COVID-19 Test to Treat Pathways: Policy Options for Achieving National Implementation

Executive Summary

The United States possesses a number of countermeasures against Covid-19—including a host of safe, effective therapeutics for mild-to-moderate disease that can be updated in response to new variants while preventing those most at-risk from progressing to severe illness. Recent actions by the Biden Administration have facilitated greater short-term availability of those treatments in conjunction with timely access to testing after symptoms or exposure. These actions include expansion of the number of Test to Treat locations, the ability of more administration sites to directly order product, and dedicated outreach to providers and patients. However, the utilization of therapeutics remains low relative to caseloads, uneven, and difficult to track.

Uneven utilization of therapeutics is due in part to: 1) gaps in public and provider awareness, with uncertainty about timely access and patient prioritization; 2) lack of clarity for continued reliable supply, with uncertainty about procurement and thus about future availability of treatments, especially during surges; and 3) inadequate and unclear policy and financial supports for coverage and access following the expiration of the public health emergency (PHE) due to a lack of clarity on reimbursement for administration and cost-sharing requirements for tests and treatments. During the PHE, health plans are required to provide access to testing, and federal procurement of treatments has lowered the cost burden for patients. With the end of the PHE looming, there is no definitive national strategy for supporting effective and equitable availability of Test to Treat pathways for Covid-19. This issue brief outlines the gaps in existing Test to Treat pathways and describes short- and long-term actions for improving timely use and supply of Covid-19 therapeutics. It includes policy options to ensure adequate therapeutic supply, steps to expand existing public health and health care Test to Treat pathways, and opportunities to address payment barriers for access to treatment.