As a pharmacist working in an HIV clinic, I often help patients organize their medications into containers that help them remember whether they took their latest dose. Recently, as I was sitting with a patient doing this, I asked her if she wanted her own pharmacy to provide this service. She looked surprised and said, “I didn’t know they could do that!”
In the complex health care system we interact with today, pharmacists have either been the unnoticed health care provider, or have received bad press. A recent example in the The New York Times pointed out unsafe conditions and medication errors that resulted from prescriptions dispensed from chain community pharmacies. Despite these system-based challenges that exist, many pharmacists are highly engaged in the care of persons living with HIV. At their best, they can be important partners who promote health.
The Person in the White Coat Behind the Counter
Who is that pharmacist?
Pharmacists who care for people living with HIV are found in different settings. You may know your local community pharmacist who works in a large retail chain store or in an independently owned pharmacy business because this is where you pick up your medications. However, HIV pharmacists can also be found working inside HIV clinics where they may dispense medications, or they may be working with the health care team on other tasks related to managing patients’ medications. Pharmacists can also be found inside the hospital, where they review prescriptions prior to patients receiving them, and where they work alongside the medical team to ensure patients get the best medications while they are hospitalized. Many people are surprised to learn that most pharmacists have a doctorate-level education. While there are still a few United States schools that offer different types of pharmacy degrees, the Pharm.D. doctorate degree is required for a pharmacist to apply for a license to practice. This means your pharmacist has likely had many years of advanced-level training. This gives them an extensive body of knowledge about medications, drug-drug interactions, side effects, and the health care system that can potentially benefit you.
Ways to Make the Most out of Your Pharmacy
Most people simply view the pharmacy (and their pharmacist) as a place and person where they pick up their medications. While that is a very important reason to visit the pharmacy, there are several other ways to really make the most out of the resource that is your pharmacist.
Schedule an annual medicine check-up
You may have several doctors: a primary care doctor, a cardiologist, a foot doctor—the list goes on. Unless these doctors are all working in the same system using the same electronic medical record, they may not know what the other one is prescribing. Similar to the way you might think about an annual physical exam, it can be really helpful to have an annual “medication exam.” Some insurance companies will even provide support for the pharmacist to perform these annual medication therapy management (MTM) reviews. Ask your pharmacist if you can schedule a specific time and date to come in (so that they can potentially protect that time) to review all of your medicines. During the session, they can update your list by removing old prescriptions, add any notes about over-the-counter medicines and herbs or supplements you may be using, and run an up-to-date check for drug interactions. They can talk with you about your medications if you’d like to learn more about them and provide suggestions on how to remember to take your medicines more regularly. If you bring in your medications, the pharmacist can review each individual bottle, help you dispose of old medications, create a personalized medication list, and even help you come up with a list of questions to ask your doctor to clarify your medications.
Ask about drug-drug interactions
Computers have made drug interaction checking faster and easier, but a computer only provides information. Sound clinical judgement is required to determine whether a potential drug interaction can harm a patient. Every time you fill a new prescription, ask the pharmacist directly, “Are there any drug interactions with my new medicine?” This includes any new herbs, over-the-counter medicines, and supplements you are thinking about adding to your regimen.
Ask the pharmacist’s opinion about using over-the-counter products
Over-the-counter products are thought to be safe (for limited use) by the general public, yet navigating the many aisles to find the right medication can be confusing and overwhelming. Even medications that seem as benign as acetaminophen can have untoward side effects if not used carefully and appropriately. A caring pharmacist will listen to your symptoms and help you navigate the plethora of brand name, combination products, and different active ingredients to address the problem that you’re trying to treat. They may also recommend that you not use certain over-the-counter products, or that you not self-treat at all if, in their professional opinion, you should follow up with your doctor about a health condition that is affecting you.
Use the pharmacy’s “other” services
Many patients do not take advantage of additional services that might be offered by the local pharmacy. One service that is commonly offered are vaccinations. In the height of the influenza season, it can sometimes be challenging to get an appointment at the doctor’s office, or make it to the doctor’s office during regular business hours. Pharmacies can often administer commonly needed vaccinations such as influenza, shingles, and other vaccines, and can have extended hours that may make it more convenient. Some specialized pharmacies offer services such as furnishing travel medicines or hormonal contraception, or smoking-cessation therapies. In California, pharmacies are gearing up to provide pre-exposure and post-exposure prophylaxis (PrEP and PEP) for HIV prevention without a prescription to eligible persons who request it in accordance with California State Bill SB 159. Lastly, several pharmacies offer services that can help you stay adherent to your medications, such as delivering medicines to your home, or putting your medicines in specialized reminder packaging (medi-sets or bubble packages). Some of these services may be free or low cost; it is helpful to know what services your pharmacy offers and how you can utilize them.
