Specialist Pharmacists Key to Complex HIV Care

Aug 28, 2013
HIV treatment is complicated and can cost up to $17,000 each month. Fortunately, Express Scripts specialist pharmacists are available to improve care.
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Significant advances have helped improve quality of life for many HIV patients. For instance, quad therapies – HIV medications with up to four drugs combined into one tablet – allow a patient to take just one medication instead of having to remember four different ones with different dosages.

But the constant evolution of treatment also comes with challenges, including confusion among patients and physicians, and the potential for harmful drug interactions and overdose.

Ellen Stiles is an HIV specialist pharmacist in the Express Scripts Immunology Therapeutic Resource Center in Willingboro, N.J. She has been specializing in the care of people living with HIV for more than six years. Ellen uses her training and knowledge of HIV treatments every day, to ensure that she can help patients and caregivers make better decisions, leading to healthier outcomes.

It is a part of her job she cherishes.

“Getting treatment right is a matter of life or death for patients with HIV,” Ellen says.

The Importance of an Appropriate HIV Medication Regimen

Just recently, Ellen helped a patient whose physician had prescribed two medications that should not be taken together – Stribild™ (elvitegravir, cobicistat, emtricitabine, and tenofovir disoproxil fumarate) and Norvir® (ritonavir).

As an HIV specialist, I know this is an unnecessary combination. Therapy duplication only raises the risk of excessive side-effects, including vomiting and increased cholesterol levels, possibly diarrhea, which could cause patients to stop taking their medication. In an HIV patient, this could be disastrous,” Ellen says. “It also adds unnecessary cost to an already expensive regimen.”

The prescribing information for Stribild states that it should not be prescribed in conjunction with other HIV medications in most cases, she pointed out.

“But keeping up with the changing guidelines can be challenging even for specialist physicians, given how many patients they see and how much treatment can vary from one patient to the next,” Ellen says.

So Ellen contacted the physician to provide assistance. Her initial attempts to contact the physician were met with resistance from his office staff who insisted that the prescriptions be filled as written.

Ellen is not one to give up easily. She persisted, even redoubled her efforts when a nurse suggested that the physician wanted to add a third medication to the mix.

In any other setting – such as a retail pharmacy – even if the potential risk had been spotted, the pharmacist might have counted on the physician knowing best and dispensed the medications.

Not Ellen.

“I knew I had to keep trying. HIV therapy is already complicated. Adding more medications to the mix often makes adherence even more challenging,” Ellen says. “It also raises the patient’s risk of developing resistance.”

In addition, depending on the medication, the cost of HIV treatment can average between $3,000 and $4,000 a month and go up to $17,000 a month, adding to the burden for both patients and their plan sponsors.

“Using inappropriate therapies adds a lot of waste to the system without providing any benefit to the patient,” Ellen says.

The physician eventually called Ellen back but appeared not to be aware of the prescribing recommendations.

Keeping Up With the Latest HIV Developments

So Ellen did what she often does and consulted with another HIV pharmacist, Bill Brumbach. They located several studies on the interactions between the various medications and how well they worked in combination with other therapies, as well as prescribing guidelines for Stribild. They shared these with the physician.

She wasn’t sure it would make a big difference, Ellen says. To her surprise, the physician sent a thank you note expressing his gratitude. He also agreed to align the patient’s medications and dosage with Ellen’s recommendation.

“It was gratifying that he acknowledged my help,” Ellen says. “But most importantly, I helped ensure a healthier outcome for a patient, who is already dealing with a difficult and complex condition.”

That focus is what makes specialist pharmacists like Ellen such a valuable part of Express Scripts’ clinical care offerings for patients and their families.

Specialists like Ellen are only a phone call away, available when patients need them and working every day to actively advocate for what’s best for HIV patients.

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