February 12, 2013
Michelle J. Sherman, R.Ph., A.A.H.I.V.P.
Table of Contents
Your pharmacist and pharmacy play a critical role in keeping you adherent with your meds, guarding against drug-drug interactions and advocating on your behalf. Take a look at these steps to finding a pharmacy that's just the right fit.
Your medications are a crucial component of your treatment plan for HIV. The pharmacist and the pharmacy staff are important members of your health care team. It is very important that the members of the staff at the pharmacy are HIV sensitive and that you feel comfortable and welcome at the pharmacy.
Pharmacy staff must be non-judgmental, non-homophobic and non-AIDS-phobic. Some examples of HIV insensitivity are the following (these are real examples that have happened to clients):
Since you have to take your antiretroviral medications for the rest of your life, you will be building a long, strong relationship with your pharmacist and pharmacy staff. It is essential that you feel comfortable and at ease with your pharmacy.
Is the staff able to answer all your questions and concerns with regard to HIV and related issues? Is your pharmacist an HIV expert with HIV credentials? An HIV expert pharmacist with HIV credentials is a pharmacist who has undergone additional or specialized training in HIV, and is an expert in HIV medications, side effects, drug-drug interactions, adherence and other HIV medication-related issues. Pharmacists are usually credentialed through the American Academy of HIV Medicine or through the HIV certification program at the University of Buffalo School of Pharmacy and Pharmaceutical Sciences.
A kickback is something the pharmacy offers you to switch pharmacies and to lure you away from your current pharmacy. Kickbacks include things like cell phones, gift cards, iPods, or paying you and your friends to switch pharmacies. This is an ILLEGAL practice, and if you accept these things you could be held liable if the authorities crack down on the pharmacy! Avoid these incentives. The BEST thing your pharmacy can offer you is PRICELESS: It is the information, education and care you receive. It can save your life!
Does your pharmacy purchase their HIV meds from a reputable drug wholesaler? Some pharmacies participate in illegal practices and purchase their medications from small wholesalers that obtain medications through illegal means, such as reselling drugs that they get from HIV clients, buying drugs from shady pharmacies or tampering with and repackaging HIV medications. These "shady" wholesalers offer drugs to pharmacies at much lower costs than the pharmacy could buy it for from one of the major drug wholesalers. This drug fraud has resulted in HIV clients getting "used medication" and medications where the meds have been changed and are not the actual medication or dosage that you doctor has prescribed. What the prescription label says and what is actually contained in the bottle are two different things.
Getting medications of this kind can be CATASTROPHIC to you because:
Actual examples of this are the following:
Drug fraud is a problem, and authorities have been cracking down where possible:
You have the right to ask your pharmacist which wholesaler they use! The major wholesalers in the United States are Amerisource-Bergen, Cardinal Health and McKesson.
If medications are not covered by your insurance company, the pharmacist and/or technician must offer solutions for you. Here are a few examples of how your pharmacist can advocate on your behalf:
You must never run out of your medication. Adherence to your HIV medication regimen is critical in maintaining your health, and not allowing opportunities for drug resistance to arise. If the pharmacy does not have your medications in stock then they are promoting your non-adherence. If the pharmacist is not an HIV expert, then you may not get all your medications filled at the same time, the pharmacist does not know how to counsel you on your regimen, and you may start taking only half the regimen, resulting in drug failure and resistance.
Taking HIV medications is a big commitment on your part. You have to take them every single day and not miss any doses. The consultation from the pharmacist is critical so that you understand exactly what to expect -- and when you are done, feel comfortable taking your meds. The pharmacist will review your medications and make sure you fully understand what each one is for, how to take it, when to take it, side effects, drug interactions and anything else you can expect. Remember to ask the pharmacist any questions that you have as relates to your medications. Remember, there is NO such thing as a stupid question. The pharmacists should always be available to answer your questions.
Complimentary delivery and/or mail order and special packaging are offered by ALL HIV specialty pharmacies. Most of the pharmacies also automatically refill your prescriptions each month, which helps you with adherence just in case you forget to call the pharmacy for a refill.
Are you comfortable with the privacy policies of your pharmacy and comfortable that your confidentiality will not be breached? Remember the pharmacy cannot disclose any of your health information to an employer, spouse, child, family member or anyone who comes into the pharmacy or calls the pharmacy without you expressly giving the pharmacy written permission with the names of those who can pick up your medications, receive your medications on delivery, or ask anything else about your medications.
Here are two examples of how your confidentiality could be breached (these actually happened):
It is your right to go wherever you choose for your pharmacy services. You may switch pharmacies as many times as you want to, until YOU feel completely comfortable. It is against the law for the pharmacy to offer you gifts or bribe you to either stay with their pharmacy, or move to their pharmacy, and it is unethical to make you feel bad or make you feel guilty about leaving and moving to another pharmacy. Again, REMEMBER THAT IT'S YOUR RIGHT!!!!!!
It is extremely important that the HIV specialty pharmacy that you choose is a member of the community and/or is very involved and committed to the HIV community. The pharmacy must support local events and activities in the community and at local AIDS service organizations. Here are a few examples:
The compassion and commitment of the pharmacy is exhibited in their involvement and work in the community.
Michelle J. Sherman, R.Ph., A.A.H.I.V.P., is a nationally recognized HIV specialist pharmacist practicing in Orange County, Calif.
Read Michelle's blog, Ask Your Online HIV Pharmacist.