Saving Lives: The Role of The Pharmacist in HIV

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In this episode, we talk with Dr Sally Rafie.

Dr. Sally Rafie

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What You Will Learn:

  • The changing role of the community pharmacist
  • The pharmacist’s Role in Women’s Health
  • Learn more about preconception care and The Pharmacist Clinic
  • Billing for pharmacy services and getting paid

About The Birth Control Pharmacist

The role of pharmacists in delivering contraceptive care is exploding!
Most pharmacists who will be providing contraceptive services are not experts in the field of family planning nor are they expected to be.

As pharmacists specializing in family planning, we’d like to support our colleagues in providing competent and evidence-based contraceptive care.

The Birth Control Pharmacist project provides education and training, implementation assistance, resources, and clinical updates to pharmacists prescribing contraception, as well as engaging in advocacy, research and policy efforts to expand the role of pharmacists in family planning.

We also maintain the Birth Control Pharmacies site and directory for people across the country to find a participating pharmacy where they can obtain contraception directly from a pharmacist.

About Dr. Rafie

Dr. Rafie graduated from the University of California San Francisco School of Pharmacy and is a Board-Certified Pharmacotherapy Specialist. She has trained and worked with Planned Parenthood, University of California San Diego Medical Center, University of California San Francisco, and San Francisco General Hospital.

Dr. Rafie is licensed as a Registered Pharmacist and Advanced Practice Pharmacist in California. She has also earned her Certified Menopause Practitioner credential from the North American Menopause Society.

Dr. Rafie is a Pharmacist Specialist at UC San Diego Health. She sees patients for contraception and more at the UC San Diego Health Women’s Health Services Clinic. Dr. Rafie founded The Pharmacists Clinic, the first pharmacist-run clinic in a community pharmacy, where she provides contraception and other clinical services.

She is an Assistant Clinical Professor of Health Sciences at the University of California San Diego Skaggs School of Pharmacy and Pharmaceutical Sciences where she teaches and trains pharmacy students about emergency contraception, youth-friendly pharmacy services, and hormonal contraception.

She helped develop the California statewide protocol for self-administered hormonal contraceptives adopted by the Board of Pharmacy. Dr. Rafie has a long record of research and advocacy in the field of reproductive health and has published in peer-reviewed medical journals.

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Transcription

Michelle
Hi, this is Michelle Sherman, president of Michelle Rex Pharmacist consulting services and the host of the conscious pharmacist podcast. Today. We are so excited to have the first guest ever on our podcast and I’m very happy that today’s guest is Dr Sally Rafie, a pharmacist specialist that UC San Diego and an expert in women’s health and reproductive services. Welcome to our show. Sally. Thank you so much for having me, Michelle. Oh my pleasure. My pleasure. Um, you know, as pharmacists here in California, we were all working so aggressively towards expanded services and expanded practices. Now that we recognize this healthcare providers. Um, so tell us about yourself and how you got into this role as, uh, the birth control pharmacist.

Sally
Sure. I actually wear a couple of different hats and I really like the diversity in the work that I do. Um, so my areas of expertise are actually in medication safety and women’s health. And with the women’s health role, I had really great opportunities to be able to practice in a variety of settings. Uh, so I do actually see patients in an academic outpatient ob Gyn clinic as well as in a community pharmacy practice. Um, both practice settings. You know, it’s a very different, uh, patient base that comes through. But the experiences are equally rewarding. Uh, and my work with birth control pharmacists really stemmed from having, you know, over a decade of experience with contraception and family planning and more and more states now really realizing the potential of pharmacists to play a direct role as providers of contraceptive services and, and wanting to support those folks in delivering those services.

Michelle
That’s, that’s fantastic. I mean, it’s so refreshing to have pharmacists who are like on the vanguard, right on the forefront of these changes in this, um, seismic shift we having in pharmacy. I mean we see such changing roles, especially like in community pharmacy where reimbursement rates or totally in the tank and you know, as healthcare providers we can provide so much more and actually effect like positive outcomes in our patients. Um, so can you tell us a little bit more about your pharmacist clinic in the community pharmacy setting and how, how does that actually work? Do you make appointments with the women? How do you get people to come to you in the, in, in the community pharmacy setting?

