NVHR Pharmacy Working Group Call
Fri, Dec 11, 10 am PT/1 pm ET
Key Themes
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CLDF/Walgreens and WSU/Bartell are two models of expanded screening in pharmacy settings
State scope of practice laws continue to provider barriers to expanding pharmacist role in
screening and treatment
VA’s model of care is one example team-based care with excellent pharmacy integration
Asian Pacific Health Foundation’s partnership with UCSD School of Pharmacy – excellent way to
leverage student volunteers and provide increased hepatitis training/focus to future
pharmacists
Ongoing issues where pharmacists can play key role: treatment capacity for hepatitis, screening
and awareness role, treatment adherence
Next Steps
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Continue to gather and summarize examples of pharmacy work in hepatitis, add to NVHR
website, gather best practices and share on site and listserv
gather state laws – Eric Rude working on this, with others
NVHR will host quarterly calls
Refine goals/mission statement of group:
o getting all states up to highest level of pharmacy integration/scope of practice for
pharmacists
o provide a forum for relationship-building and sharing of best practices
o advocate for the role of pharmacists in National Viral Hepatitis Action Plan & IOM
Elimination Plan
o elevate the role of pharmacists and pharmacies in hepatitis community – program and
advocacy work
Attendees:
Rick Shalvoy, Eric Rude & Dan Calder NYDPH, Ryan Clary, Susan Lee, Glen Pietradoni, Paulina Deming,
Bill Remak, Ariel Ma, Binh Tranh, Robert Gish, Lucinda Porter, Emily Stets, Julie Akers, Christine
Rodriguez, Thaddeus Pham, Tina BRoder
Agenda:
Update from Walgreens – (Glen Pietradoni)
Work with CLDF – HCV screen in 8 markets, 8 wks into project – 10% positivity rate – Philly, NYC,
Houston, Phoenix, Oakland, Miami, St Antonio, Dallas, Chicago – 768 screenings, first 8 wks, 62 wks – 12
wks since first market opened – pretty good uptake, traffic not as heavy as hoped – paying
phlebotomists for time, - limited to marketing – in stores as people come in – get info out to community
orgs – can’t do too much more about awareness. Challenges – select locations for events where they
have a private room, limits where they’d like to be – may not be most high potential area. Suburban
area have room/space but not traffic. Continue as long as sponsorship $ from abbvie is avail – managed
through CLDF grant, publishing as a study, went thru IRB approval part of research – some interesting
outcomes when get to end
Update from Washington State study team (Julie Akers)
Small pilot project w/ fam-owned Bartell Drugs Seattle area – also former employer – community
pharmacy foundation grant – AB screening in 5 locations in Seattle/suburbs – all stores do have priv
counseling rooms and use those – hoped to start by late Oct – ran into some hurdles on operational side
of getting ready w/ marketing, could start as early as Jan. with research grant – trying to take boomer
but also risk and pre-screen with AB – those that are AB+ leave pharmacy that day w/ either an appt w/
someone for conf test or attempt to make that appt – call that person’s PCP, if no care providers.
Working w/ State Dept ID expert – John Stockton so their dept is looking at addresses of each site &
putting together a list of who can be called in that area. Right now using Harborview Hospital – liver &
hep clinic – plan is to call them, or ask PCP if want them to come into them or get them in w/ a specialist
for confirmatory testing – not all PCP will be as prepared for direct referral. Also looking at developing
tools for other community pharmacies so they can more easily implement it – mini-business plan of why
to do this and also put together documents to take to health insurance companies – something to add
into health plan. In WA state have another law recently passed – insurance co. required to have
pharmacists as healthcare providers – this could fit in easily w/o patients paying out of pocket – track
time to get into PCP or specialist – know if there’s a wait, lost to follow up – Dr Gish working w/ on grant
– refresher training and presented to pharmacists. Pre/post test on knowledge of hepatitis, donated
some expired orasure kits – practiced doing test and counsel patients who are AB+, successful training
back in sept. 30 and 60 day calls after to find out if patient has been seen. If haven’t been seen at 30
days, then try at 60 days – and track what those barriers are – couldn’t get in, pt didn’t f/u
WA state law can’t deny provider into network if it’s w/i their scope of practice – involved in state board
– in 2013 we got a letter from state AG to look at the 95 law – go thru same process as other providers.
