Pharmacist Prescribing Models for HIV Pre-exposure and Post-exposure Prophylaxis

Abstract

State strategies for pharmacist prescribing exist on a continuum from most restrictive to least restrictive. Using human immunodeficiency virus (HIV) pre-exposure prophylaxis and post-exposure prophylaxis as a case study, there are 3 viable pharmacist prescribing models: (1) population-based collaborative practice agreements; (2) government protocols; and (3) standard of care prescribing. The advantages and disadvantages of these 3 models are reviewed.

Keywords

pharmacy scope of practice collaborative practice agreement prescriptive authority

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References

Roberts

Rubin

Smith

Adams

Klepser

DG.

Public health perceptions of community pharmacy partnership opportunities. J Public Health Manag Pract. 2015;21(4):413-415. doi:10.1097/PHH.0000000000000276

Gubbins

Klepser

Adams

Jacobs

Percival

Tallman

GB.

Potential for pharmacy-public health collaborations using pharmacy-based point-of-care testing services for infectious diseases. J Public Health Manag Pract. 2017;23(6):593-600. doi:10.1097/PHH.0000000000000482

Rosenfeld

Etkind

Grasso

Adams

Rothholz

MC.

Extending the reach: local health department collaboration with community pharmacies in Palm Beach County, Florida, for H1N1 influenza pandemic response. J Public Health Manag Pract. 2011;17(5):439-448. doi:10.1097/PHH.0b013e31821138ae

Hogue

Grabenstein

Foster

Rothholz

MC.

Pharmacist involvement with immunizations: a decade of professional advancement. J Am Pharm Assoc. 2006;46(2):168-179. doi:10.1331/154434506776180621

Adams

Suchanek Hudmon

Pharmacist prescriptive authority for smoking cessation medications in the United States. J Am Pharm Assoc. 2018;58(3):253-257. doi:10.1016/j.japh.2017.12.015

Belluck

Tavernise

States lead effort to let pharmacists prescribe birth control. New York Times. November 22, 2015. http://www.nytimes.com/2015/11/23/health/states-lead-effort-to-let-pharmacists-prescribe-birth-control.html

Taylor

Joubert

Pharmacist-led minor ailment programs: a Canadian perspective. Int J Gen Med. 2016;9:291-302. doi:10.2147/IJGM.S99540

Atkinson

Dering-Anderson

Adams

Pharmacy-based tuberculosis skin testing (TST): approaches to legal authority. Innov Pharm. 2017;8(2):13.

Beahm

Smyth

Tsuyuki

RT.

Outcomes of urinary tract infection management by pharmacists (RxOUTMAP): a study of pharmacist prescribing and care in patients with uncomplicated urinary tract infections in the community. Can Pharm J. 2018;151(5):305-314. doi:10.1177/1715163518781175

10.

Adams

Frost

TP.

The over-regulation of pharmacist services: why over-the-counter naloxone should spark conversation about a “standard of care” regulatory approach. J Am Coll Clin Pharm. 2023;6(6):615-620. doi:10.1002/jac5.1794

11.

Adams

Eid

Federal pharmacist paxlovid prescribing authority: a model policy or impediment to optimal care?

Explor Res Clin Soc Pharm. 2023;9:100244. doi:10.1016/j.rcsop.2023.100244

12.

Adams

Weaver

KK.

Pharmacists’ patient care process: a state “scope of practice” perspective. Innov Pharm. 2019;10(2):1-8. doi:10.24926/iip.v10i2.1389

13.

Adams

Weaver

KK.

Pharmacists’ patient care process: state “scope of practice” priorities for action. Ann Pharmacother. 2020;55(4):549-555. doi:10.1177/1060028020950193

14.

Adams

Frost

Weaver

Pharmacy regulatory innovation index: benchmarking the regulatory environment in 10 western states. J Am Pharm Assoc. 2021;61(5):e84-e89. doi:10.1016/j.japh.2021.05.003.

15.

California Society of Health-System Pharmacists. SB 493. Date unknown. Accessed March 4, 2023. https://www.cshp.org/page/SB493

16.

National Alliance of State Pharmacy Associations (NASPA). Pharmacist prescribing: hormonal contraceptives. Published September 2022. Accessed March 4, 2023. https://naspa.us/resource/contraceptives/

17.

Adams

Weaver

KK.

The continuum of pharmacist prescriptive authority. Ann Pharmacother. 2016;50(9):778-784. doi:10.1177/1060028016653608

18.

Adams

Weaver

Adams

JL.

Revisiting the continuum of pharmacist prescriptive authority. J Am Pharm Assoc. 2023. doi:10.1016/j.japh.2023.06.025

19.

Centers for Disease Control and Prevention (CDC). HIV prevention in the United States: mobilizing to end the epidemic. Date unknown. Accessed March 4, 2023. https://www.cdc.gov/hiv/policies/strategic-priorities/mobilizing/introduction.html

20.

