Important Program For Covid Patients Closes, Leaving Many Stranded

The home “Test to Treat” program is closing April 16, leaving disabled and vulnerable Covid-19 patients without good options for accessing timely diagnosis and care.

While the Rapid Acceleration of Diagnostics Tech claims an intent to “reduce disparities for those underserved and vulnerable populations who are disproportionately affected by” Covid-19, dropping the program is an odd way of demonstrating this. The program allowed people to enroll and receive Pfizer’s COVID-19 & Flu Home Test. If they were symptomatic and had a positive test, they could receive free telehealth services.

When the program was announced as a pilot in Pennsylvania in January 2023 and then expanded nationally in December, no mention was made about how short-lived the program would be.

Andrew Weitz, Ph.D., program director at the National Institute of Biomedical Imaging and Bioengineering at NIH, responded to questions by email. He said, “Home Test to Treat was always intended to be a pilot program that would end in spring of 2024.” He indicated in addition to helping patients, it was always a“research study, aiming to help us understand how technologies like at-home tests and telemedicine can improve healthcare access.” It had “an enrollment target of 60,000 individuals, which has been met.”

Asked about the reach of the program, Weitz said that approximately 63,000 people enrolled in the program, 8,300 received telehealth consultations, and 6,700 received treatment. As expected, many of the enrollees have limited healthcare access and 2/3 of program participants were uninsured or underinsured. “Roughly half reported a delay in seeking medical care in the past year due to concerns about paying for a visit, not having access to a provider, etc.,” Weitz added.

Thus, there was shock and anger when the disabled community discovered the program would be discontinued on April 16, 2024. Julie Lam, Founder of MaskTogetherAmerica, has been very vocal, encouraging people to petition to keep the program. She reports she contacted eMed, the program administering Test to Treat, and that they were unaware that the program was to be axed.

Lam, who is herself immunocompromised, encourages people to write their public officials and to personalize their message about how ending this program will affect them.

Several others expressed concern and dismay over the Test to Treat program ending. Maeve Sherry is a person with long Covid and ME/CFS. With their last Covid-19 infection, Sherry said, “Test2Treat sent the prescription to my local pharmacy immediately, and I was able to take the first dose of Paxlovid an hour after testing positive.” In addition to receiving care much more rapidly than if they had to seek and appointment and go in person, they noted, “Being able to access healthcare from my bedroom allowed me to keep my family safe” and that “Test2Treat gave me the ability to fully quarantine myself.” Paying for Paxlovid is out of the question for them. Sherry also noted that long Covid disproportionately affects transgender and nonbinary people—46% and 37% of transgender and nonbinary people respectively have experienced long Covid, per the Census Bureau.

Johnnie Jae, a Native American member of the Chocktaw tribe, said that Test to Treat was invaluable in helping urban Natives who lacked access to the Indian Health Service. Many Native Americans live in poverty and can’t afford maskes and testing, let alone Paxlovid. It’s risky for the elderly and vulnerable to expose themselves to public transportation. Now, if one goes for care, that is also risky because basic “precautions aren’t in place.” Her experience is that, “If you are masked, you are going to be waiting longer” at a hospital. It’s “not friendly,” Jae added. She also recounted how earlier in the pandemic, when Native communities requested personal protective equipment, “we were actually sent body bags in many cases instead of the PPE.” Abigail Echo-Hawk turned some of these into traditional ribbon dresses.

Weitz tried to reassure that people who are uninsured or enrolled in Medicare/Medicaid would still have access to testing and treatment through the CDC’s ICATT program and the Pfizer Patient Assistance Program through the end of 2024. This is not quite accurate. The no-cost testing program is not readily available in my community, for example. The closest testing center is in Romney, WV, about a 45 minute drive on a winding country road. Another government (different Test to Treat) site through HHS shows free Paxlovid available in the Hyndman, Pa health center that is 30 miles north of Cumberland. If you are poor or ill, you can’t readily make such a trip.

According to patient Amy Mitchell, who has primary immune deficiency and long Covid, access to Paxlovid is not straightforward. She said, “My insurance only covers one box of Paxlovid every 6 months. My doctor requested a prior authorization, justifying another course of Paxlovid because I am immune deficient. He was following NIH Special Considerations guidelines for Immune Compromised.” (These Covid guidelines will be removed from the NIH website in August, leaving special needs populations without official medical guidance.) But insurance denied her physician’s request and “without insurance approval, the Paxcess copay discount doesn't work,” Mitchell explained. Again, the pharmacy said it would cost $1600 for 5 days of Paxlovid, which was unaffordable. Instead, on one occasion, she had to receive IV Remdesivir (Veklury) in a hospital that was an hour away. Her family was placed at risk transporting her and she created additional needless exposures at the hospital. Paxcess is only available once in 30 days. If someone needs a second course, they are out of luck. Mitchell concluded, removal of Paxlovid “puts lives at risk.”