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NVHR Pharmacy Working Group
NVHR created the Pharmacy Working Group to focus on the role of pharmacies and pharmacists to help expand awareness, screening, vaccination, linkage to care, and treatment for hepatitis B and C.
Notes from Working Group call on 2/10/17 here.
Notes from Working Group call on 9/12/16 here.
Notes from Working Group call on 7/11/16 here.
Notes from Working Group call on 12/11/15 here.
If you would like to join the Pharmacy Working Group, email Tina Broder, NVHR's Program Director, at firstname.lastname@example.org.
Research Articles from Partners
Hepatitis C Point-of-Care Screening in Retail Pharmacies in the United States
The authors conducted a screening program in retail pharmacies and calculated the percentages of anti-HCV-positive individuals and how many subsequently entered a pathway to care. These results provide evidence in support of point-of-care HCV screening in retail pharmacies for at-risk individuals in the United States.
Hepatitis C Antibody Screening in a Retail Pharmacy Setting: Local Testing and Linkage to Care via an HCV Management Specialist
This study aimed to identify the prevalence of HCV AB+ using birth cohort and high risk factors in individuals screened at retail pharmacies and to link HCV AB+ individuals with a pathway to care. They found that the overall prevalence with pharmacy customers was higher than predicted with 9.2% (46/502) individuals testing HCV AB+. However, there still remain barriers to care for infected individuals even with the assistance of a dedicated HCV Management Specialist.
Hepatitis C Testing Now at CVS Minute Clinics
In partnership with the Hawaii Department of Health, all CVS Minute Clinics at select Longs Drug Stores on Oahu offer a “Prevent Liver Cancer: Get Checked for Hepatitis” assessment form at the pharmacy counter hepatitis C antibody testing. This preventive health service is fully covered by most insurance plans with no out-of-pocket costs for members.
The Role of Pharmacists in Viral Hepatitis
The “The Action Plan for the Prevention, Care & Treatment of Viral Hepatitis 2014-2016,” prepared by U.S. Department of Health and Human Services (HHS) identified pharmacists as key stakeholders in the continuum of care of those living with viral hepatitis. According to CDC, pharmacists can reduce fragmentation of care, lower health care costs, and improve patient health outcomes. There are many opportunities for pharmacists beyond the traditional role of dispensing and managing medications.
Screening & Testing
Pharmacists are able to support the screening efforts for viral hepatitis, and testing for hepatitis B and C in certain states. The role of pharmacists in testing is dictated by state and federal policies.
Key Policies & Terms
Clinical Laboratorial Improvement Amendment (CLIA): Established the Centers for Medicare and Medicaid Services (CMS) laboratory certification program, ensuring quality of all patient tests regardless of where they are performed. One can enroll in the CLIA program by contacting CMS.
CLIA Waiver: Waived tests are categorized as “simple laboratory examinations and procedures that have an insignificant risk of an erroneous result.” OraQuick® HCV Rapid Antibody Test are currently the only CLIA Waived tests for viral hepatitis.
Laboratory testing has federal oversight, but the CLIA and Occupational Safety and Heath Administration (OSHA) permit states to establish requirements that take precedence over federal standards. State laws vary greatly the areas they address and impact, such as defining the personnel who can draw blood for laboratory testing. Although most states accept the federal guidelines, some have regulations that prevent pharmacists from providing laboratory services.
Linkage to Care & Treatment
Pharmacists often interface with patients more frequently, and are well situated to support patients in linkage to care from vaccination to curative treatments. Pharmacists are able to support medical providers through the use of collaborative practice agreements (CPAs). States regulate pharmacies through “scope of practice” laws. Depending on the state, CPAs can be utilized to create formal relationships between pharmacists and medical provides that allow for expanded services the pharmacist can provide to patients and the healthcare team.
Pharmacists working in the context of a defined protocol are permitted to execute some of the following services: assessing patients; ordering laboratory tests; administering drugs; and selecting, initiating, monitoring, continuing, and adjusting drug regimens.
Examples from NVHR Partners:
Asian Pacific Health Foundation collaborated with UC San Diego Skraggs School of Pharmacy and Pharmaceutical Sciences, CDC and other prevention partners for “Hepatitis Free San Diego.” They provided Hepatitis B screenings at community-based events. Learn more about APHF's work here.
The Hawaii Department of Health (HDOH) partnered with local pharmacies to increase hepatitis B vaccination rates among contacts of persons living with chronic hepatitis B. This partnership enabled greater follow-up capacity, referring susceptible HBV contacts to a hepatitis immunization clinic. Pharmacies agreed to waive the administration fees for hepatitis B immunization, which they were already in the practice of providing. The HDOH provided free hepatitis B vaccines for the uninsured from the HDOH. The outcomes of the project were mutually beneficial, as pharmacies enjoyed more customers and the state benefits from greater HBV vaccination coverage. Pharmacies also provided HBV testing and screenings. Pharmacies that did not have the capacity to provide testing provided risk assessment screenings and referrals to primary care.
Walgreens collaborated with Chronic Liver Disease Foundation (CLDF) to offer free hepatitis C (HCV) testing at more than 60 retail pharmacies in 12 major cities nationwide. Health care professionals will conduct testing and patient education at retail locations. Those who test positive will be linked to one of CLDF’s Hepatology Centers of Educational Expertise the nationwide. Details on the initiative can be found here.