Walk‑in “test and treat” services are changing how Americans get care for sore throats and flu‑like illness. In many states, pharmacists can now swab you, run a rapid test, and—if positive—prescribe medication on the spot. This model is growing because it closes a timing gap. Antivirals work best early in the flu. Antibiotics only help bacterial strep, not viral sore throats. A fast, accurate test at a nearby pharmacy means the right drug, sooner, without an unnecessary clinic visit.
What “test and treat” means
“Test and treat” is a same‑visit service built around point‑of‑care tests. Pharmacies obtain a CLIA waiver, which allows them to run simple, low‑complexity tests in‑house. The pharmacist follows a protocol: assess symptoms, test, interpret, and either prescribe or refer. It is designed for a narrow set of conditions where quick tests are reliable and first‑line treatments are well‑defined—most commonly influenza and group A strep.
Why it helps:
- Speed matters for flu: Antivirals are most effective within 48 hours of symptoms. Testing and treatment in one stop preserves that window.
- Antibiotic stewardship: Most sore throats are viral. A strep test prevents unnecessary antibiotics, which fuel resistance and side effects.
- Access and convenience: Pharmacies are close by, open evenings and weekends, and do not require appointments in many cases.
How pharmacists gained this authority
In the U.S., scope of practice is set by states. Pharmacist test‑and‑treat authority has expanded through three main routes:
- Collaborative Practice Agreements (CPAs): A pharmacist follows a standing order by a local physician or health system. The agreement spells out the conditions, tests, and medications allowed. Many early programs used CPAs to launch strep and flu services.
- Statewide protocols: Some states issue protocols that let any qualified pharmacist test and prescribe for specific conditions (e.g., flu or strep) without an individual CPA. These define inclusion/exclusion criteria, documentation, and referral rules.
- Independent prescriptive authority: A smaller number of states grant pharmacists independent prescribing for a limited set of minor ailments and public‑health needs. Strep and flu are often included because guidelines and treatments are standardized.
COVID‑19 accelerated this shift. The pandemic normalized pharmacy‑based testing, highlighted access gaps, and pushed states to modernize outdated rules. The result is a patchwork: some states allow testing but require referral for prescriptions; others permit full test‑and‑treat; a few still limit prescribing to CPAs.
The pharmacy workflow: from swab to script
A safe, efficient test‑and‑treat visit follows a consistent sequence. Here is what it usually looks like:
- 1) Intake and screening: The pharmacist collects symptoms, timing, exposures, allergies, pregnancy status, and medical history. A quick screen excludes red flags (e.g., shortness of breath, severe dehydration) that require urgent care.
- 2) Informed consent: The pharmacist explains what the test can and cannot tell you, possible next steps, and costs. You consent to testing and treatment under the protocol.
- 3) Swab and test: For flu, a nasal or nasopharyngeal swab; for strep, a throat swab. Rapid antigen tests give results in 10–15 minutes. Some pharmacies also use rapid molecular (NAAT) platforms with higher sensitivity.
- 4) Interpret results: Results are read alongside your symptoms and risk factors. Protocols detail what to do with positive, negative, and invalid results.
- 5) Treat or refer: If you qualify, the pharmacist prescribes and counsels on the medication. If not, you get a referral to urgent care or your clinician, and guidance on what to watch for.
- 6) Documentation and follow‑up: The pharmacy records the encounter, provides after‑care instructions, and, when possible, notifies your primary care team.
What gets prescribed, and when
Influenza: Antivirals shorten illness and reduce complications when started early.
- Oseltamivir (oral) is the workhorse. It is preferred for pregnant patients and many high‑risk groups. It needs dose adjustment in kidney disease. Side effects are usually mild (nausea, headache).
- Baloxavir (single dose) is convenient and may reduce viral load fast. It is not used in pregnancy and has drug‑interaction considerations with certain supplements and dairy due to chelation.
- Timing: Best within 48 hours of symptoms. High‑risk patients (older age, chronic disease, immunosuppression) may still benefit beyond 48 hours, so pharmacists assess case‑by‑case within protocol limits.
Strep throat (group A streptococcus): Antibiotics prevent complications and shorten illness when the test is positive.
- Penicillin V or amoxicillin are first‑line because group A strep remains universally susceptible, and these drugs are narrow‑spectrum.
- If you have a true penicillin allergy, cephalexin or azithromycin may be used, guided by allergy severity and local resistance patterns.
- Why testing matters: Most sore throats are viral. Treating only test‑confirmed strep avoids side effects and resistance from unnecessary antibiotics.
Test accuracy and clinical judgment
Point‑of‑care tests are useful, but not perfect. Pharmacists manage this uncertainty with protocols.
- Influenza rapid antigen tests: Fast and specific, but sensitivity can be modest, especially later in illness. A negative result early in an outbreak may still leave room for clinical suspicion. Rapid molecular (NAAT) flu tests have much higher sensitivity and are increasingly used in pharmacies.
- Strep rapid antigen tests: High specificity (a positive is very likely true). Sensitivity is generally good but not perfect. In children and teens, a negative test with classic strep features may require confirmatory culture; many pharmacy protocols refer those cases to primary care for follow‑up testing.
- Pretest probability matters: A classic flu presentation during a community surge raises the chance that a negative antigen test is a false negative. Protocols account for this by allowing referral or, in some states, treatment based on strong clinical suspicion for high‑risk patients.