Last session 2015 leg session bill that says to follow 1995 law. Insurance companies were confusing
about billing codes & scope – advisory committee putting that together to give to insurance companies
– pharmacists that work in a health syst or hospital w/ internal credentialing process – 1/1/16 insurance
co have to add pharmacists to network, 2017 for all other pharmacists – community pharm don’t have
billing codes & privileges process. 2016 pharmacists can be added on the health insurance side – same
as if an ARNP or PA or MD had billed. Does it require an adv practice CLIA waiver & other certification –
in addition to being enlisted in network? (Bill) – WA law not specific to that. Already had in practice to
do CLIA waived tests in pharmacies – order & interpret labs already part of practice act – bill for services
already able to do
Update from Veterans Affairs/VA Model of Care (Ariel Ma)
ID/HCV pharmacist VA san diego – see patients twice a wk – social worker, hcv clinical coord, chief of
gastro, PCP, & pharmacists, LVN – work in multidisciplinary team in clinic same day – MH providers also
involved during HCV tx – also organize monthly hcv mtgs to update providers, new drug educ. As HCV
pharmacist workgroup vision 22 – network of 5 VA hospitals – access to care, budget, HCV test in birth
cohort & at risk patients
Integration of Pharmacy School Students into Hepatitis Work (Binh Tran)
Binh represents small grassroots org San Diego – another perspective on hep B & C screening – screened
more than 250 ppl at 14 outreach events – outcomes not always optimal. Started 15 yrs ago as a
community health clinic – first one in san diego then switched to foundation to provide screen at health
fairs & outreach – main activity on hep B & C screening. Collab w/ Bob Gish in SD and pharmacy school –
volunteer work, work on lots of study, point of care work to compare w/ standard of care – 450 ppl so
far. In next year have mini-grant from HBF and before collab w/ UCSD grant from CDC – approached
HMO there whenever they have someone w/o insurance – refer to them – work w/ dr from childrens
hospital to raise awareness of physicians esp among Asian groups – target children. A few events
planned for Dec – Vietnamese, Chinese, tried to work w/ Hmong group but they declined involvement –
hard to reach
FQHCs – one hired an ID Christian Ramers – specific line in structure, will work w/ La Maestra more – to
build a mini-liver team inside FQHC 120,000 or so – 8-10% range – may find 8000-15000 in that group, as
people develop pharmacy story – look at FQHCs and how to network inside them – direct rel-building or
direct marketing to them – Binh not working w/ ppl who use drugs now – have pharmacy students
interested in project – 14 students for the summer for hep B & C, esp 1st and 2nd yr – collaborate w/ big
events – cervical cancer awareness, cholesterol, etc – way to attract to more people – continue project
until graduation another way to benefit both parties – school relies on us, starting scholarship under our
name to promote pharmacy care in community. Since 2006 almost 10 yrs w/ the school.
Discussion of State Laws on Pharmacist Scope of Work/role of working group (all)
How this group can move forward – getting all states up to highest level of integration – WA state is
great example – should be a top priority for this group, also other ways of relationship-building
VA cutting edge pharmacy integration programs – written up as operational publication but would be
great to capture that info & publish in peer-reviewed list
CLDF screening in pharmacy settings – could be amplified thru country – pilot project w/ Julie in WA
state – priorities in place, mission statement, work on 2-3 things initially
IOM met last week on hepatitis B & soon on hep C – operational roadmap for CDC & IOM to embrace
pharmacists as part of this team – complaints about testing ppl & not being able to link them to care – if
pharmacists as team member is on roadmap hopefully include in their statement – May 2016, final
early-mid 2017 – chance for people to respond, be ready as an action group to put document together
that pharmacists need to be part of elimination plan and need to be involved – get hep to rare disease
Capacity – shortage of PCPs & many physicians – complaint of no capacity – expansion of pharmacy
training & graduates – should be part of capacity answer
Glen – Ryan at Gilead meeting next wk regarding screening, support from pharma to help tell story
Atlanta conf on HIV prevention – new technologies on HCV screen, still CLIA waived tested – new tech
easily adaptable to retail pharmacy improved over orasure – newer tech may make it easier to see more
people & incorporate into business
Julie – excited to see new tech – why waste time on AB+, test everyone PCR – could overwhelm system.
