Ontario pharmacists want authority to prescribe antivirals to ‘test and treat’ COVID-19

This week, the United States launched a test-and-treat program that allows people to get tested for COVID-19 at a pharmacy, and if positive and eligible, receive therapeutic antiviral pills on the spot. The Ontario Pharmacists Association (OPA) says it’s an initiative they’d like to emulate here at home.

With the province rapidly reopening even as COVID-19 continues to spread in the community, the CEO of the Ontario Pharmacists Association says putting the program in place before the next wave or next variant would be smart future planning.

“Let’s be prepared for what may come down the pipe and, let’s not be naive. We’re not out of the pandemic,” said Justin Bates. “We don’t want to be caught in a scenario where we’re playing catch up. We have an opportunity to be more forward thinking on this, plan ahead and get it right.”

So far, Health Canada has only approved Pfizer’s antiviral pill Paxlovid. It is available only at provincial testing centres and supply is limited. The eligibility criteria is narrow, with priority given to patients who have the highest risk of severe illness or death.

Bates says as supply increases and eligibility criteria expands, pharmacies can once again add critical distribution capacity to the healthcare system, much like they did for testing and vaccination.

He adds that the OPA has been in “active dialogue” with the province’s Ministry of Health about rolling out a test and treat program in pharmacies across the province — what it might look like and what resources would be required.

Why pharmacies should be included in test and treat programs

Pharmacies are everywhere

Bates says allowing pharmacies to participate in test and treat programs will add another, often more accessible avenue for people to get treatment, along with hospitals and family doctors’ offices, among others.

“I think it has value as a complimentary channel … so it’s not taking anything away from any other healthcare provider,” he said. “Pharmacies are in every community. We are in rural and remote areas. There’s really no town without a pharmacy within five kilometers. So you want to be able to leverage that as a healthcare community hub.”

Infectious disease doctor Isaac Bogoch agrees that the concept is a “very smart approach.”

“We know there are still barriers to healthcare. Not everyone has a family physician, or will wait to go to perhaps an urgent care center,” he said. “There’s pharmacies all over the place …it’s a wonderful opportunity to really ensure that people have timely access and more equitable access to COVID therapeutics.”

Bogoch added that such a program would also contribute to keeping people out of the hospital, as part of a broader healthcare strategy to mitigate COVID-19 in the community.

“It lowers barriers to healthcare and I think people having additional options with multiple locations throughout the country would only be a good thing,” he said.

Pharmacists are well positioned for the task

Bates says pharmacies have been a “key distribution channel” for the COVID-19 vaccine campaign, administering over 7.2 million doses thus far. They have also conducted more than a million tests including PCR tests, rapid antigen tests and rapid molecular tests.

“That’s really the point that we want to leverage — that we already have these pharmacies that are providing testing,” said Bates.

He adds that pharmacists also have community confidence on their side.

“We know based on our opinion polling that pharmacists are highly trusted healthcare professionals, right up there with nurses and physicians. I think many people would prefer to go into their pharmacy to get their test and treatment.”

In addition, pharmacists are also well versed in drug interactions and potential side effects.

Paxlovid is in a class of medications called protease inhibitors. It is prescribed for five days and each course requires 30 pills.

RELATED: EXPLAINER: How do the new COVID-19 antiviral pills work?

“Paxlovid is a very complex medication. So it does require [knowledge of] drug-to-drug interactions, particularly for those patients that may have had a kidney transplant or are on medications for the liver. Pharmacists have access to that medication history” said Bates, “So it makes a lot of sense to be able to further expand on that and make it so that it’s a one-stop-shop, if you will, in terms of patients being able to get tested and treatment.”

“[With a drug like Paxlovid] you have to know what you’re doing. Pharmacists know what they’re doing. Who better to look at drug interactions? They’re perfect for the job,” added Bogoch. “They are a major pillar of healthcare provision in the inpatient and outpatient setting. They have a big role to play and this can be included in their role.”

What pharmacies need to implement test and treat programs

Symptomatic testing capabilities

Bates says in order for pharmacies to be able to offer test and treat programs, more of them will need to be supplied with rapid molecular tests for symptomatic patients. The tests, called ‘ID now’ are considered to be as accurate as PCR tests with a turnaround time of about 15 minutes.

Currently, 800 out of the province’s 4,700 pharmacies are conducting rapid molecular tests.

Bates says he doesn’t believe every pharmacy across the province will participate, but expects around 1,000 to join in initially if tests are made available, and expand from there.

“It will just depend on the individual pharmacists, but this is certainly within their wheelhouse of expertise and education,” he said.

Ability to prescribe medication

Several provinces across Canada allow pharmacists to prescribe medication.

“Alberta allows for the prescribing of anything other than a controlled substance. Ontario tends to lag when it comes to scope of practice for allied health professionals, including pharmacists,” said Bates. “Right now, pharmacists in Ontario can only prescribe smoking cessation products, so it’s on a very limited basis.”

Bates says the OPA has also been asking the province for the implementation of a “minor ailments” program. It would allow pharmacists to prescribe medications for common conditions like pink eye or an uncomplicated urinary tract infection. Prescribing Paxlovid or other COVID-19 antivirals, as they get approved, would be an extension of that ask.

“[This case] is different in the sense that the you’re dealing with a very specific drug,” he said. “As the association representing and supporting pharmacy professionals, we would provide education and all of the tools to be able to do it. It won’t be for everyone, but it does need to be enabled.”

When can we expect test and treat programs in Ontario?

The short answer is – it is currently unclear but the idea has been brought to the table.

Bates says the OPA has been in talks with the Ministry of Health for about two months, since soon after Pfizer applied for the approval of Paxlovid in Canada.

Discussions have revolved around expanding the scope of practice for pharmacists to bring Ontario in line with other provinces, which includes prescribing medications like Paxlovid.

“It’s not that we meet every day but we have regular touchpoints with the ministry and this is one of those subjects that we have raised,” he said.

CityNews reached out to the Ministry of Health (MOH) to confirm whether they are considering a test and treat program for the province and if any progress has been made toward it, but did not receive a response in time for publishing.