Pharmacist-prescribed PrEP and PEP pilot expands pharmacy scope of practice

By Jennifer Finocchiaro, PharmD, AAHIVE

The role of the pharmacist has changed significantly over the years, expanding from medication dispensing and counseling to providing direct patient care.

As the pharmacy scope of practice increases, states across the U.S. are authorizing pharmacists to prescribe certain medications.¹ In 20 states, pharmacists can prescribe pre-exposure prophylaxis (PrEP) and/or post-exposure prophylaxis (PEP), a change that aims to improve access to the HIV prevention medications.^2,3,4

Genoa Healthcare^® recently launched a pilot program enabling its pharmacists in two Las Vegas pharmacies to prescribe PrEP and PEP. When used effectively, PrEP can reduce the risk of HIV from sex by about 99% and from injection drug use by at least 74%, while PEP is estimated to be over 80% effective at preventing HIV.^5,6 Starting and staying on the medications, however, can be difficult for medically underserved populations.

As part of the new pilot, patients can stop by the Genoa pharmacy to talk to their pharmacist about starting PrEP or PEP – no appointment needed. There, the pharmacist will perform targeted clinical and laboratory assessments to see if one of the medications is right for them. If it is, they’ll prescribe and fill it right at the pharmacy.

Reducing barriers and improving access to care

The Centers for Disease Control and Prevention (CDC) estimates that only 36% of the around 1.2 million people in the U.S. who would benefit from PrEP were prescribed it in 2022.⁷ For some, barriers like low access to medical care, a lack of PrEP awareness, low perception of HIV risk and stigma can prevent people from initiating and continuing PrEP.⁸

Increasing physician appointment wait times⁹ can also prevent people from engaging in conversations about prevention and overall sexual health. If someone does start the conversation and is prescribed PrEP or PEP, they don’t always leave the physician’s office with medication in hand. Seeing a provider before going to the pharmacy to fill their prescription is an added step that can prevent patients from walking away with their medication. 

Genoa’s latest pilot aims to increase access to HIV prevention services and linkage to care for people who need it most. As one of the most accessible health care providers,¹⁰ authorizing pharmacists to initiate and prescribe PrEP or PEP without a physician’s order makes it easier for at-risk populations to access the medications. Pharmacists can also help patients overcome financial barriers and pay for their prescription by enrolling those who are un- or underinsured in alternative sources of medication funding, like patient assistance programs or foundations.

Improving medication adherence

The role of the pharmacist in HIV care goes beyond initiation. A recent study published in JAMA Network Open found that more than half of PrEP users had discontinued their treatment during the study period,¹¹ reflecting the barriers that exist even after a person starts taking PrEP.

Systemic issues, medication concerns and behavior change can all drive PrEP non-adherence,¹² but accessible, consistent HIV care through targeted interventions at the pharmacy can help keep people on track.

Pharmacists can see firsthand if patients are picking up their medications, which opens the door for enhanced adherence support, check-in calls and education – especially for communities that experience the biggest gaps in care. 

Genoa pharmacies across the U.S. specialize in providing high-touch, stigma-free care to people living with and working to prevent HIV/AIDS. We’re excited to see and share the impact of Genoa’s pharmacist-prescribed PrEP and PEP pilot and continue reducing barriers to care for people who need it most.

Let’s connect

Want to learn more about how Genoa’s pharmacy services can make a difference for your patients? Fill out the form below and we’ll be in touch.

About the author

Jennifer Finocchiaro, PharmD, AAHIVE is a Senior Clinical Pharmacist for Genoa’s Clinical Product & Strategy team. She specializes in providing pharmacy care to people living with and working to prevent HIV/AIDS and other chronic conditions and works to ensure Genoa pharmacy teams are equipped to provide the best care possible to the people they serve.

This information was accurate at the time of posting.

1. Pharmacist prescribing: Statewide protocols and more. NASPA. (2024, January 11). https://naspa.us/blog/resource/swp#unique-identifier-continuum
2. Selvage, R. (2023, September 5). CEO blog. American Pharmacists Association. https://www.pharmacist.com/CEO-Blog/pharmacists-expand-access-to-prep-in-17-states
3. NASTAD. (n.d.-b). Pharmacist-initiated prep and pep. https://nastad.org/sites/default/files/2021-11/PDF-Pharmacist-Initiated-PrEP-PEP.pdf
4. HB579. (n.d.). https://legis.la.gov/legis/BillInfo.aspx?&i=246337
5. Centers for Disease Control and Prevention. (2022, July 5). Pre-exposure prophylaxis (prep). Centers for Disease Control and Prevention. https://www.cdc.gov/hiv/risk/prep/index.html#:~:text=PrEP%20is%20highly%20effective%20for,use%20by%20at%20least%2074%25
6. U.S. Department of Health and Human Services. (2024, February 6). Post-exposure prophylaxis (PEP). National Institutes of Health. https://hivinfo.nih.gov/understanding-hiv/fact-sheets/post-exposure-prophylaxis-pep#:~:text=The%20exact%20effectiveness%20of%20PEP,no%20further%20exposures%20to%20HIV.
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8. Mayer, K. H., Agwu, A., & Malebranche, D. (2020, March 30). Barriers to the wider use of pre-exposure prophylaxis in the United States: A narrative review – advances in therapy. SpringerLink. https://link.springer.com/article/10.1007/s12325-020-01295-0#:~:text=Awareness%20and%20Knowledge%20as%20a%20Barrier%20to,be%20aware%20of%20the%20existence%20of%20PrEP
9. AMN Healthcare. (2022). Survey of Physician Appointment Wait Times and Medicare and Medicaid Acceptance Rates. https://www.wsha.org/wp-content/uploads/mha2022waittimesurveyfinal.pdf
10. Berenbrok, L. A., Tan, S., Gabriel, N., Patel, N., Dickson, S., Hernandez, I., Guo, J., & Sharareh, N. (2022, July 12). Access to community pharmacies: A nationwide … APhA | Journal of the American Pharmacists Association. https://www.japha.org/article/S1544-3191(22)00233-3/fulltext
11. JAMA Network Open (2021). Characterization of HIV Preexposure Prophylaxis Use Behaviors and HIV Incidence Among U.S. Adults in an Integrated Health Care System. https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2783509
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