Sally
Yeah, I’m glad you asked because I do believe it’s quite a unique model that we have going. Um, so the pharmacist clinic is based inside of an independent community pharmacy that’s family owned and uh, I provide all of the clinical services, uh, for the pharmacy and it is appointment based. Uh, so I provide everything from contraception to immunization services, travel, um, lab tests and, and other clinical services there. Um, many of the patients who come to see me are already patients of the pharmacy, uh, but others are finding me online. Um, and coming in from really around around the city and sometimes around the county of San Diego.

Michelle
Oh, that’s, that’s fantastic. I mean, these services are, are, are so important and um, you know, as re as our role expands in, you know, both you and I are, I think we’re so fortunate to be in California, which, you know, as usual, California seems to be the state that’s on the forefront of so many of these services with their advanced practice license, um, that’s available now and everything. So being able to change our roles to this clinical role, even in a community pharmacy setting, I think our ultimate goal is to get paid for these services. So have you been successful in getting paid for these services up in [inaudible]?

Sally
So now, well, I would say that our ultimate goal is really reaching patients with our services. But in order to do that, of course we need to get paid. Certainly it’s a bit important part of the equation because you know, as much as we’d love to just, um, you know, provide volunteer services, you know, that’s of course not possible. Um, so my model varies. Um, we do collect, um, from insurance for, um, vaccine administration fees for example. Uh, but for most of the other services, unfortunately patients have to pay out of pocket because insurance companies don’t recognize pharmacists as providers largely, uh, that has changed here in California for a State Medicaid program, uh, which is called medical. Um, as of this year, uh, due to a law that was recently passed, uh, we are recognized as providers and will be paid for a limited list of services. Uh, and they’ve opened up enrollment for pharmacist. But as far as I know, my application and those of other pharmacists who’ve applied are still pending approval.

Michelle
Oh, thank you so much. Yes. I’ve, I’ve also applied for the m o r p through medical and um, it’s been like three months and they say it can take up to six months. So I think once, once we get that through, um, not only for the birth control services but for Naloxone and the vaccines, you know, to be able to bill for those services through a statewide program will be very beneficial, not only to the patients but to clearly to the pharmacy for increased revenue as well. And um, with SB one five, nine, the prep and pep build, that’s hopefully if, if that gets signed into law, would that’ll be added to that as well? Yeah,

Sally
that’s another indication. So with the Medicaid Insurance of course are probably least likely to be able to pay out of pocket. So we really need to be able to utilize their insurance and not have insurance limitations that discriminate on which types of providers patients can seek further services. Um, and generally speaking, most patients do have insurance now, whether it be a state or federal program or commercial insurance. And for example, birth control services are covered benefit for nearly all insurance plans and patients should be able to use their insurance if they choose select two, a pharmacist for their care rather than any other provider type.

Michelle
No, absolutely. And you know, as a pharmacist, as a provider, it’s just going to decrease the burden on the healthcare system. Um, you know, the shortage of physicians and ex-US, especially like in rural areas like across the country. So one of the questions I had today is how do you think we as pharmacists can, can empower women to make reproductive choices for themselves and to give them power of their own bodies? We, we see a lot of things on the news and legislation going through that, you know, seem to be taking some of those choices away. How can we as pharmacists make a difference in our very unfun unity’s?

Sally
Yeah, that’s a great question. I mean, as you said, women already have power over their own bodies and we just need to stop limiting their choices. Unfortunately, our society at times can be a bit paternalistic and really create a lot of barriers and hoops for patients to jump through. We’re really, they already have power over their own bodies. They know their own bodies best. And, uh, really we just want to facilitate access to, you know, medications that allow them to, um, keep themselves healthy and really be able to, to live the lives that they want to lead. Absolutely.

Michelle
I couldn’t agree more. So for, for all those, um, community pharmacists listening out there and those that own pharmacies who have been struggling with, um, the tsunami of reimbursement issues and you know, all these PBMs and insurance companies just wanting to take away from pharmacists and Dir fees and all those things. And when they look at the business plan and the, the, the clinical experience and they thinking of expanding the, their services into clinical services, just like you’ve described a birth control, um, travel medicine, vaccines, doing lab tests and all those things. Someone who’s thinking like, oh my God, where do I go from here? How would you recommend they start the, the road to, to navigating these clinical services? Where do they even start? How do they begin?