Guardrails that keep care safe
Pharmacy protocols use inclusion and exclusion criteria to limit risk and maintain quality.
- Age limits: Many programs set minimum ages (e.g., 5 years for strep, 12 years for flu) because very young children have different risks and dosing needs.
- Pregnancy and breastfeeding: Some medications are safe, others are not. Protocols specify which drugs can be used and when to refer.
- Severe or systemic symptoms: Chest pain, shortness of breath, persistent high fever, confusion, severe dehydration, or symptoms beyond a set number of days trigger immediate referral to urgent care or the ER. These signs can indicate pneumonia, sepsis, or other complications.
- Immunocompromised patients or complex comorbidities: Higher risk of complications and atypical presentations; most protocols refer to a physician.
- Medication allergies and interactions: True penicillin allergy history, or drugs that interact with antivirals, affect prescribing choices. When safe alternatives are unclear, referral is safer.
- Time since symptom onset: For flu, limited benefit beyond 48 hours for otherwise healthy people, so protocols may restrict prescribing after that window.
These guardrails exist because test‑and‑treat is meant for straightforward cases. They protect patients from missed diagnoses and ensure the right level of care.
Evidence on outcomes and costs
What we know so far:
- Faster treatment: Pharmacist‑led flu testing leads to earlier antiviral starts compared with traditional clinic pathways. Earlier therapy reduces symptom duration and may lower complications, especially in high‑risk patients.
- Appropriate antibiotic use: Requiring a positive strep test before prescribing lowers unnecessary antibiotics for viral sore throats. That reduces side effects and supports antimicrobial stewardship.
- Comparable safety: Studies of pharmacist protocols show high adherence to guidelines, with appropriate referrals for red flags. Adverse events are rare and similar to usual care when screening is applied.
- Cost and capacity: For many patients, total out‑of‑pocket costs are similar to or lower than urgent care, especially when accounting for time saved. Shifting simple, protocolized care to pharmacies frees clinics to focus on complex cases.
Limitations remain. Pharmacies do not manage pneumonia workups, dehydration, or severe complications. And test accuracy varies by platform and timing, which is why referral pathways matter.
Payment, liability, and documentation
Payment models are still catching up to the service.
- Reimbursement: Pharmacies bill for the test and dispense the medication. Payment for the clinical assessment varies. Some insurers and Medicaid programs reimburse pharmacist services; others do not. Patients may see a small service fee when coverage is lacking.
- Medicare: Pharmacists are not broadly recognized as Part B providers, limiting direct billing for clinical time. This slows adoption in some areas.
- Liability and quality: Pharmacists carry professional liability insurance. Protocols, checklists, and documentation protect patients and clinicians by standardizing care.
- Records and privacy: Pharmacies document encounters under HIPAA. Many can share visit summaries with your primary care practice, but electronic connections vary. When electronic exchange is not available, patients often receive a printout or secure message to take to their clinician.
Who benefits and who could be left out
- Beneficiaries: People without a regular doctor, workers who need after‑hours care, rural communities with limited clinics, and parents who want an answer quickly. For these groups, nearby access can prevent missed school or work and reduce spread.
- Those at risk of being left out: Uninsured patients if fees are a barrier; non‑English speakers without language support; minors who arrive without a guardian; pregnant or medically complex patients who end up being referred. Clear pricing, translation services, and warm handoffs to clinics help close these gaps.
What to watch in the next 2–3 years
Several trends will shape where test‑and‑treat goes next:
- Broader state authority: More states are moving from CPAs to statewide protocols for flu and strep, creating consistent rules and reducing paperwork.
- Better tests: Rapid molecular platforms with near‑PCR accuracy are spreading into community pharmacies. Higher sensitivity should reduce false negatives and unnecessary referrals.
- Data integration: Expect tighter links between pharmacy systems and primary care EHRs, so your clinician sees results and treatments automatically.
- Payment reform: Insurers are piloting reimbursement for pharmacist clinical services. If sustained, this will make programs more available, especially in independent pharmacies.
- Stewardship and quality metrics: Programs are adopting measures like “antibiotics only with positive strep test,” documented counseling, and timely primary care notifications.
Practical takeaways for patients
- Go early for flu‑like symptoms: If you feel feverish with aches and cough, visit a pharmacy within 48 hours. Early antivirals work better.
- Do not demand antibiotics for a sore throat: Ask for a strep test. If it’s negative, rest, fluids, and pain relief are usually the right treatment.
- Bring your med list and allergy details: This helps the pharmacist choose safely and quickly.
- Know when to escalate: If you have trouble breathing, chest pain, confusion, or can’t keep fluids down, go to urgent care or the ER.
The bottom line: pharmacist test‑and‑treat for flu and strep is a practical, evidence‑based way to get timely care for common infections. It speeds appropriate treatment, reduces unnecessary antibiotics, and expands access—while keeping clear guardrails for safety. As states and insurers modernize rules, expect these services to become a routine part of everyday care.
I am a Registered Pharmacist under the Pharmacy Act, 1948, and the founder of PharmacyFreak.com. I hold a Bachelor of Pharmacy degree from Rungta College of Pharmaceutical Science and Research. With a strong academic foundation and practical knowledge, I am committed to providing accurate, easy-to-understand content to support pharmacy students and professionals. My aim is to make complex pharmaceutical concepts accessible and useful for real-world application.
Mail- Sachin@pharmacyfreak.com