How Specialty Pharmacists Can Keep HIV Patients on ART
Originally published by our sister publication Specialty Pharmacy Continuum
By Fran Kritz
A team of specialty pharmacists and pharmacy liaisons in Brooklyn successfully transitioned a small group of patients living with HIV from daily oral antiviral therapy (ART) to injectable long-acting antiretroviral therapy (LA-ART). The switch improved medication access and adherence, and optimized treatment outcomes for HIV management and PrEP, the team reported at the NASP 2025 Annual Meeting & Expo, in Denver (poster OPR17-OR).
Treatment shortcomings of oral ART, according to the poster, include daily pill fatigue, social stigma, and inconsistent access to medication. There are also challenges for LA-ART, but the pharmacy team aimed to tackle such barriers, including prior authorization, patient financial support, and close monitoring to be sure patients are accessing the medication and to handle adverse events, if needed.
The poster detailed the success of one program at the Brooklyn Hospital Center (TBHC), where a coordinated multidisciplinary model had been established to enhance HIV and PrEP management. The retrospective, observational study was based on electronic health record review and a specialty pharmacy patient management tool. The study included any adult patient who started LA-ART from January 2023 to December 2024 at TBHC.
A total of 141 patients at TBHC were initiated on LA-ART, with 51 (36.2%) receiving their first dose on the same day as their initial consultation. An additional eight patients returned the following day for treatment. Patients who initiated therapy past the two-day mark did so “due to clinically uncontrolled reasons,” including patients already receiving LA-ART who were not yet due for their next dose, consultations required before switching to long-acting therapy, or changes in insurance or employment status.
The workflow involving specialty pharmacy began when the provider, after initial consultation and required labs, sent the LA-ART prescription to the TBHC outpatient pharmacy, where the claim was sent to insurance and payment issues handled by the clinical liaison. Once approved, the adherence liaison prepared and delivered the injection to nurses to administer, and the liaison conducted a follow-up call after the injection.
Among the participants, the median age was 37; 101 were male and 40 were female; and 107 were African American, 17 Hispanic, 7 Caucasian, and 10 “other.” For all patients, prior authorization approval took less than one day once initiated, and the average copay was $0. Viral suppression was at 10% at the start of the study and reached 100% at the end.
In an interview with Specialty Pharmacy Continuum, Jean Estime, PharmD, the site director for specialty pharmacy services company Clearway Health and one of the study authors, said counseling involved helping many patients with their fear of needles. “Explaining that it would only be several injections each year instead of regular trips to the pharmacy helped convince patients,” Dr. Estime said. The June 2025 approval of lenacapavir (Yeztugo, Gilead Sciences), given twice a year, will have an even more dramatic impact for patients, Dr. Estime predicted.
Dr. Estime reported no relevant financial disclosures.