TCCRI’s white paper highlights how allowing pharmacists to “test and treat” for common acute conditions, like strep throat, can improve health care access in spite of the primary care shortage across Texas, particularly in rural & underserved areas.
Accessing primary care providers in Texas is increasingly difficult due to a significant shortage of healthcare professionals, particularly in rural areas. Projections indicate Texas will face a shortfall of over 10,330 physicians by 2032, mirroring a national shortage estimated to reach 124,000 doctors by 2034. More than 80 percent of Texas counties are designated as Health Professional Shortage Areas (HPSAs) for primary care, reflecting a critical gap in provider availability. This shortage contributes to prolonged wait times for primary care appointments, which can be significantly longer in rural communities. These delays exacerbate barriers to care, particularly for time-sensitive conditions such as influenza, strep throat, and COVID-19, where timely intervention is crucial to prevent complications. The shortage of primary care providers disproportionately impacts underserved areas, where residents often face both geographical and financial barriers to accessing healthcare. Addressing these issues requires innovative solutions to ensure affordable and timely access to primary care across the state.
Pharmacists play an increasingly vital role in public health by administering vaccines and conducting certain medical tests. Their practice has evolved to address accessibility gaps and improve healthcare delivery, particularly for underserved populations. This paper examines the current authority of pharmacists to administer vaccines and conduct, and how other states are using pharmacists to address shortages in primary care providers.
The federal Public Readiness and Emergency Preparedness (PREP) Act was instrumental in addressing healthcare provider shortages during the COVID-19 pandemic by leveraging pharmacists to expand access to care. Under the PREP Act, pharmacists were authorized to operate within specific parameters to provide essential healthcare services, including the administration of vaccines and diagnostic testing for COVID-19. This temporary authorization allowed pharmacists to fill critical gaps in the healthcare system by delivering timely, low-acuity care, particularly in underserved and high-demand areas. The success of these measures highlighted the potential for pharmacists to play a broader, permanent role in healthcare delivery.
Several states have implemented “Test and Treat” programs, allowing pharmacists to provide diagnostic testing and treatment for specific conditions such as influenza, strep throat, and COVID-19. States like Idaho, Arkansas, and Colorado have led the way in granting pharmacists the authority to use Clinical Laboratory Improvement Amendments (CLIA)-waived tests and prescribe treatments independently or under physician protocols. For instance, Idaho’s innovative legislation has allowed pharmacists to utilize their roles as community healthcare providers by supplementing primary care providers and proving same-day tests and treatments for common illnesses in non-complex patients. Idaho is serving as a model for improving healthcare access in underserved areas. More recent legislative efforts in states like Illinois and Tennessee have adopted similar frameworks, highlighting the growing recognition of the effectiveness of Test and Treat programs in addressing gaps in care, particularly in rural and underserved communities.
Test and Treat programs can positively affect patient outcomes by reducing delays in care and ensuring timely treatment for common acute conditions. Pharmacists’ ability to provide immediate diagnosis and treatment for minor conditions, including skin conditions, strep throat, influenza, and COVID-19, improves health outcomes by mitigating the risk of complications that arise from delayed care. For example, untreated strep throat can lead to rheumatic fever, while delayed treatment of influenza can result in severe illness and hospitalization. By offering accessible and efficient care, Test and Treat programs could help ensure better health management for patients in areas with limited access to primary care providers.
The economic benefits of Test and Treat programs can be significant, as they help reduce unnecessary healthcare expenditures associated with emergency department (ED) visits and advanced treatments for preventable complications. There is evidence that even routine testing and treatment by a primary care provider can be more expensive to patients than that same care provided by a pharmacist. For example, treatment with antibiotics for an uncomplicated urinary tract infection costs about $30 on average at a pharmacy, compared with an average cost of $121 at a primary care provider’s office and $963 in the ED. Pharmacists' ability to manage low-acuity cases directly in the community decreases reliance on higher-cost care settings, such as emergency rooms and urgent care centers. Additionally, timely diagnosis and treatment lower the likelihood of complications that require costly interventions, such as hospitalizations for severe flu cases or cardiac issues stemming from untreated strep infections. By optimizing healthcare resource utilization and preventing avoidable complications, Test and Treat programs contribute to overall cost savings for the healthcare system, particularly in regions where access to primary care is limited. These savings benefit both patients and the broader healthcare system by improving efficiency and reducing financial strain.
Texas should implement a Test and Treat process, as various states have done. Doing so will ensure help overcome the state’s ongoing provider shortage and ensure access to affordable care for the Texans who struggle most to access primary care, including those without health insurance. House Bill 2079 (Jetton, 88R) and House Bill 2049 (Howard, 87R) are examples of sample legislation because they highlight specific, limited uses of Test and Treat in order to alleviate these primary care shortages. Test and Treat policies should not be designed to replace primary care providers, but rather to supplement existing healthcare services and reduce the reliance on urgent care facilities and emergency departments for minor, acute conditions. By empowering pharmacists to conduct CLIA-waived tests and provide immediate treatment for minor illnesses such as influenza, strep throat, and COVID-19, pharmacists can offer accessible, affordable, and timely care in community settings. In the 89th Legislative Session, Texas should adopt a version of Test and Treat similar to the legislation highlighted above.
Adopting Test and Treat would mitigate the strain on overcrowded EDs and costly urgent care centers, where many patients seek treatment for conditions that could be managed more efficiently and more cost effectively at pharmacies. Additionally, it complements primary care by addressing acute healthcare needs that may not require a primary care visit, allowing primary care providers to focus on managing more complex or chronic conditions and providing preventive care. A permanent state policy of Test and Treat would optimize the healthcare system by improving accessibility and efficiency, particularly in underserved areas.
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