PrEP Delivery Toolkit for Pharmacies

    Competencies         Resources for Competencies         Video List

Ending HIV at the Pharmacy

Although Washington state has made major advances in reaching state and federal benchmarks towards ending HIV, disparities in access to PrEP remain. While interest in PrEP is consistent across region, uptake is much lower in regions outside of King County. Pharmacists are an emerging partner in the HIV prevention field and can help expand access to underserved populations. Washington state is uniquely poised to leverage pharmacists as a new partner in PrEP delivery, with landmark legislation and supportive programming for pharmacists hoping to expand into new service delivery fields.

PrEP Delivery Toolkit

The Pharmacy-based PrEP delivery toolkit is intended to equip pharmacists in Washington state with the education, resources, and tools needed to initiate and manage PrEP pharmacy programs. This toolkit is a product of collaborative work between the Washington State Department of Health, Public Health Seattle & King County, and the Mountain West AIDS and Education and Training Center Program (MWAETC). The tools featured within were developed, vetted, and produced by subject matter experts with technical expertise in different components of HIV/STI and PrEP delivery. This toolkit is divided into six competency areas. These areas were part of activities conducted within the Pharmacy Integration into PrEP and ART Provision and Retention (PIPAR) demonstration project, funded by the Centers for Disease Control and Prevention (CDC-RFA-PS18-1802).

• Purpose: To expand capacity of pharmacists to initiate and manage PrEP Pharmacy Programs.
• Audience: Washington state pharmacists and pharmacy administrative/program support.
• How to Use: The toolkit is presented within six key competency areas. We have included a suggested order for completing each competency area; however, you can navigate through according to your learning style.

 Toolkit Competency Areas

1. Prepare Your Pharmacy for a PrEP Program

How do I get started?

  Video: Pharmacy-Based HIV Prevention (PrEP) and Sexual Health Care: Getting Started

This competency area will provide you with foundational knowledge, tools, and resources to start your journey toward competency in Pharmacy-based PrEP delivery. After completing this section, you will have the context needed to continue through this toolkit.

 Objectives

After completing this competency area, you will be able to:

• Describe existing scope of pharmacists in Washington State

• Identify and build your own process workflows, intake forms, and other tools

 Estimated Time to Complete: 2-4 weeks

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A PrEP pharmacy program brings with it many new process workflows, for managing intake, assessment, testing/labs, referrals, and reporting. After accessing these tools, you will understand what workflow and parameters to consider, what your testing options are, and how to manage test results, reports, and referral processes. Finally, you will be able to build your own workflows, processes, and tools for your PrEP pharmacy program.

• Identify workflow and setting considerations, testing options and understand how to manage results
• The Emerging Role of Pharmacies in Expanding Access to PrEP
• Get your MA-Phlebotomy Certification!
• Review template intake forms and workflows. Adapt based upon the needs of your program.
• Watch & Learn: “Pharmacy-Based HIV Prevention (PrEP) and Sexual Health Care: Getting Started”

Describe existing scope of pharmacists in Washington State

Pharmacists in Washington state have a defined scope within the state. It is important to understand what duties and roles pharmacists can fulfill as part of their existing scope and what duties should be included within a Collaborative Drug Therapy Agreement (CDTA). The resources below are useful in understanding the existing scope of pharmacists in Washington state.

• Understand pharmacist’s professional responsibilities
• Learn about pharmacist’s scope in monitoring drug therapy in the absence of a CDTA
• Professional Standards

2. Obtain Prescriptive and Service Delivery Authority with a Clinician

How can I initiate a Collaborative Drug Therapy Agreement (CDTA) for my PrEP pharmacy program? 

  Video: Pharmacists can do more...but where do we start?

Now that you have a full understanding of what components are required to start your program, it’s time to get to work on developing one of the most essential parts of the PrEP pharmacy program: establishing a Collaborative Drug Therapy Agreement, (CDTA).

 Objectives

After completing this competency area, you will have: 

• Created the CDTA for your PrEP pharmacy program.