Use pharmacy to widdle down to AB+ and send in to confirmatory testing. Pharmacists job is to counsel
patients – enhance hep knowledge good use in institution or community setting
Interested in partnering – talking to company. Some insurance co concerned about putting on
formularies due to high cost, adherence, black market – state medicaids – ppl who supposedly failed
first rd of tx, do another 3 mos in expense – did they really fail tx or not take it/sell it?
Only one test – company based in san diego – urine screen – check levels of Sof – test for adherence
issue, community pharmacy to do adherence counseling – find ppl w/o proper levels not adherent – dr
think after talking to person that they’ll be adherent, test for other drugs – no obj adherence data
Mail order, prior auth – adherence kit to get back to community pharmacy – admin coaches w/I PBM –
doesn’t require pharmacists – could be done by pharm tech or health educator
Health plans have internal checklist of risk for non-adherent patients
Paulina from NM – gut feeling of other bias – don’t test like this for other disease states or medication –
having a lab report – patients w/ viral load undetectable w/ questionable results on their compliance &
people stopping their meds – looking at ways pharmacists can utilize tools on supporting adherence
NM – pharmacists prescriptive authority act – allow pharmacists to initiate therapy, specifically w/
training - prescribe naloxone, dispense vax, also pharm-clinician law – start therapy training w/
supervising physicians – exams, order labs, procedures, etc – operate like a clinician – that’s what’s
happening in NM
Eric Rude – trying to see if they can allow pharmacists to do rapid testing – looking to gather resource
and build a coalition in NY to try to initiate a policy change in NY – looking for laws in other states to
borrow from – pieces of legislation – when they do try to draft legislation –
states where pharmacists can do rapid testing – NM, CA, WA, - look to see if reimbursement is included?
Glen will connect NY w/ walgreens state folks in VA – most states can do CLIA waived testing – look at
board of pharmacy and state laws – help identify where the laws are to see what it reads like so in NY
they could use that language – any examples of how it’s reimbursed
Most of what WA can do goes back to their practice act – if we have collab agreement w/ physician, can
do anything that the physician signs off on – list of things that pharmacist can write rx for – prescriptive
authority in practice act – can be worrisome to open a practice act needs to be in scope of practice act
addit trainings pharmacists can get thru cont educ – not collab act – but ind practice - certain # hours of
practice experience – not lots of interaction w/ physician re-signed every 2 yrs, no addit cert or training
issue of energizing pharmacists to expand their role/testing at pharmacies – what can we do to energize
the pharmacies at large – publish in journals, publications for pharmacists
Binh – UCSD initiated talks w/ Rachel McLean – pharmacists can do POC tests – ask permission from
UCSD which has connections w/ hospitals, ok’d the POC work
Rick – NY severely restricted in scope of practice – NYC one of markets for walgreens. Orasure provide
tests for a number of walgreens pharmacies, 3-4 retail locations – CLDF doing test there but not
conducted by pharmacist staff – hired phlebotomists
Comments by Dr. Gish on POC (12-14-15)
The idea is to have Pharmacies, under the direction of pharmacists to do (order and perform) POC
testing and eventually regular lab testing.
The tests themselves could be done by pharmacists, physician assistants, nurse practitioners, and
involve phlebotomists with the collaboration of and linkage to providers offices for care and treatment
Next Steps
 Continue to gather and summarize examples of pharmacy work in hepatitis, add to NVHR
website, gather best practices and share on site and listserv
 gather state laws – Eric Rude working on this, with others
 NVHR will host quarterly calls