On July 6th, the FDA announced a revised EUA to allow pharmacists to prescribe Paxlovid. And the crowd went wild! Yay for Pharmacy! A real win for the profession. But, "who" is being served?

A recent article published by the US Department of Health and Human Services/Centers for Disease Control and Prevention on October 28th, 2022, revealed what people from historically marginalized populations (HMP) have known for centuries, White patients are afforded greater access to healthcare.

This study looked at electronic health record (EHR) data from 692,570 COVID-19 patients aged  ≥ 20 years who sought medical care during January-July 2022. The results showed that between April – July of 2022, when Paxlovid use was at its peak, as compared to White patients, Black or African-American patients were prescribed Paxlovid 35.8% less often, multiple or other race patients 24.9% less often, AIAN/HHOPI patients 23.1% less often, Asian patients 19.4% less often, Hispanic patients 29.9% less often than non-Hispanic Whites. What’s more alarming is that these racial and ethnic disparities were generally higher among patients who were at risk for severe COVID-19, including those >50 years and those who were immunocompromised.

The article sites several potential reasons for these barriers to include:

• High (social vulnerability index) SVI areas with majority HMP having limited access to COVID-19 treatment facilities.
•  Previous negative experiences with the healthcare system influenced decision not to seek treatment.
• Racism and implicit bias among health care providers.
• Race and ethnicity could be proxies for other barriers, such as limited knowledge of treatment options, lack of internet access for telemedicine services, limited transportation, and language barriers.

So what does this mean for you as a pharmacy professional? Obviously, you cannot own all of the potential barriers highlighted in this article, and nor should you. You are but one person in a failed system. At the end of the day, you can only control the person in the mirror.

Here are 3 things you can do now to help all patients, but especially patients of color stay healthy and alive during the Flu Season and what is now being referred to as the "Twindemic" of COVID-19 and RSV:

1. Encourage everyone to stock up on at-home test kits. Patients have a five (5) day window from the onset of symptoms to receive treatment with Paxlovid. The convenience and accessibility of at-home test expedites the process of getting treated if a patient knows they are positive. COVID-19 tests are available via mail through State partnerships and/or may be covered by a patient's insurance at retail pharmacies. In the state of North Carolina, patient may pick-up at-home test kits from a local Community Access Point (CAP) here. Patients may also be referred to a local Test-To-Treat location for testing, evaluation, and treatment in one location. Find your nearest Test-To-Treat location here if your practice setting is not already providing this service. Update yourself on the resources in your State ahead of the surge here so you can best prepare yourself to serve your community.
2. Educate yourself on Paxlovid therapy and who is at high-risk for disease progression. Many of the patients you see everyday fall into the high-risk category, but may not know this therapy is available if they were to test positive for COVID-19. Bring up the conversation of Paxlovid therapy in your regular counseling conversations for patients who are at an increased risk for disease progression even if you are counseling on diabetes, hypertension, and COPD, especially if they are > 50+ years of age.
3. Embrace diversity and be and advocate for the patients that go unseen and unheard. Whoah! That took a turn huh? Not really. If you don't see color, you are missing all of the patients who are not being adequately treated. Yes, I said it. The data doesn't lie. Medical providers do see color and so do you. We cannot celebrate this 'Big Win' from the FDA if pharmacy cannot and will not step-up by ensuring the most marginalized patients also receive quality care. The good news is that recent data shows that the gaps are closing with respect to Paxlovid therapy, but that's not the case for nearly every other disease known to man where people of color have the poorest outcomes.

Many pharmacists entered the professions saying, "I just want to help people", but you have to do some personal reflection and really ask yourself, "Who" do I want to help? For me, it's a "Both-And" situation. I entered this profession because I wanted help people from the HMP community gain access to life-saving medications. And because this problem still exists 20 years later, I am committed to fighting for a cultural transformation in the pharmacy profession. People are literally dying for us to get this right and that includes your co-workers of color as well.

If you are a pharmacy professional who wants to be a part of the solution and not the problem, I invite you to join me for the Graceful Leadership CE experience. This 4-hour ACPE accredited workshop, offered November 19th and December 10th, will be an experience like no other. You will deepen your awareness of diversity, equity, and inclusion as you explore what all of this means to your personally and leave equipped with the tools and resources to care for yourself, your colleagues, and your patients from diverse backgrounds. For more information on how you can register, visit the Graceful Leadership CE registration pager here. I hope to see you there!

Grace & Peace,

Dr. LaQuoia Johnson