 Estimated Time To Complete: 3-4 weeks

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Create the CDTA for your PrEP pharmacy program

Understanding the requirements and process for engaging a CDTA are essential steps in developing and signing the CDTA for your PrEP pharmacy program. The CDTA is the set of written guidelines or protocols that establish the scope of prescriptive authority for you or your pharmacists. When prescribing under a CDTA, a pharmacist is exercising their own prescriptive authority. The information and templates below will help inform and guide this process for your program.

• Understand the requirements, eligibility, roles and scope for pharmacists and authorized prescribers entering into CDTAs.
• Write your own CDTA!
• Learn about the major components of a CDTA, what is required, and how to enter into one.

 Go to the Academy!

Ready to deepen your knowledge? The following resources and information are for you!

• Review the practice and scope of pharmacy under a CDTA.
• Learn about the pharmacist’s scope in monitoring drug therapy in the absence of a CDTA. 
• Watch and learn: Pharmacists Can Do More But Where Do We Start?

3. Apply Best Practices for HIV/STI Clinical Care

What clinical training and education are needed for me to run my PrEP pharmacy program? 

 Video: Essential training for pharmacist running a PrEP Program

Now that you understand what is required to run a PrEP pharmacy program and have developed the first draft of your CDTA, it is important to complete (or ensure your pharmacy staff complete) essential training in the clinical and public health aspects of running the program. After completing this section, you will have established a training plan for your program that will ensure your pharmacists have the knowledge, training, and confidence to conduct all aspects within the CDTA and clinical protocol.

 Objectives

After completing this competency area, you will have:

• A knowledge base on what the best clinical practices and recommendations are for running a PrEP pharmacy program.

 Estimated Time To Complete: 3-4 weeks

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Obtaining a knowledge base on what the best clinical practices and recommendations are for running a PrEP pharmacy program

While pharmacists are knowledgeable and very competent healthcare providers, they still require specialized training and education in the clinical components of running a HIV/STI and PrEP program. The educational and training resources below will help pharmacists build the knowledge base and confidence to manage clinical procedures within their PrEP program.

• Study & Learn: The 2021 CDC Clinical Practice Guidelines for HIV and PrEP.
• Review: National HIV Curriculum (University of Washington)
• Watch & Learn: Essential training for pharmacist running a PrEP Program prescribers entering into CDTAs.

 Go to the Academy!

Ready to deepen your knowledge? The following resources and information are for you!

• Watch & Learn: Pharmacy-based HIV Prevention and Sexual Health
• Study:  The 2021 CDC PrEP Clinical Practice Guidelines. Clinical Provider’s Supplement
   

4. Support PrEP Patients

How can I support retention and adherence for my PrEP patients?   

  Video: PrEP Navigation, Your Patients, and You

You have now established your CDTA, training, and other needed tools to support your program; but you may be wondering how you will manage retention and adherence issues for a new patient population. After completing this section, you will have established referral processes and plan with a local community-based organization that can help support your patients.

 Objectives

After completing this competency area, you will have:

• A connection to a local community-based organization that can support your patients with Sexual Health Navigation Services.
• Developed a referral process and plan with your Sexual Health Navigator(s).

 Estimated Time To Complete: 4-6 weeks

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Establishing a connection to a local community-based organization that can support your patients with Sexual Health Navigation Services

Sexual Health Navigators serve patients and providers throughout Washington State. Find your local agency and connect with a navigator to develop information materials that you and your pharmacists can use to educate patients about Sexual Health Navigation services available to them.

• Connect with a PrEP Navigation Agency Now!

Develop a referral process and plan with your Sexual Health Navigator(s)

Develop release and referral tools and process to facilitate linkages between your new PrEP patient population and the Sexual Health Navigators in your region. 

• Adapt release and referral tools to link patients to Sexual Health Navigators.

 Go to the Academy!

Ready to deepen your knowledge? The following resources and information are for you!

• Learn More about PrEP Navigators: Protocol (guidance) on providing PrEP navigation services for agencies contracted with DOH 
• Learn more about how PrEP Navigators can help promote retention and adherence at your PrEP program. 
• Watch & Learn: “PrEP Navigation, Your Patients, and You” 

5. Secure Revenue for PrEP

How can I get reimbursed for medical services?

