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Download the article PDF: The Test And Treat Shift 2026
“Test and treat” legislation at the state level is transforming pharmacists from dispensers into providers, authorizing them to diagnose and prescribe for conditions like flu, strep, and COVID-19 without physician oversight. As the map illustrates, this model is now active in more than 20 “direct open market” states (green), with legislation pending in key “battleground” states (yellow).
JUCM first reported this disruption in 2015, and now the strategic intent is finally meeting regulatory reality.1
As retail pharmacy declines, major chains are repurposing their highest value resource—pharmacists—potentially using AI-automated dispensing as the catalyst. Many of these laws have been passed under the radar in the last 3 years to solidify this new revenue channel.
However, significant concerns exist among urgent care clinicians:
- Fails rural health: The transformation ignores true primary care shortages, merely duplicating access already provided by urgent care and telemedicine.
- Erodes safety: Bypassing physical exams and differential diagnoses lowers the standard of care and risks antibiotic misuse.
- Fragments care: It encourages episodic “quick fixes” rather than integrated chronic disease management.
- Ethical conflict: It directs vulnerable patients into retail environments designed to cross-sell alcohol, tobacco, and lottery tickets rather than promote holistic health.
Reference
- Ayers AA. Pharmacists With Prescribing Privileges: A New Class of Medical Practitioner. J Urgent Care Med. May 21, 2015. Accessed February 12, 2026. https://www.jucm.com/pharmacists-with-prescribing-privileges-a-new-class-of-medical-practitioner/
