PEP, or post-exposure prophylaxis, is a combination of antiretroviral medications that can be given to someone who thinks they have come in contact with the virus. When a patient starts PEP within 72 hours of exposure, the drugs can be effective in preventing infection. (PEP is different from PrEP, which is pre-exposure prophylaxis and is taken regularly by people who are at a high risk of contracting HIV.) PEP is a once or twice daily pill for 28 days.
Upstate’s Outpatient Pharmacy is located near the main lobby of the downtown campus and is open to the public seven days a week. (Parking is available in the front circle.) Anyone who thinks they may have been exposed to HIV can visit the pharmacy and speak with a pharmacist about his or her possible exposure. The pharmacist will discuss those risk factors – instances often include unprotected sex or sharing needles – and obtain insurance information from the patient. Many insurance carriers cover PEP and Upstate has a variety of programs that can help pay for the medication, according to Eric Balotin, RPh, associate director pharmacy enterprise.
The patient is then given a seven-day dose of PEP, a New York state PEP information leaflet and is scheduled for a follow-up appointment at Upstate’s Immune Health Clinic. Immune Health Clinic staff will conduct HIV testing, offer information about reducing risk factors and prescribe the remaining 21 doses of PEP, which is a combination of name brand drugs Truvada and Tivicay. Often patients who are initially prescribed PEP will later be prescribed PrEP, which when taken consistently can reduce the risk of infection by up to 92%, according to the Centers for Disease Control and Prevention.
“We have the ability to get these types of medications to the patients quickly to reduce their risk of HIV,” Balotin said of the Outpatient Pharmacy offering PEP. At Immune Health, providers will review patients’ histories and determine whether they have ongoing risk for HIV and may be a candidate for PrEP, said Elizabeth Asiago Reddy, MD, MS, medical director of the clinic.
Making PEP available through Upstate’s Outpatient Pharmacy – which is open 8 a.m. to 6 p.m. Monday through Friday and 9 a.m. to 2 p.m. Saturdays and Sundays – should cut down on people spending long hours in the emergency department seeking the emergency prescription, Balotin said. Currently between 12 and 15 patients per month visit Upstate’s ED to obtain PEP. The new Outpatient Pharmacy policy will make access to the drugs quicker and easier.
“This should make it much better for patients,” Balotin said. “And we will make it as affordable as we possibly can.”
Improving access to PEP could encourage patients to seek it out more often and improve relationships and return rates to the Immune Health Clinic, Asiago Reddy said.
“Potential HIV exposures are very stressful. This program will really streamline people’s ability to access preventive treatment, counseling and a referral in a much calmer environment than the ED,” she said. “The service is going to be a lot more efficient for patients and it’s a better use of resources for us as a medical center.”
Despite New York state allowing pharmacies to dispense PEP starting in 2017, few want to because the drugs are expensive and have a short shelf life, Balotin and Asiago Reddy said.
“We’re the only pharmacy in the area offering this. The other closest ones are in Rochester and the Albany area,” he said. “We recognize that the drugs are expensive but our job is to take care of the patient. It’s all about getting patients on meds as fast as possible.”
Patients can search for available PEP programs through the New York State Department of Health and Upstate partner ACR Health will also refer patients to the Outpatient Pharmacy for PEP.