“Maria” walked into the free medical clinic with a fever, cough and sore throat so severe that she could barely hold a conversation. Testing confirmed influenza A. As I spoke with her, I learned that she did not have a primary care physician and had ignored her symptoms until she could no longer do so. We were able to treat her, take her on as a new patient and schedule a follow-up appointment. But her experience stayed with me. 

In Arizona, where every county includes an area with a shortage of health professionals, many patients do not have that same option. For them, a nearby pharmacy may be easier to reach than a physician’s office.

This is why I believe Arizona’s new pharmacist test-and-treat law, Senate Bill 1713, has the potential to make a meaningful difference. Having taken effect Sept. 12, the law allows trained pharmacists working under statewide protocols to test and treat eligible patients for influenza, strep throat, COVID-19 and certain public health threats. 

It also allows pharmacists to initiate HIV preexposure and postexposure prophylaxis under separate protocols. These changes recognize that pharmacists are not merely dispensers of medication; they are highly trained and accessible members of the health care team.

The test-and-treat law gets many things right. It requires evidence-based clinical guidelines, patient screening, documentation, referral criteria and follow-up plans. It also requires pharmacists to notify a patient’s primary care clinician within 72 hours after initiating treatment, if one can be identified. 

Herein lies my concern: What happens when there is no primary care clinician to notify? The patients most likely to benefit from pharmacy-based care are often the same patients who cannot find a physician, obtain an appointment or navigate an already fragmented healthcare system.

At our clinic, we did not simply hand Maria a diagnosis and tell her to find help elsewhere. We made sure there was a next step. A pharmacy referral should work in a similar manner. Telling a patient to follow up does not ensure that the follow-up happens, and sending a message to a physician does not establish who is responsible for reviewing it or responding if the patient gets worse. A notification is not the same as a completed handoff.

This becomes especially important with HIV postexposure prophylaxis, or PEP. PEP must be started as soon as possible and no later than 72 hours after a potential exposure. Baseline testing should include HIV, kidney and liver assessments, hepatitis B testing and pregnancy testing when appropriate. 

However, treatment should not be delayed while those results are pending. This creates a narrow window in which a pharmacy must be able to start medication quickly, review laboratory results, make changes when necessary and connect the patient with follow-up testing. Access to the first dose matters, but so does helping the patient complete the 28-day course.

As the statewide advisory committee develops these protocols, it should build in a clear path for what happens after a pharmacy visit. Participating pharmacies should have referral partnerships with clinics that can accept patients who do not already have a primary care physician, including low-cost and telehealth options. With the patient’s consent, there should also be a way to confirm that an urgent follow-up appointment was scheduled and to reach out when it was not, ensuring a closed referral loop. 

For PEP, the protocol should require prompt review of laboratory results and early contact to make sure the patient obtained and is tolerating the medication. Finally, patients should leave with plain-language instructions explaining warning signs, where to go if they cannot get an appointment and when they need emergency care.

There is no doubt that the test-and-treat law can improve access to care, especially in communities where a pharmacy is easier to reach than a physician’s office. But access alone is not enough. If we expand the front door to care while leaving patients to navigate what comes next on their own, we have not solved the entire problem. The law opens the door. The statewide protocols will determine whether patients safely make it through.

Nikhita Attiganal Jagadeesh is a medical student at Creighton University School of Medicine- Phoenix with experience in community medicine and health policy advocacy.