  Video: Pharmacists can do more...but where do we start?

  Video: Talking Medicaid Managed Care Contracts and Billing with Molina Healthcare of Washingtons?

  Video: How Pharmacies Can Benefit from PrEP DAP in Washington

Now that you have a foundational understanding of what processes and considerations there are for developing a PrEP pharmacy program, have become competent in what the clinical guidance and recommendations are, and have identified resources to support PrEP patients, you are now ready to learn how to secure revenue and reimbursement for the new medical services you will be providing. 

 Objectives

After completing this competency area, you will be able to:

• Enter into provider agreements with private and public insurers
• Become an in-network provider with PrEP DAP
• Confidently code and bill for medical services

 Estimated Time To Complete: 4-6 months

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Enter into provider agreements with private and public insurers

The health insurance credentialing process can be daunting for all providers. For pharmacists who are new to credentialing with health insurance plans, successfully navigating this process requires additional guidance. The tools below will provide you with competency on the major steps required to complete the health insurance credentialing process as well as best practices and guidance for pharmacists. 

• Get credentialed with ProviderSource (OneHealthPort application) through ProviderSource
• Get credentialed with Apple Health (ProviderOne).

Become an in-network provider with PrEP DAP 

Washington State’s PrEP Drug Assistance Program (PrEP DAP) can be a valuable resource for pharmacists seeking to expand their services to populations at most need while still securing revenue for PrEP and PrEP-related services. Learn more about the process for becoming an in-network provider with PrEP DAP’s Early Intervention Program (EIP), what services are covered, and what patient-facing resources you can provide to patients interested in enrolling in PrEP DAP.

• Watch & Learn: How Pharmacies Can Benefit from PrEP DAP in Washington
• Complete & Submit the PrEP DAP provider application, managed by the Early Intervention Program
• Understand what requirements there are for clients hoping to enroll in PrEP DAP
• Get your patients into PrEP DAP (client app)
• Understand what services PrEP DAP covers, what your roles/duties are as a provider, and other important provider information.

Confidently code and bill for medical services

Medical coding and billing is new terrain for pharmacists. The training tool below is designed for pharmacists and will give you the confidence to code and bill for the new medical services offered within your PrEP program. 

• Start billing for medical services (access training). CE credit available. Training is offered at cost ($)

 Go To The Academy!

Ready to deepen your knowledge? The following resources and information are for you!

• Learn the process, as well as best practices, for applying to become an in-network provider with PrEP DAP. Learn about the services that pharmacists can bill PrEP DAP for.
• Understand how ESSB 5557 opens the door for pharmacists to be recognized as providers by Washington state payers
• Learn what the major steps within the health insurance credentialing process are for Washington state pharmacists.
• Learn about the process and best practices for pharmacists applying to managed Medicaid plan networks. Understand how to bill for medical services to managed Medicaid plans.  
• Identify the Managed Medicaid Plan(s) in your region. Prioritize credentialing with them.
• Watch & Learn: How Pharmacies Can Benefit from PrEP DAP in Washington
• Watch & Learn: “Pharmacists can do more...but where do we start?”
• Watch & Learn: “Talking Medicaid Managed Care Contracts and Billing with Molina Healthcare of Washington”

6. Receive Technical and Consultative Support

How do I access HIV/STI and PrEP clinical training, detailing, and more support?  

  Video: Resources for One-Stop Shop HIV and Sexual Health Services, Technical Assistance, and Capacity-Building

Now that you have a foundational understanding of what the processes and considerations are for developing a PrEP pharmacy program, have become competent in what the clinical guidance and recommendations are, have identified resources to support PrEP patients, and have learned how you can secure revenue for the new HIV/STI and PrEP services your program will provide, you are now ready to familiarize yourself with additional technical and consultative support for your program.

