Implementing Long-Acting HIV PrEP: Clinic and Pharmacy Infrastructure

This episode, "Implementing Long-Acting HIV PrEP: Clinic and Pharmacy Infrastructure," features the faculty unpacking what it takes to run long-acting PrEP programs in clinics and pharmacies.

Dr. Urbina explains that a long-acting injectable program requires substantial infrastructure. The model is nursing-heavy, and the medications are expensive enough that most patients cannot pay out of pocket. Coverage through insurance is therefore essential. Dr. Cocohoba lists the practical hurdles: insurance verification, buy-and-bill versus pharmacy acquisition, prior authorization, and new billing codes for injection visits.

Describing Mount Sinai's approach, Dr. Urbina says his institution built a dedicated long-acting injectable team. A benefits investigation team focuses solely on securing authorization and managing copay and patient assistance programs. He notes that New York State should have no cost sharing for PrEP, but that does not always hold in practice, so staff must advocate for patients. Nursing leadership is the second pillar, since nurses administer the injections and track patients. Missed visits put patients at risk for HIV acquisition and drug resistance. A quality team rounds out the model, monitoring adherence to visits and troubleshooting quickly. He acknowledges the approach is resource intensive.

Dr. Cocohoba shares that her clinic faces similar challenges. She then describes a parallel frontier in pharmacy. Several states now allow pharmacists to furnish PrEP more independently rather than under a collaborative practice agreement. She explains that granting that authority is only the first step. Pharmacies also need adequate staffing, electronic health record support, and the ability to order labs without surprise bills for patients. Pharmacists must be reimbursed for their time. Pharmacies must also manage costly inventory, communicate with primary care offices, and track patients over time. Sustainability, she says, is the core issue for these innovative models. Dr. Urbina adds that teams also need capacity to manage adverse effects. Dr. Cocohoba closes by stressing that partnerships between pharmacies and local clinicians are critical, since no one is working in a bubble.

Our next episode, "The Future of HIV PrEP and One Step to Take Tomorrow," looks ahead to annual, every-4-month, and once-monthly oral options, and closes with the single change each expert would make tomorrow.