Centers for Disease Control and Prevention (CDC). PrEP effectiveness. Date unknown. Accessed March 4, 2023. https://www.cdc.gov/hiv/basics/prep/prep-effectiveness.html

21.

Paltiel

Freedberg

Scott

, et al. HIV preexposure prophylaxis in the united states: impact on lifetime infection risk, clinical outcomes, and cost-effectiveness. Clin Infect Dis. 2009;48(6):806-815. doi:10.1086/597095

22.

Centers for Disease Control Prevention (CDC). Are there different types of PrEP? Date unknown. Accessed March 4, 2023. https://www.cdc.gov/hiv/basics/prep/about-prep.html

23.

The Chicago Center for HIV Elimination. What is PrEP. Date unknown. Accessed March 4, 2023. https://hivelimination.uchicago.edu/prep/

24.

Centers for Disease Control Prevention (CDC). Post-exposure prophylaxis (PEP). Published March 2023. Accessed March 4, 2023. https://www.cdc.gov/hiv/risk/pep/index.html

25.

Centers for Disease Control Prevention (CDC). Updated guidelines for antiretroviral postexposure prophylaxis after sexual, injection drug use, or other nonoccupational exposure to HIV—United States. Published April 2016. Accessed March 4, 2023. https://stacks.cdc.gov/view/cdc/38856

26.

Lopez

Dong

BJ.

Implementing PrEP in the pharmacy. Pharm Today. 2020;26(4):39-53.

27.

Krakower

Ware

Mitty

Maloney

Mayer

KH.

HIV providers’ perceived barriers and facilitators to implementing pre-exposure prophylaxis in care settings: a qualitative study. AIDS Behav. 2014;18(9):1712-1721. doi:10.007/s10461-014-0839-3

28.

Petroll

Walsh

Owczarzak

McAuliffe

Bogart

Kelly

JA.

PrEP awareness, familiarity, comfort, and prescribing experience among US primary care providers and HIV specialists. AIDS Behav. 2017;21(5):1256-1267. doi:10.1007/s10461-016-1625-1

29.

Havens

Scarsi

Sayles

Klepser

Swindells

Bares

SH.

Acceptability and feasibility of a pharmacist-led HIV pre-exposure prophylaxis (PrEP) program in the midwestern United States. Open Forum Infect Dis. 2019;6(10):ofz365. doi:10.1093/ofid/ofz365

30.

Zhao

Dangerfield

2nd Nunn

, et al. Pharmacy-based interventions to increase use of HIV pre-exposure prophylaxis in the United States: a scoping review. AIDS Behav. 2022;26(5):1377-1392. doi:10.1007/s10461-021-03494-4

31.

Tung

Thomas

Eichner

Shalit

Implementation of a community pharmacy-based pre-exposure prophylaxis service: a novel model for pre-exposure prophylaxis care. Sex Health. 2018;15(6):556-561. doi:10.1071/SH18084

32.

Bellman

Mohebbi

Nobahar

Parizher

Apollonio

DE.

An observational survey assessing the extent of PrEP and PEP furnishing in San Francisco Bay Area pharmacies. J Am Pharm Assoc. 2022;62(1):370-377. doi:10.1016/j.japh.2021.08.001

33.

Gauthier

Toro

Carrasquillo

Corentin

Lichtenberger

A PrEP model incorporating clinical pharmacist encounters and antimicrobial stewardship program oversight may improve retention in care. Clin Infect Dis. 2019;68(2):347-349. doi:10.1093/cid/ciy640

34.

Khosropour

Backus

Means

, et al. A pharmacist-led, same-day, HIV pre-exposure prophylaxis initiation program to increase PrEP uptake and decrease time to PrEP initiation. AIDS Patient Care STDS. 2020;34(1):1-6. doi:10.1089/apc.2019.0235

35.

Bacci

Coley

McGrath

Abraham

Adams

McGivney

MS.

Strategies to facilitate the implementation of collaborative practice agreements in chain community pharmacies. J Am Pharm Assoc. 2016;56(3):257-265. doi:10.1016/j.japh.2016.02.014

36.

Adams

Klepser

Physician-pharmacist collaborative practice agreements: a strategy to improve adherence to evidence-based guidelines. Evid Based Med Public Health. 2015;1:e923. doi:10.14800/emph.923

37.

Adams

Dering-Anderson

Klepser

The roles of pharmacy schools in bridging the gap between law and practice. Am J Pharm Educ. 2018;82(4):6577. doi:10.5688/ajpe6577

38.

Adams

AJ.

Pharmacist scope of practice expansion: the virtue of forbearance. J Am Coll Clin Pharm. 2021;4(9):1067-1069. doi:10.1002/jac5.1465

39.

Ohio Revised Code. Section 4729.39. Consult agreement with physicians. Date unknown. Accessed March 4, 2023. https://codes.ohio.gov/ohio-revised-code/section-4729.39

40.

