N.S. pharmacists to prescribe HIV prevention medication, but cost can still be a barrier

The province is continuing to work with pharmacists on how to prescribe an HIV prevention medication, but with no current plans to improve affordability, it could remain out of reach for some. 

Pre-exposure prophylaxis (PrEP) has been approved for use for eight years in Canada. The Nova Scotia College of Pharmacists approved assessing and prescribing PrEP as of July 1, according to the provincial Health Department. 

"We will be working with the Department of Health and Wellness over the next few months on funding for a number of clinical services within the pharmacists' scope of practice, including HIV PrEP,'' said Allison Bodnar, CEO of the Pharmacy Association of Nova Scotia. 

The move follows a six-month demonstration project led by Kyle Wilby, a Dalhousie University health researcher, that allowed pharmacists to prescribe the medication. The project last year consisted of 50 patients receiving care from 10 different pharmacy sites. 

Widespread rollout will take time

Wilby said enabling pharmacists to prescribe the medication will decrease the burden on primary care physicians, nurse practitioners and Sexual Health Nova Scotia

"We're extremely pleased by the reception we've gotten from pharmacists in [the] province who are curious about this expansion of their scope of practice and interested in implementing it," Wilby said in a news release Friday. "But given that it requires new actions and workflows, such as the requesting and analyzing [of] blood work, it will take a bit of time for the service to become widespread." 

Wilby expects the first prescriptions to be written in early fall. 

Nova Scotia Health and Wellness Minister Michelle Thompson said the department is working with the Pharmacy Association of Nova Scotia, Nova Scotia Health Authority and the Halifax Sexual Health Centre around how best to deliver services. 

"Anybody who feels they might be at risk can be prescribed the medication," said Chris Aucoin, executive director of the Health Equity Alliance of Nova Scotia.

"There's certainly key target demographic groups that are encouraged to explore that option, and anybody who's at high risk for HIV because of their sexual activity or perhaps their substance use would certainly fall into those categories." 

Aucoin said the organization, formerly known as the AIDS Coalition of Nova Scotia, oftepn hears frustrated comments about the difficulty of accessing testing for sexually transmitted infections —  which is part of the protocol for renewing a PrEP prescription every three months. 

"One of the, I guess, glimmers of light in that regard is that pharmacies are now exploring the possibility of becoming part of the followup for STI testing," he said.

Aucoin said Health Equality Alliance has provided thousands of at-home HIV tests directly to Nova Scotians. He said the organization is also participating in a research study with pharmacies on at-home gonorrhea and chlamydia testing.

"If that shows to be as fruitful as we expect it will and becomes part of the landscape, as will prescribing PrEP on its own at a pharmacy, we'll see sexual testing become connected to pharmacists." 

Cost a barrier for some

Aucoin said the cost can be prohibitive for those who are underinsured or don't qualify for public programs. Unlike some provinces where high-risk groups qualify for full coverage, he said PrEP could cost someone without coverage $200 a month. 

The medication is covered through the Family Pharmacare Program, and the province isn't currently looking at ways to make the medication more affordable, according to Thompson. 

"It's really frustrating when you know, there's a tool that works and the people who could benefit from the tool don't have it," said Aucoin. "If we had a national pharmacare program in Canada, PrEP would be already covered for everybody across the country."