(1012) Exploring Factors Influencing Paxlovid Prescribing at Wisconsin Community Pharmacies: A Qualitative Study

Objectives: The COVID-19 Test to Treat Program (T2T) allows community pharmacists to prescribe Paxlovid for COVID-19 treatment in eligible patients to improve timely and equitable access to COVID-19 treatments. Little is known about barriers and facilitators that impact community pharmacists’ role in Paxlovid prescribing.

Objectives: 1) To describe the process of Paxlovid prescribing in community pharmacies and 2) to determine barriers and facilitators to performing Paxlovid eligibility screening at community pharmacies.

Methods: An exploratory qualitative study utilizing semi-structured virtual interviews with key informants from community pharmacies enrolled in the T2T program in Wisconsin (n= 5). Key informants at pharmacies identified through the Wisconsin Department of Health Services (DHS) and the Pharmacy Practice Enhancement and Action Research Link (PearlRx) network were invited to participate in the study via email throughout June-September 2023. A short online survey was used to collect general pharmacy information before the interview. An interview guide was developed using the Consolidated Framework for Implementation Research (CFIR). Descriptive statistics were used to analyze survey responses and qualitative analysis of interviews followed an inductive and deductive hybrid approach guided by the CFIR domains (inner setting, individual characteristics, and outer setting).

Results: Participants included key informants from independent pharmacies that, on average, dispensed 129.8 standard and renal doses of Paxlovid. Depending on the case, the process of screening patients for Paxlovid eligibility took between 5 and 45 minutes. Typically, the process started with the patient reporting a positive COVID-19 test, pharmacists asking about the symptoms and their onset, and a review of patient medications to assess for potential drug interactions. Next, if the patient has access to their lab work, pharmacists review the lab data to assess liver and kidney functions. If the pharmacist or patient is unable to access lab data right away, pharmacists call a physician’s office to verify lab work. Pharmacists with EHR access would do the screening by accessing data contained in the EHR. If the patient is deemed eligible, pharmacists initiate the appropriate Paxlovid prescription and provide patient counseling. To minimize the exposure to staff and other patients, Paxlovid screening and patient counseling occur over the phone and outside the pharmacy (drive-through/patient car), unless the caregiver presents to pick up the prescription. The most frequently cited facilitators of Paxlovid prescribing at the pharmacy included: 1) availability of Paxlovid decision-support tools (e.g., the FDA Paxlovid Eligibility Screening Checklist), 2) access to an EHR, 3) previous involvement with COVID-19 testing and immunization, and 4) remote eligibility screening and contactless delivery (i.e., telehealth, curbside, drive-through). Conversely, the following acted as barriers to Paxlovid prescribing at community pharmacies: 1) limited access to patient health information and 2) inadequate reimbursement.

Conclusions: Pharmacies went above and beyond to ensure patients received Paxlovid on time. However, pharmacists are not adequately compensated for the time and effort they put into the eligibility screening process which is complicated by limited access to needed patient information. Securing EHR access is critical to treating patients within the 5-day treatment window, expediting the process for similar services, and freeing pharmacists time to perform more clinical-based services. Similarly, ensuring pharmacists are properly reimbursed for their clinical services, through advocating for pharmacists’ provider status, will guarantee better care for patients. For such programs to be successful, public health officials must include pharmacists in program design efforts to capture a better understanding of the information and resources pharmacists will need to be able to accomplish the task.