The federal Test-to-Treat program, announced in March, aims to reduce COVID-19 hospitalizations and deaths by rapidly delivering antiviral pills to those who test positive. But even if cases rise again, many Americans will not be able to participate in the program.

Both Pfizer’s Paxlovid and Merck’s Lagevrio are designed to start within five days of someone experiencing their first symptoms. They are for people who are at high risk of serious illness but are not currently hospitalized due to COVID-19. Millions of Americans with chronic illnesses, disabilities and older age are eligible for treatment, and Dr. Anthony Fauci of the National Institutes of Health said April 11 that many more will be eligible soon.

The program allows people with COVID symptoms to be tested, prescribed antiviral pills and filled in a single visit. The federal government and many state and local health departments are directing residents to an online national map where people can find test treatment sites and other pharmacies where prescriptions can be made.

But as of April 14, there were no pharmacies or health centers for testing and treatment on the market in much of the country. The biggest player, CVS, had major technical issues with its website that made appointments difficult.

Even people who see a doctor a lot may not get their prescriptions in time, which is where the program comes in. Before the pandemic, 28% of Americans had no regular source of health care, with a higher percentage of blacks and Hispanics.

“All of our public health responses depend on lowering the barriers to getting treatment to the right people,” said Dr. Kirsten Bibbins-Domingo, chair of the UCSF Department of Epidemiology and Biostatistics.

Fragmented federal, state and local public health systems, the Department of Health and Human Services’ reliance on partners charging high appointment fees, and a lack of clear information have hindered this effort, she said. “The best tools we have don’t reach the people who need them most,” she said.

Bibbins-Domingo, who is also a practicing physician at Zuckerberg’s San Francisco General Hospital, said the hospital not only tests patients for COVID and prescribes them antiviral drugs, but also provides them with medication — which is the result from testing to All elements of treatment. But the hospital, which primarily treats low-income and uninsured patients, doesn’t appear on the federal map. It only shows three locations in San Francisco: two community health centers and one CVS.

Ninety-one percent of the sites listed on the national map are federal partners: pharmacy chains such as CVS, federally qualified medical centers, and military and Indian health service clinics. HHS has asked state and local health departments to identify other potential players, such as San Francisco General Hospital, so they can be added. Most states do not yet list these partners.

Nationwide, CVS MinuteClinics accounts for more than half of all tested treatment sites, according to federal data. About 1,200 clinics in 35 states and Washington, D.C. are under the same roof as CVS pharmacies, where patients can get prescriptions for COVID antiviral drugs. Walgreens Pharmacy and Kroger Grocery Affiliates operate approximately 400 websites.

The federal government has reserved nearly 400,000 courses of antiviral drugs for its federal pharmacy partners — about a quarter of the total supply since the program began in March.

While the cost of the pills is covered by the federal government, getting a prescription at the pharmacies that dominate the program can be expensive. While CVS doesn’t charge symptomatic uninsured people for on-site COVID testing, MinuteClinics charges more than $100 for in-person or telehealth appointments to examine patients and prescribe antiviral medication if needed. People with no insurance, health plans that don’t cover clinic visits, or people with high deductible plans must cover the full cost of the appointment.

Even if they can afford it, a cure may not be found.

KHN aims to find out how easy it is to book a test treatment appointment at CVS. Journalists searched for COVID testing and treatment appointments online and in person in April.

It took a KHN reporter in Washington, D.C., to drive three hours between stores before figuring out if MinuteClinic’s four locations had available tests and stocks of antiviral drugs — generally few people can afford, Not to mention when sick.

Each store offers services from testing to treatment and can be pre-ordered through a kiosk. But three of the stores either didn’t have same-day appointments or didn’t have antiviral pills that day.

A KHN reporter also tried making an appointment online at clinics in several states listing upper respiratory symptoms. After reporters flagged a positive COVID test on the screening form, a message appeared — “For the safety of our patients and staff, we cannot let you into the clinic at this time” — and the patient was instructed to book a telehealth visit.

KHN also searched CVS’s website for all of the MinuteClinics test appointments shown on federal maps of the District of Columbia, Maryland and Virginia, with just over 100 clinics in total. Only half listed any future available testing appointments.

Amy Thibault, a spokeswoman for CVS, said all MinuteClinics offered on-site test treatments, and a software glitch made it appear not to be. She said CVS is working on that. Thibault said COVID patients were “encouraged” to use telehealth.

Some Americans, especially older adults, do not have the equipment, internet connection or technical skills required for virtual visits. HHS spokeswoman Suzanne Sellman said the program requires participants like CVS to offer the option of in-person appointments.

KHN also searched online for appointments at participating Kroger and Walgreens clinics in several states and found many available in-person appointments.

Another complication: FDA requires doctors, advanced practice registered nurses or physician assistants to write prescriptions. Pharmacists can’t do it. Many of the nation’s leading pharmacy organizations have asked the Biden administration to lift the restrictions, which would expand the program to dozens of rural and underserved communities.

Because of this rule, the plan requires clinics and pharmacies to be located under the same roof – a setup that doesn’t exist in many areas, especially in rural areas.

Federal maps show no locations in Wyoming or South Dakota other than military clinics that do not serve the public. People in dozens of other areas have to drive more than 100 miles to get to the nearest clinic, according to KHN’s review of participating locations.

Spokesman Kinderty said the Wyoming Department of Health is working to get providers into the program.

Montana has four testing and treatment clinics for the public, according to the federal website and the Montana Department of Public Health and Human Services spokesman Jon Ebelt. He said the seven ministries of defense and the Indian health service also provide services from testing to treatment, but those services are not open to most people.

Billings, the state’s most populous city, is more than three hours’ drive from the closest location shown on the map. The agency is working with local primary care nonprofits to find more facilities to sign up, Ebelt said.

We have to get this right, said San Francisco professor Bibbins-Domingo. As the U.S. moves away from restrictions like wearing masks, the public health system must ensure everyone has access to these new treatments, which could get people back to work faster, prevent serious illness and even save lives, she said.

Telehealth may be the easiest form of treatment for people far from clinics, people with disabilities, and people who are too ill to leave their homes. Some local governments, including Los Angeles County and New York City, have launched virtual care programs.

Truepill, a company that provides telehealth and pharmacy technology, offers online COVID assessments through its website, findcovidcare.com, at a fraction of the cost of CVS’ in-person or telehealth operations. Over the past five years, the company has filled more than 10 million prescriptions.

The service is available in all 50 states and Washington, DC, and costs $25 to $55. While insurance is not accepted, the cost is comparable to insurance copays for in-person doctor appointments. Prescriptions can be delivered to your local pharmacy for free or delivered to your home overnight via FedEx for $20.

HHS has not responded to requests for data on antiviral drug use and has repeatedly refused to allow KHN to observe weekly virtual meetings with state health officials, clinic directors and other health care providers about the program.

To be effective, the federal government must make testing and treatment easier, Bibbins-Domingo said, especially as the program targets those at highest risk of devastating complications from COVID.

“If you’re just a normal person trying to navigate this,” she said, “it’s actually completely impossible.”

KHN correspondents Katheryn Houghton and Rachana Pradhan contributed to this report.

KHN (Kaiser Health News) is a national newsroom providing in-depth news on health issues. Along with policy analysis and opinion polls, KHN is one of the three operating programs of the KFF (Kaiser Family Foundation). KFC is a donating non-profit organization that provides information on health issues to the state.