Klepser

Adams

Klepser

DG.

Antimicrobial stewardship in outpatient settings: leveraging innovative physician-pharmacist collaborations to reduce antibiotic resistance. Health Secur. 2015;13(3):166-173. doi:10.1089/hs.2014.0083

41.

Illinois General Assembly. Full Text of HB4430. 102nd general assembly. Date unknown. Accessed March 4, 2023. https://www.ilga.gov/legislation/fulltext.asp?DocName=&SessionId=110&GA=102&DocTypeId=HB&DocNum=4430&GAID=16&LegID=&SpecSess=&Session=

42.

New York State Department of Health. The licensed pharmacist’s role in initiating HIV post-exposure prophylaxis: overview and frequently asked questions. Published August 2022. Accessed March 4, 2023. https://www.health.ny.gov/diseases/aids/general/pep/docs/pharmacists_role.pdf

43.

Adams

Frost

TP.

Pathways to pharmacist prescriptive authority: do decentralized models for expanded prescribing work. Res Social Adm Pharm. 2022;18(4):2695-2699. doi:10.1016/j.sapharm.2021.07.016

44.

Utah State Legislature. HB 178. Pharmacy practice modifications. Date unknown. Accessed March 4, 2023. https://nabp.pharmacy/wp-content/uploads/2022/02/February-2022-Utah-Newsletter.pdf

45.

Utah Division of Occupational Professional Licensing. Utah guidance for pre-exposure and post-exposure prophylaxis of HIV. Published September 2021. Accessed March 4, 2023. https://dopl.utah.gov/wp-content/uploads/2022/09/utah-guidance-for-pre-exposure-and-post-exposure-prophylaxis-of-hiv.pdf

46.

Adams

AJ.

Pharmacist prescriptive authority: lessons from Idaho. Pharmacy. 2020;8:112. doi:10.3390/pharmacy8030112

47.

Adams

AJ.

Transitioning pharmacy to “standard of care” regulation: analyzing how pharmacy regulates relative to medicine and nursing. Res Social Adm Pharm. 2019;15(10):1230-1235. doi:10.1016/j.sapharm.2018.10.008

48.

Adams

Chopski

NL.

Rethinking pharmacy regulation: core elements of Idaho’s transition to a “standard of care” approach. J Am Pharm Assoc. 2020;60(6):e109-e112. doi:10.1016/j.japh.2020.07.013

49.

Adams

Klepser

Adams

JL.

Pharmacy-based point-of-care testing: how a “standard of care” approach can facilitate sustainability. Innov Pharm. 2021;12(4):1-4. doi:10.24926/iip.v12i4.4290

50.

Idaho Code. 54-1705. Definitions. Date unknown. Accessed March 4, 2023. https://legislature.idaho.gov/statutesrules/idstat/Title54/T54CH17/SECT54-1705/

51.

Idaho Administrative Code. Rules of the Idaho state board of pharmacy. Date unknown. Accessed March 4, 2023. https://adminrules.idaho.gov/rules/current/24/243601.pdf

52.

Adams

Klepser

ME.

Pharmacist prescriptive authority for acne: an evidence-based approach to policy. Innov Pharm. 2021;12(2):1-4. doi:10.24926/iip.v12i2.3897

53.

Akers

Adams

Klepser

ME.

Review of pharmacy-based management of uncomplicated urinary tract infections (UTIs) in community pharmacy settings. Int J Pharm. 2018;8(2):63-69.

54.

Klepser

Adams

AJ.

Pharmacy-based management of influenza: lessons learned from research. Int J Pharm Pract. 2018;26(6):573-578. doi:10.1111/ijpp.12488

55.

Vanderholm

Renner

Stolpe

Adams

AJ.

An innovative approach to improving the proposed CMS star rating “statin use in persons with diabetes. J Manag Care Spec Pharm. 2018;24(11):1126-1129. doi:10.18553/jmcp.2018.24.11.1126

56.

Adams

AJ.

Pharmacist prescriptive authority for epinephrine auto-injectors in Idaho. Innov Pharm. 2016;7(3):14. doi:10.24926/iip.v7i3.457

57.

Athay Adams

Chopski

Adams

AJ.

Opportunities for pharmacist prescriptive authority of buprenorphine following passage of the mainstreaming addiction treatment (MAT) act. J Am Pharm Assoc. 2023; S1544-S3191. doi:10.1016/j.japh.2023.06.001

58.

Adams

Klepser

ME.

Pharmacy-based assessment and management of herpes labialis (cold sores) with antiviral therapy. Innov Pharm. 2020;11(3):1-6. doi:10.24926/iip.v11i3.1532

59.

Adams

Does increased state pharmacy regulatory burden lead to better public safety outcomes?. Innov Pharm. 2021;12(1):1-6. doi:10.24926/iip.v12i1.3598