 Objectives

After completing this competency area, you will be able to:

• Access technical assistance and support through MWAETC’s Detailing program.
• Tap into local clinical consultation support and services through MWAETC’s ECHO program.
• Identify national clinical consultation services

 Estimated Time To Complete: 2-4 weeks

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Access technical assistance and support through MWAETC’s Detailing Program

As you learn new clinical skills and apply them in your program, you may require more customized support and technical assistance. The Mountain West AIDS and Education Training Center Program (MWAETC)’s Detailing program provides technical assistance and support customized to the needs of your pharmacy.

Note: Always include or counsel with your Authorized Prescriber about any clinical guidance or recommendations you may receive if it may impact your CDTA.  

• Connect with a MWAETC Detailer and get technical assistance tailored to your pharmacy.  
• Learn about other resources and tools offered through the MWAETC.
• Watch & Learn: “Resources for One-Stop Shop HIV and Sexual Health Services, Technical Assistance, and Capacity-Building”

Tap into local clinical consultation support and services through MWAETC’s ECHO Program 

Leading experts in HIV/STI, PrEP, and Infectious Disease regularly meet to consult on clinical cases and management. Pharmacists, new to the PrEP delivery service area, can learn more about clinical decision making from the local provider community.  

Note: Always include or counsel with your Authorized Prescriber about any clinical guidance or recommendations you learn of if it may impact your CDTA.   

• Join an MWAETC HIV ECHO session and receive clinical consultation services.
• Access recordings of previous MWAETC HIV ECHO sessions.

Identify national clinical consultation services  

Learn how to identify additional clinical consultative support through the National AETC’s Clinical Consultation Center. Learn from other HIV/STI, PrEP, and Infectious Disease clinicians across the country.

Note: Always include or counsel with your Authorized Prescriber about any clinical guidance or recommendations you learn of if it may impact your CDTA.   

• Learn about the National AETC Coordinating Resource Center resources.
• Access the National AETC Clinician Consultation Center

 Resources for Each Competency Area

1. Resources: Prepare your pharmacy for a PrEP program

Describe existing scope of pharmacists in Washington State

1. WAC 246-945-305 (Pharmacists Professional Responsibilities)

2. WAC 246-945-355 (Monitoring of Drug Therapy by Pharmacists)

3. WAC 246-945 (Professional Standards, Part 3)

Identify and build your own process workflows, intake forms, and other tools

4. Identify workflow and setting considerations, testing options and understand how to manage results (PDF)

4.a. Get your MA-Phlebotomy Certification! - WA DOH MA-Phlebotomy Certification Application/ Process

5. Identify the essential components to building a PrEP pharmacy program in Washington state (PDF)

6. Create your own intake forms and workflows. Adapt based upon the needs of your program. 

7. Watch and learn: “Pharmacy-Based HIV Prevention (PrEP) and Sexual Health Care: Getting Started”

2: Resources: Obtain prescriptive and service delivery authority with a clinician

8. Review the practice and scope of pharmacy under a CDTA.

9. Learn about the CDTA application process 

10. Understand the requirements, eligibility, roles and scope for pharmacists and authorized prescribers entering into CDTAs.

11. Write your own CDTA today!

12. Video: “Pharmacists can do more...but where do we start?”

13. Learn about the major components of a CDTA, what is required, and how to enter into one.

3. Resources: Apply best practices for HIV/STI clinical care

CDC 2021 Guidelines

14. Study: The CDC PrEP Guidelines (2021)

15. Review: the CDC PrEP Guidelines Provider Supplement (2021)

PIPAR Project Training Videos

16. Watch and learn: Essential training for pharmacist running a PrEP Program (5-part series covering clinical procedures pharmacists conduct within PrEP Program.)