Ask for help affording your medicines (and don’t shoot the messenger)
The cost of health care continues to rise. Health care spending in the United States accounted for $3.6 trillion dollars, or approximately $11,000 per person, in 2018. For many patients, medications can be a frustrating part of those high costs, and navigating insurance can be challenging. When a pharmacy quotes a price for a medication, many patients do not understand that this price is primarily influenced by how drug manufacturers (not the pharmacy) regulate the cost of their medicines and how much insurance companies decide they are going to pay. The pharmacy staff end up being the messenger, communicating to patients what the remaining cost is after the insurance company puts in their part. Pharmacies will often charge a dispensing fee on top of this, but it is typically a low addition (usually less than $20). So what is a person to do, when a medication costs a lot? Ask the pharmacist if they have any ideas. Some medication manufacturers offer co-pay assistance, which can greatly reduce the monthly cost of your medicines if you have private insurance. For HIV antiretrovirals, state AIDS Drug Assistance Programs can also be very helpful in covering costs. Sometimes, switching a brand name drug for a generic one can also save costs. While your pharmacist may not have all the answers to solve your out-of-pocket medication cost challenges, they can be good allies to help you save as much as you can.
Getting the Medicines You Need
It sometimes can feel like an impossible task to get your medicines from your pharmacy, due to various issues and problems that arise. There are some helpful strategies you can use to ensure you do get your medicines when you need them.
Request your refills ahead of time
Just like for anything you need on a regular basis, don’t wait until the last minute to refill your medicines. The best time to request a refill is when you have about five days remaining. This gives the pharmacy enough time to request a new prescription from the doctor’s office if they need to, to run the prescription through your insurance plan to make sure all goes smoothly, and order the medication if they don’t currently have it (or enough of it) in stock. Better yet, ask your pharmacy if they have programs that can help you refill your medicines on time. Some pharmacies will automatically refill your medications if you give permission—and remind you when it is time to pick up those refills.
Ask if the pharmacy can “sync” your medications
A new medicine might be prescribed after you have a doctor’s visit, but maybe you’re not due to pick up the rest of your medications until two weeks later. Now you have to visit the pharmacy two times per month instead of one, because your medicine refills have different dates. Some pharmacies will work with you to help decrease the number of times you have to go to the pharmacy to pick up medications that you use regularly. Depending on what medications you are taking, sometimes it is OK to delay the start of a new medication. Sometimes the pharmacy might have to contact the doctor’s office to ask for a small prescription to make the dates of all of your prescriptions align correctly. Ask your pharmacist if this is possible for your prescriptions, and if so, whether you need to make an appointment at the pharmacy to complete the process.
Ask targeted questions when you’re having trouble getting your medicine
Many people walk away from the pharmacy confused when they cannot get their medication. A number of things may go wrong, resulting in a prescription not being filled. So that you have a better understanding of what is going on, it can be useful to remember these four questions:
- Am I out of refills? If so, the pharmacist has to contact your doctor’s office to obtain a new prescription to fill.
- Is there a problem with my prescription? Sometimes a prescription can’t be filled because it is written wrong (wrong drug, wrong dose, wrong directions, missing information). Again, in this case, the pharmacist has to contact your doctor’s office to straighten out the issue.
- Is there a problem with my insurance? For this problem, sometimes the pharmacist has to work with your doctor’s office to request that your insurance cover a medicine, or the pharmacist has to submit other paperwork. In some cases, you may have to contact your insurance to determine coverage.
- What should I do next? Once you have a better understanding of what the problem is, get clarification on what the next steps are. Will they call the doctor? Should you call your doctor? Will they work on the insurance issue? >When will they let you know? Get a concrete plan, so that you know what steps you might need to take to resolve the issue.
Ultimately, patients are the ones that are responsible for the medicines we put into our bodies. However, it takes a village to do it safely. Seeking out a pharmacist who is willing to be a partner in health and adding them to your team can improve the way your medicines work for your body.