What the test-to-treat debate means for the future of retail health

The Biden Administration’s test-to-treat initiative for COVID-19 has reignited a debate on the appropriate role of retail health in care delivery. 

The initiative announced on March 8 allows retail clinics (along with long-term care facilities and federally qualified health centers) to prescribe antiviral pills “on the spot” to anyone who tests positive for COVID-19. The administration said the initiative removes barriers to testing and treatment. However, the American Medical Association cautioned that the approach oversimplified COVID-19 treatment. 

Though antiviral medications have a high success rate, they also have a range of drug interactions. The AMA said in a statement that safely prescribing them requires prior knowledge of a patient’s medical history or current medications, which retail clinics may not possess. “We urge patients who test positive for COVID-19 to contact their physician to discuss treatment options,” the AMA said.

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Limited access to patient history isn’t the only concern that industry stakeholders have about retail health. A 2019 literature review found retail clinics provided similar care for lower per-visit costs, though comparative evidence of care quality and patient satisfaction was “minimal.” Meanwhile, a 2016 study concluded retail health contributed to $14 in additional spending per person per year, due in large part to increased overall utilization. 

At the same time, the test-to-treat initiative comes at a time when patient interest in retail health is rising. According to a Morning Consult survey, 35% of adults sought care at a retail clinic during the pandemic, and 55% planned to do so in the future. Respondents also tended to prefer the quality of services provided at a retail clinic to the care they typically receive at the doctor’s office.

COVID-19 testing and vaccination provided retailers a boost in business. CVS Health reported that 9% of customers who visited for a COVID-19 test filled a new prescription, while Walgreens saw a 41% jump in account registrations from new customers scheduling vaccination appointments, Morning Consult reported. 

Patient interest reflects a long-term trend. As Kaiser Health News pointed out, more than a dozen U.S. states let pharmacists test and treat patients for common illnesses such as strep throat and flu, while several states let pharmacists prescribe medications based on the results of a rapid point-of-care test – as they now can for COVID-19. On top of that, federal legislation has been reintroduced to let Medicare bill for care delivered in a retail clinic setting.

Even with an expanded scope of practice, experts told Managed Healthcare Executive that retail health’s place in the care paradigm is largely preventive health – vaccinations and conditions with few complications – as opposed to longitudinal condition management. Walmart’s new diabetes program, for example, is a telehealth-based service sold to employers, not something offered in stores.

Nonetheless, the Chartis Group said disruption from retail clinics should put traditional providers on notice. “New market entrants are … raising the competitive bar for what patient consumers expect from their care experiences,” the consultancy said. “Consumers will not wait for hospitals and health systems stuck in planning mode.”

Brian Eastwood is a Boston-based writer with more than 10 years of experience covering healthcare IT and healthcare delivery. He also writes about enterprise IT, consumer technology, and corporate leadership.