.

This system permits individuals with covid signs to get examined, be prescribed antiviral tablets, and fill the prescription multi functional go to. The federal government and lots of state and native well being departments direct residents to a web-based national map the place individuals can discover test-to-treat websites and different pharmacies the place they’ll fill prescriptions.

However giant swaths of the nation had no test-to-treat pharmacies or well being facilities listed as of April 14. And the web site of the largest participant, CVS, has vital technical points that make reserving an appointment tough.

Even individuals who often see a physician could also be unable to get a prescription in time, and that’s the place the program is available in. Earlier than the pandemic, 28% of Individuals didn’t have a daily supply of medical care, with charges even greater for Black and Hispanic Individuals.

“All of our public well being response depends on decreasing the barrier to getting remedies to the proper individuals,” mentioned Dr. Kirsten Bibbins-Domingo, chair of the Division of Epidemiology and Biostatistics at the College of California-San Francisco.

She mentioned the fragmented federal, state, and native public well being techniques, the U.S. Division of Well being and Human Companies’ reliance on companions that cost excessive costs for appointments, and the lack of clear data are stymieing the effort. “The perfect instruments that we’ve are usually not going to achieve the individuals who most want them,” she mentioned.

Bibbins-Domingo can be a training doctor at Zuckerberg San Francisco Basic Hospital, which she says is just not solely testing sufferers for covid and prescribing them antivirals, but additionally delivering them medicines — all the components of test-to-treat. However the hospital, which largely treats low-income and uninsured sufferers, doesn’t seem on the federal map. It reveals simply three places in San Francisco: two group well being facilities and one CVS.

Ninety-one p.c of the websites listed on the nationwide map are federal companions: pharmacy chains like CVS, federally certified well being facilities, and army and Indian Well being Service clinics. HHS has requested state and native well being departments to determine other potential participants, like San Francisco Basic Hospital, to allow them to be added. Most states have none of these companions listed but.

Nationally, CVS MinuteClinics make up greater than half of all test-to-treat places, in accordance with the federal knowledge. The roughly 1,200 clinics, in 35 states and Washington, D.C., are housed underneath the similar roof as CVS pharmacies, the place sufferers can choose up prescriptions for covid antivirals. Walgreens drugstores and Kroger grocery retailer associates run about 400 extra websites.

The federal authorities has put aside practically 400,000 programs of the antivirals for its federal pharmacy companions — a few quarter of the total supply since the program started in March.

Though the price of the tablets is roofed by the federal authorities, acquiring a prescription at the pharmacies that dominate the program could be costly. Although CVS doesn’t cost symptomatic uninsured individuals for on-site covid exams, MinuteClinics cost upwards of $100 for in-person or telehealth appointments to look at sufferers and prescribe an antiviral, if wanted. Folks with out insurance coverage, whose well being plans don’t cowl visits to the clinics, or who’ve high-deductible plans should shoulder the full price of the appointment.

Even when they’ll afford it, discovering remedy may be unattainable.

KHN aimed to learn how simple or onerous reserving a test-to-treat appointment at a CVS could be. Reporters searched on-line and in individual for covid testing and remedy appointments in April.

It took a KHN reporter in the Washington, D.C., space three hours driving between shops to determine whether or not testing was obtainable and antivirals in inventory throughout 4 MinuteClinic places — time that few individuals can afford generally, not to mention after they’re sick.

Every retailer offered test-to-treat companies, which might be booked via a kiosk. However three of the shops both didn’t have same-day appointments obtainable or didn’t have the antiviral tablets in inventory that day.

A KHN reporter additionally tried to e book appointments on-line at clinics in a number of states, itemizing higher respiratory signs. After the reporter marked a optimistic covid take a look at on the screening kind, a message appeared — “For the security of our sufferers and employees, we are able to’t permit you into the clinic presently” — and the affected person was then directed to e book a telehealth go to. 

KHN additionally searched CVS’ web site for testing appointments in any respect MinuteClinics proven on the federal map in the District of Columbia, Maryland, and Virginia, simply over 100 clinics complete. Solely half listed any future testing appointments obtainable.

Amy Thibault, a CVS spokesperson, mentioned that every one MinuteClinics present in-person test-to-treat companies and {that a} software program glitch made it seem they don’t. She mentioned CVS is working to repair that. Thibault mentioned covid sufferers are “inspired” to make use of telehealth. 

Some Individuals, particularly seniors, don’t have the units, web connection, or know-how expertise wanted for digital visits. This system requires members like CVS to supply choices for in-person appointments, mentioned HHS spokesperson Suzanne Sellman.

KHN additionally searched on-line for appointments at taking part Kroger and Walgreens clinics in a number of states and located many obtainable in-person appointments.

One other complication: The FDA requires docs, superior observe registered nurses, or doctor assistants to jot down the prescriptions. A pharmacist can’t do it. Many of the nation’s main pharmacy organizations have asked the Biden administration to take away the restriction, which might develop the program to scores of rural and underserved communities.

As a result of of this rule, the program requires clinics and pharmacies to be underneath the similar roof — a setup that doesn’t exist in lots of areas, notably in rural areas.

The federal map reveals no websites in Wyoming or South Dakota apart from army clinics, which don’t serve the public. Folks in dozens of different areas must drive greater than 100 miles to achieve the nearest clinic, in accordance with a KHN assessment of taking part places.

The Wyoming Division of Well being is working to enroll suppliers in the program, spokesperson Kim Deti mentioned.

Montana has 4 public-facing test-to-treat clinics, in accordance with the federal web site and Jon Ebelt, a spokesperson for Montana’s Division of Public Well being and Human Companies. He mentioned that seven Protection Division and Indian Well being Service amenities additionally present test-to-treat companies, however these aren’t open to most individuals.

Billings, the state’s most populous metropolis, is greater than a three-hour drive from the nearest website proven on the map. Ebelt mentioned the company is working with a neighborhood primary-care nonprofit to search out extra amenities to enroll.

We’ve to get this proper, mentioned Bibbins-Domingo, the San Francisco professor. She mentioned that as the U.S. strikes away from restrictions like masks mandates, the public well being system should be certain that everybody can get these new remedies, which might get individuals again to work sooner, stop critical sicknesses, and even save lives.

For these removed from clinics, individuals with disabilities, and other people too sick to go away house, telehealth might be the best technique to get handled. A number of native governments, together with Los Angeles County and New York City, have launched digital care initiatives.

Truepill, an organization that gives telehealth and pharmacy know-how, affords on-line covid assessments via its web site for a fraction of the price of CVS’ in-person or telehealth operations. The corporate has stuffed greater than 10 million prescriptions in the previous 5 years.

The service, obtainable in all 50 states and Washington, D.C., prices $25 to $55. Although insurance coverage isn’t accepted, the price is corresponding to insurance coverage copays for in-person physician appointments. Prescriptions could be despatched to a neighborhood pharmacy for no further cost or shipped to a house in a single day by way of FedEx for a $20 price.

HHS didn’t reply to requests for knowledge on antiviral use and has repeatedly declined to permit KHN to watch weekly virtual meetings about the program held with state well being officers, clinic administrators, and different well being care suppliers.

Bibbins-Domingo mentioned that to be efficient, the federal authorities should make it simpler to get testing and remedy, particularly when the program is geared towards these at highest threat of devastating issues from covid.

“In case you’re simply a mean individual making an attempt to navigate this,” she mentioned, “it’s truly utterly unattainable.”

KHN correspondents Katheryn Houghton and Rachana Pradhan contributed to this report.

Hannah Recht: [email protected], @hannah_recht