UW’s National HIV Curriculum

17. Study and Learn: Clinical practice guidelines for HIV and PrEP. (National HIV Curriculum self-study module)

4. Resources: Support PrEP patients

18. Connect with a PrEP Navigation Agency Now! Information for PrEP navigation agencies contracted with DOH

19. Develop and Adapt: Release and Referral Tools and Processes with your Sexual Health Navigator(s)

20. Learn More about PrEP Navigators: Protocol (guidance) on providing PrEP navigation services for agencies contracted with DOH

21. Watch & Learn: “PrEP Navigation, Your Patients, and You” video

22. Learn more about how PrEP Navigators can help promote retention and adherence at your PrEP program.

5. Resources: Secure revenue for PrEP

Understand legislative framework/basis for pharmacists billing insurances in WA state

23. Understand how ESSB 5557 opens the door for pharmacists to be recognized as providers by Washington state payers

Enter into provider agreements with private and public insurers

24. Learn what the major steps within the health insurance credentialing process are for Washington state pharmacists.

25. Complete the OneHealthPort application through ProviderSource

26. Complete the Apple Health application through ProviderOne (guidance)

27. Identify the top Managed Medicaid Plan(s) in your region. Prioritize credentialing with them.

28. Watch & Learn: “Pharmacists can do more...but where do we start?” video

29. Learn about the health insurance credentialing process and considerations related to coding and billing. Slide series (PDF)

30. Watch & Learn: “Talking Medicaid Managed Care Contracts and Billing with Molina Healthcare of Washington” video

31. Learn about the process and best practices for pharmacists applying to managed Medicaid plan networks. Understand how to bill for medical services to managed Medicaid plans.

Become an in-network provider with PrEP DAP to bill for medical services

32. Complete & Submit the PrEP DAP provider application, managed by the Early Intervention Program 

33. Understand what services PrEP DAP covers, what your roles/duties are as a provider, and other important provider information.

34. Understand what requirements there are for clients hoping to enroll in PrEP DAP

35. Share the PrEP DAP application with your interested patients.

36. Watch & Learn: How Pharmacies Can Benefit from PrEP DAP in Washington

37. Learn the process, as well as best practices, for applying to become an in-network provider with PrEP DAP. Learn about the services that pharmacists can bill PrEP DAP for.

Confidently code and bill for medical services

38. Start billing for medical services ( access training). CE credit available. Training is offered at cost ($)

6. Resources: Receive technical and consultative support

Access technical assistance and support through MWAETC’s Detailing Program

39. Connect with a MWAETC Detailer and get technical assistance tailored to your pharmacy’s needs.

40. Learn about other resources and tools offered through the MWAETC

41. Watch & Learn: Resources for One-Stop Shop HIV and Sexual Health Services, Technical Assistance, and Capacity-Building

42. Learn about the resources, technical assistance, and educational tools with the MWAETC

Tap into local consultation services and support through MWAETC’s UW ECHO

43. Join an MWAETC HIV ECHO session and receive clinical consultation services

44. Access previously recorded MWAETC HIV ECHO sessions

Identify national clinical consultation services

45. Learn about the National AETC Coordinating Resource Center resources

46. Access the National AETC Clinician Consultation Center

 Training Videos

Seven Sessions

Session 1 (2/4/22): How Pharmacies can Benefit from PrEP DAP in Washington
(Presenter: Carri Comer, DOH OID)

Session 2 (3/4/22): PrEP Navigation, Your Patients and You
(Presenters: Michael Barnes (DOH OID) and Joseph Campbell (Cascade AIDS Project, CAP)) 

Session 3 (4/1/22): Mountain West AIDS Education and Training Center (MWAETC): One-Stop Shop HIV and Sexual Health Resources
(Presenters: Victor Ramirez and Sarah McDougal, MWAETC)

Session 4 (5/6/22): Pharmacists Can Do More...But Where Do We Start? Collaborative Drug Therapy Agreements and First Steps to Medical Billing
(Presenter: Mylinh Nguyen (Washington State Pharmacy Association, WSPA)

Session 5 (6/3/22)​​​​​​: Pharmacy-Based HIV Prevention (PrEP) and Sexual Health Care: Getting Started
(Presenters: Elyse Tung and Annalisa Thomas (Kelley-Ross Pharmacy)

Session 6 (8/5/22): Talking Medicaid Managed Care Contracts and Billing
(Presenters: June Smith and Kelsey Gratton, Molina)

Session 7 (9/9/22): PrEP Delivery Network Panel
(Panelists: TPCHD, PHSKC, Snohomish HD, Spokane HD, Yakima HD, AHF Pharmacy)