Challenges and Opportunities for Patients With HIV During COVID-19 - Episode 5
Insight regarding prescribing patterns and utilization of HIV therapies during the COVID-19 pandemic and strategies implemented by providers and payers to help patients navigate around challenges accessing treatment.
Moti Ramgopal, MD, FACP, FIDSA: When we look at our prescribing patterns in the last few months, it has changed from refills every month to normally we write a prescription for 30 days and refill times 3 or 4 or 6. Now we tend to write for 9 months, or a 90-day supply. And we discuss with the pharmacies, and a lot of the insurance companies have allowed this. Prescribing has changed significantly.
We also have not seen new patients initially because they are not going to get tested. A lot of patients are reluctant to come to the office. The challenge again … was when you prescribed medications. We had been doing electronic prescription and they go to the pharmacy. A lot of our pharmacies do home delivery, that process has become quite routine, quite streamlined. And we haven't had a significant issue with that.
However, there are patients now because of the COVID-19 [coronavirus disease 2019] story, a lot of people are becoming depressed. They are stopping the medications and we begin to see a big challenge developing over the next 26 months—patients who have completely stopped their medications. I have one of the centers that have a pharmacy in house. We also have social work in-house, we have a team approach to all patients, where we call them if you don't pick up your medications. We call the patients to find out why they did not pick up their medications. We have a lot of support in our organization to provide those services.
Mary Malek, PharmD, BCPS, AAHIVP: During COVID-19, we've faced many challenges that were new to us and very different from what we're used to in our day-to-day life that I would like to share with you.
First, the biggest question that we started out with was drug shortages. What does that mean for our HIV populations? Especially when it comes to HIV, we know that patients need to be on their medications with an adherence of 90[%] to 95% for the medications to be working and to be effective, unlike other disease states, where it might be 80%. For HIV, we did not want to see drug shortages, and we wanted patients to continue being able to get their medications.
The first thing that we did was get in contact with manufacturers for HIV products. We have really great connections with them, and they were able to let us know that currently there were no shortages, and we agreed that if any shortages are coming up in the future, they would let us know. Thankfully, many of the HIV products are branded, they are coming from single resources, so it was easy for us to know if changes were about to happen. During the pandemic, and so far, we haven't had any shortages in HIV medications.
We did otherwise have shortages for other medications, like inhalers and other maintenance products, which, still, our HIV patients usually have more than HIV.
We were always on the lookout to learn of any medications that are on back orders or drug shortages, and we consider our formulary to other products and other alternatives. If one format of inhaler, for example, goes on back order, we were flexible to change our formulary and use other medications in order to meet the patient's needs in the quickly changing environment of drug availability.
That question really tied to 90-day supply. If there are drug shortages, everybody wanted 90-day supplies. We were getting providers calling asking for 90 days. Patients were asking, “Will I have enough medications? We don’t know when this is ending. We don't know what's happening.” That was really the second-biggest challenge that we were facing, the question of 90-day supply.
From a health plans perspective, we didn't want what happened with toilet paper, with hand sanitizers, to happen with medications. We didn't want everybody running to get the same thing at the same time, and we would cause the drug shortage. Our health care system is not set up, our drug supply chain is not set up for every American to be getting a 90-day supply at the same time.
We decided to stick with getting 30-day supplies and continue doing that. But we also allowed early refills, and that's something that we worked around with our PPM to allow patients to get an early refill, and that's usually a setup that during emergencies is available. We opened that up, and patients were able to go to their pharmacy, get their medications earlier to make sure that we had enough supplies, especially at the beginning, during March. A lot of patients did use the early refill setup that we had.
But that caused another question to come up and another challenge, which was “how do I go to the pharmacy and get my medications?” We did not want our patients to get out to the pharmacies, to go out on the streets and get their medications. And, having 30 days meant patients would go to the pharmacy 3 times, instead of 90 days, when it's just 1 time. We had to think through this quickly, and we worked with a lot of our pharmacies to see if they can offer deliveries. Really, for New York City, deliveries, some pharmacies have them, but not all of them did. New York City, you could walk out in the street, just down the block, you'll find 10 pharmacies next to each other. Getting access and going to the pharmacy was never an issue. But, now it was.
We wanted to make sure pharmacies are delivering and that we had a list of delivery pharmacies in case a patient calls in to our plan and says, “I don't have access to medications.” We were able to provide a list of pharmacies in the area that they can get access to.
We also saw that big chains offered free deliveries, which is something they didn't have before. That was very helpful to get our patients to continue being on their medications and to continue having access to drugs, while being at home and not having a lot of interruptions.