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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.
1. The Pharmacy Staff MUST be HIV Sensitive
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):
- A pharmacy staff member looks down on you and treats you differently from other customers at the pharmacy counter
- When you sign for your prescription and use a staff member's pen, you see them throw the pen in the trash when you are done
- A client ran out of his medications because his ADAP (AIDS Drug Assistance Program) coverage was expired and he went into the pharmacy. The pharmacist came out from behind the counter, slapped a Bible down on the counter and said, "I can't help you, you people deserve what you get, read the Bible, there is nothing I can do." As you can imagine, the client was devastated
- The pharmacist comes out to the counter and tells you how to take your "AIDS" medication while there is a line of people right behind you from your neighborhood who can hear every word
- The pharmacy gets on the store public address system and says " John Doe, your AIDS medication is ready"
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.
2. Your Pharmacist and Pharmacy Staff MUST Be Knowledgeable About HIV
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.
3. Avoid Pharmacies Offering Kickbacks! Where Do Your Meds Come From?
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:
- The medication has been tampered with and can be contaminated
- It is ILLEGAL to re-use another person's prescription
- The actual medication in the bottle may be different from what is prescribed, and this can result in failure of your antiretroviral regimen. The contents may be different, or it may be a lower dose, or it may contain a completely different drug altogether
- The bottle may contain a drug that you are allergic to or be a drug that you were not prescribed at all, resulting in severe side effects, drug-drug interactions, or even hospitalization and death
Actual examples of this are the following:
- Prezista (darunavir) 600mg tablet bottle containing Prezista 300mg tablets inside the bottle
- Combivir (AZT/3TC) tablets containing Ziagen (abacavir) tablets inside the bottle
- Zerit (stavudine, d4T) 40mg capsules containing Zerit 20mg
- Procrit (epoetin alfa) injections that have been diluted so you don't get the correct dose
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.
4. The Pharmacy Staff Advocates on Your Behalf
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:
- If a medication is not covered by your insurance company, the pharmacist will contact your physician to discuss the situation and switch the medication to something similar if indicated. For example, your doctor prescribes Lipitor (atorvastatin) for your high cholesterol and it is not covered by your insurance plan. The pharmacist will then contact your doctor to discuss this and your doctor may change your cholesterol medication to Crestor (rosuvastatin) or another drug that would be appropriate for you and is covered by your insurance
- If your doctor wants you to have a medication that is not covered by your insurance company, the pharmacist will work to obtain a prior authorization for the medication from your insurance company
- If your insurance company denies a medication your doctor has prescribed, BUT you must have it as it is medically necessary, then your pharmacist will work with you to obtain the medication from the patient assistance program from the drug manufacturer
- If your ADAP coverage or any other insurance has expired, your pharmacist works with you to get your insurance reinstated. Your pharmacist also assists you in accessing resources and ways to get you access to your medications
- Pharmacist and staff are able to refer you to community resources that can assist you with other issues that you may be having, e.g. legal aid, support groups, housing, food, transportation.
5. The Pharmacy Must Always Have Your Medication in Stock
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.
6. You Must Always Receive a Consultation on New Prescriptions or Prescription Changes -- It's the Law
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.
7. Additional Services
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.
8. Confidentiality and HIPAA
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):
- You and your wife are getting divorced. You are going through a difficult custody battle and she is unaware of your HIV status. She is at the pharmacy picking up her prescription and the pharmacy clerk says to her "Your husband's prescriptions are also ready, would you like to pick them up as well?" With that your wife says "Sure," picks them up and leaves. Your prescriptions are for your HIV meds and she gets home and looks up what the medication is for ... Do you get the picture? The consequences for the HIV-positive person were catastrophic
- A pharmacy technician went home and discussed an HIV client around the dinner table. The HIV client's son and technician's son were friends. The technician's son went to school the next day and told the HIV client's son, "Your dad has AIDS." The HIV client had not disclosed his status to his son and this was how the little boy found out.
9. You Can Switch Pharmacies WHENEVER You Choose
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!!!!!!
10. Your Specialty Pharmacy Is Part of the Community and Supports the Community
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 pharmacy participates in local AIDS Walk
- The pharmacist speaks at local support groups
- The pharmacy provides support at fundraisers for local organizations
- The pharmacist is a community activist and sits on the board of directors of local organizations
- The pharmacist and/or staff members are part of the community, either living with HIV or LGBT
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.