Didactic Series Role of Community Pharmacists in Getting

Didactic Series Role of Community Pharmacists in Getting to Zero Campaigns Kirsten Balano, Pharm. D, AAHIVP University of California, San Francisco July 26, 2018 1

Learning Objectives 1) Identify where on HIV Care Cascade pharmacists can play a role. 2) Describe expanding roles of community pharmacists in health prevention. 3) Counsel patients on how best to choose community pharmacy services. 2

Poll Question Think about the last time you used a community pharmacy – what was the main reason you chose the pharmacy you did? A) B) C) D) E) Location Hours Expertise of Pharmacist Non-judgmental approach of pharmacy staff Other reason 3

HIV Care Continuum

Chat pod discussion In the Chat Pod, type some of the other services you have seen provided at a community pharmacy other than dispensing prescriptions.

Prevention in Pharmacies

HIV Pr. EP Services in Pharmacies • One-stop shop – Standing order for medications, HIV testing, labs, STI and pregnancy testing – Training of staff for testing – Phlebotomy • On-going monitoring and support – Adherence monitoring – HIV and STI lab ordering • Insurance and PAP know-how

Linkage and Retention to Care

Pharmacy coordination project • 2017: 4 HIV ACCESS primary care sites serving 860 patients in Alameda County, CA – Communication process with single points of contact – Tracked missed refills & expedited dispensing • Viral load suppression rates increased from 86% in Dec. 2016 to 91% in Dec. 2017

Treatment as Prevention

340 B Pharmacy Contracts • Allow discounted acquisition cost of meds for uninsured patients. • Significant source of revenue for covered entities (i. e. FQHC, Ryan White Clinics) – Revenue used to support safe and effective medication use and access • Compliance issues are critical and complicated 19

2017 California ADAP Pharmacy Survey (n=57) • • 23% have staff trained to furnish OCP 34% have staff trained to furnish naloxone 59% have HIV specialty pharmacist on staff 20% dispense naloxone without a prescription 42% offer immunization services 71% dispensed Pr. EP 53% furnish Non-Prescription Syringes 84% offer MTM services

What will it take?

Poll Question How do you usually ask patients about their pharmacy? A) Where do you want your prescription sent? B) Tell me about your satisfaction with your current pharmacy? C) What services does your pharmacy offer? D) I make recommendations for what pharmacy is best for people living with HIV. E) I have never discussed pharmacy with patients.

Considerations in Choosing Community Pharmacy • Convenience: Hours, Location • Services: Delivery, Languages spoken, text reminders, automatic refills, mediset/blister packaging. • Expertise: HIV experience, counseling services/area, Prior Authorizations/TAR • Communication: Single point of contact accessible for linkage & retention in care.