Pharmacists improve adherence in HIV care

The HIV-specialized pharmacy model can improve adherence and outcomes for patients. More specifically, at Walgreens, mean medication adherence among patients who received antiretroviral therapy from an HIV specialized pharmacy was 6.2% higher than comparable patients who used traditional pharmacy services, according to a recent study. ACVS Health analytics study based on the company’s own patient population revealed that 90% of persons with HIV using CVS Specialty pharmacy are adherent to their therapies.

Glen Pietrandoni“We’ve built our reputation with our HIV specialized pharmacies over the last 30 years,” proudly stated Glen Pietrandoni, RPh, AAHIVP, Walgreens Senior Director of Virology and one of the authors of the study, “Patient adherence to antiretroviral medicines among patients using HIV-specialized pharmacy and traditional pharmacy settings,” That study, was presented at the 2016 National Ryan White Conference on HIV Care. Walgreens currently operates about 700 specialized pharmacies nationwide where specially trained pharmacists work closely with the physician and patient to manage the patient’s care, Pietrandoni told Drug Topics. 

“At CVS Specialty, we have a long history of supporting HIV patients and helping them understand and manage their condition,” said a spokesperson for CVS Health. “Our clinical pharmacists are specially trained to help people living with HIV take their medications as prescribed, manage relevant comorbidities, and understand new and existing FDA-approved treatment regimens.”

At Walgreens, Pietrandoni explained that the pharmacies may be stand-alone, connected to a health system, or carved out in an area of a larger Walgreens store. Many of the pharmacies are located in areas of the country where the incidence of HIV is high. “We identify our high-incidence stores by patient populations and by physician prescriptions,” said Pietrandoni. Our goal is to “build a support network” in these areas to serve the HIV community. 

 “At CVS, patients are identified during the patient on-boarding process when they first fill their HIV prescription(s),” said the  CVS Health spokesperson. “During this process, pharmacists provide a clinical consultation to understand the patient and where he/she is in the disease management process. Patients also receive a welcome kit, which includes information about the disease and available resources.”

Once a patient is in the system at Walgreens, personalized care, including discreet one-on-one medication consultation, is readily available to patients, either in person at the pharmacy or via the telephone. Adherence is fostered through monthly reminders and follow-ups. Pharmacists also have expertise in managing patients with comorbid conditions, such as diabetes and hypertension. 

Adherence to medication is critical for patients with HIV, but can be difficult because “antiretroviral therapy is not just one drug, but a combination of drugs,” Pietrandoni said. “Our pharmacists are proactive” at scrutinizing patients’ drug habits to ensure they are compliant. The pharmacist works closely with both the physician and the patient to ensure optimal care. The specially trained HIV pharmacists also work with payers to ensure patients have easy access to medication therapies,” he said.

CVS Specialty patients receive proactive calls for refills, clinical assessment, and therapy support. “Our pharmacists perform a days-on-hand evaluation to ensure adequate medication supply, safety, efficacy, and drug-drug interaction reviews, side effect management, and personalized interventions based on member needs,” said the spokesperson. In addition, at CVS Specialty “HIV patients have access to digital tools to help manage refills and daily adherence. Members can set reminders, receive alerts, and track activity.”

Patients at CVS also have “access to specialists to help maximize their insurance benefits, coordinate prior authorizations, find billing resources, and even help identify assistance programs for which they qualify.”

The clinical training program offered by Walgreens to pharmacists interested in providing HIV care is based on the President’s National HIV Strategies with input from the AIDS Education and Training Centers. But beyond that, said Pietrandoni, “we offer cultural competency and awareness training. Visiting an HIV pharmacy can be stigmatizing, so pharmacists need to help patients feel comfortable in reaching out to them  as a collaborator in their care,” Pietrandoni added.

Walgreens is proactive in its outreach to the community. “Each year, we participate in National HIV Testing Day in June and World AIDS Day in December,” said Pietrandoni. “On HIV Testing Day, our stores, in conjunction with our testing partners, make HIV testing available to the community. He noted that in some states, like Virginia, pharmacists can do the actual testing. “I would love to see that role for the pharmacist continue to expand, he said. On World AIDS Day, pharmacy students serve as information resources at Walgreens pharmacies.

Walgreens is currently awaiting the results of another study that could confirm the valuable role of the pharmacist in HIV care. One of the Walgreens’ sites is the Desert AIDS project: https://www.desertaidsproject.org/

This site is participating in a Medication Therapy Management study to determine whether good communication between pharmacists and physicians can improve lab values in HIV patients. Currently, 10 sites nationwide are participating in the CDC-sponsored study. “The data collection [phase of the study] is completed,” said Pietrandoni. The results will be analyzed the next 18 months.