Sally
Uh, well, one good place to begin is by getting the necessary training to do those things, whether it be certificate programs, board certification, additional licensure, um, s the beginning, all of their ducks in a row, getting there, anything mean all of those things. Um, and then really trying to figure out what services are needed in their community. Um, so if they’re next door to a family planning clinic, perhaps birth control wouldn’t be the first service that they focus on. Uh, but they really have to look at their community and what the needs are and where they can make the most impact really and, and provide the most critical services. Um, and then looking at state specific protocols that they might be able to participate in. Like in California, we have protocols that allow us to directly provide, remember contraception, hormonal contraception, no blocks on our nicotine replacement rates or vaccines, uh, lab testing and, and other services.

Sally
So really utilizing statewide protocols. Whenever possible. We are very much turnkey. Uh, you will complete the required training and can go ahead and use the protocol basis route. Then the next day. Um, there’s also the opportunity to do coder practice agreements with local physicians to collaboratively take care of patients. And this can be used for potentially more calm [inaudible] move as an issue. First. We know we have lots of farmers to do wonderful job of managing, whether it be HIV, heart failure, hypertension, uh, but there’s also a large opportunity for us to provide some simple acute care services like a patient who may come in with pink eye or has strep throat or Flugel and some of these other kind of issues that might end up in an urgent care emergency department that’s truly not warranted and can be very well managed out of a community pharmacy.

Michelle
Oh yeah. And that’s fantastic because these services provided by us as community pharmacists would really ultimately decrease healthcare costs and limit the burden that’s placed on that, on the healthcare system overall. Or that’s, that’s really great information, um, that our listeners can absorb, um, that you provided. And I think, you know, community pharmacies around the country can create their own blueprint, can chart their own course with any of the services that they can go out and see that would be a value within their own specific community. So duplicating exactly what you’re doing in San Diego might not work exactly the same in the middle of Nebraska, but I think each pharmacist needs to assess the needs in their community and they can make such a significant, um, impact.

Sally
Yeah. And I think pharmacists are doing a really great job now actually sharing their expertise. We’ve been such, almost an untapped resource for so long and I think firms are starting to feel comfortable really, um, almost advertising all of their expertise so that their communities are aware of what they have to offer. And that’s so key because we need to raise awareness about how we can help.

Michelle
Exactly. Um, so out of all the services and everything that you provide, what is the most rewarding experience you’ve had in, in this field? So,

Sally
well, you know, I really enjoy providing all the services, but I, you know, of course the birth control services are nearest and dearest to my heart. I’m very passionate about reproductive rights and access to contraception. So it really is rewarding to be able to help patients with their contraception. Um, and, and at the women’s health needs, they, I get to do quite a bit of menopause care as well in my other clinic. And really, I just, I really enjoy helping people who feel like they’ve perhaps been, you know, dismissed by other providers or feel like their concerns haven’t been heard and, and really giving them more information about what’s going on with their box

Michelle
and, and that. Oh, then that is amazing. It is. So it’s so important. And, um, you know, I, I wanted to thank you for taking the time today. I’m out of your busy schedule and taking care of patients too to come on our podcast. And um, you know, I want to tell listeners if they have any questions, um, to be able to contact you. Um, on the sh on the show notes we’re going to put, um, a link to your website and your bio and everything. And um, is there any other way that you want people to reach you if they need to contact you?

Sally
Yeah, there’s, there’s a few different things. So if, if a pharmacist is in a state where they have a prescribing authority for contraception or dispensing per statewide protocol, we have a training programs could be able to provide that service so they can go to birth control pharmacist.com website to check out our training, uh, or if they’re opposed to providing this service. We’d love to make sure that they’re on the map of providers@birthcontrolpharmacies.com and that website is really intense. Did to um, create awareness on what’s the general community about pharmacist access to contraception and help people find a provider near them, a pharmacy where they can go and get direct access to birth control. Um, and then we’ve got Facebook [inaudible] is for both of those and an Instagram page for birth control pharmacies. And if folks are excited about this and maybe they don’t have the authority in their state yet, but they’d like to start championing something, we’d love to work with you on. We do a lot of that. So please do reach out. My email is sally@birthcontrolpharmacist.com or you can contact me through either website or on my linkedin as well.

Michelle
Fantastic. Or Sally, I want to thank you for this conversation and thank you for taking time out of your schedule to be, to be on the show today and I hope people listen and get empowered because we as pharmacists, we’ve got to be the change. Thank you so much Sally.

Sally
Thanks so much Michelle.