How a pharmacy aims to surmount barriers to LGBTQ+ care

In a metropolitan area where a CVS or a Walgreen’s is seemingly on every other corner, it might be hard to imagine communities without close access to a pharmacy.

But though often associated with rural areas, metro areas also have pharmacy “deserts.”

Geography might be only one factor that limits access to medications for some communities. 

Genoa Healthcare, a pharmacy company focused on behavioral health and complex, chronic conditions like HIV, partnered with the nonprofit The Center, which serves the LGBTQ+ community to expand affordable health care. The Genoa pharmacy at The Center had its grand opening at the end of April. 

The LGBTQ+ community faces barriers to accessing health care like stigma, discrimination, cost, HIV prevention and treatment, and violence which can worsen health outcomes.

Built inside The Center to address the area’s pharmacy desert – there is no other pharmacy within a half mile radius – the pharmacy specializes in HIV medication and prevention but can fulfill all the same duties as a larger chain pharmacy. It also services in the same building where many patients get their care at the Arlene Cooper Community Health Center on Maryland Parkway between Charleston and Fremont, making it easier to get their medication and stay on it. 

“There’s no pharmacy within walking distance, there’s no access to a pharmacist anywhere near where we are located, so that’s one thing,” said Leana Ramirez the chief clinical officer at the Center. 

“The other thing is that it just makes sense for patient care. You have the clinic and you have the pharmacy, you can give them everything they need and walk out completely enabled to take care of their health care,” Ramirez said. 

Pharmacy deserts are low-income communities that either have limited access to cars and are more than half a mile away from a pharmacy, or are more than a mile away from a pharmacy regardless of access to a car, according to research tying pharmacy access to health outcomes by the University of Illinois.

Pharmacy deserts in Nevada are nothing new, and were cited as a cause of inequalities in COVID-19 vaccination rates during the height of the pandemic, disproportionately impacting low-income and marginalized communities. 

“I had a Medicare patient who was recently diagnosed with HIV and his copay was $1,300 a month,” said Angie Gabriel, the pharmacist and site manager at Genoa Healthcare pharmacy at The Center. “That’s a lot of money for anyone. He was like, that’s all the money I have.”

Gabriel, currently the only person working at the pharmacy, also must dedicate time to help find grants, discounts, and alternative funding to help with the costs of co-pays.

She secured a $7,500 grant from Patient Advocate Foundation that covered five months of his prescriptions as he waited to be approved for the Nevada Ryan White program grant which pays for the full cost of co-pays as long as he is eligible, which happened Thursday morning. 

“It’s nothing, but it’s something, he’s newly diagnosed, he doesn’t know what to do and that’s something I wouldn’t have time to do if I worked at a regular retail pharmacy,” she said, noting that she feared the outcome if the grant hadn’t come through.

“He probably wouldn’t have gotten the prescription and the disease could have progressed to AIDs, right?” she said. “He’s an older gentleman and I don’t know how far along he was with HIV, but there are a lot of other co-morbidities and there are a lot of other things that could potentially happen, your immune system isn’t as great. A lot of bad things could have happened if he wasn’t started on antiretroviral (ART) medication right away.” 

A person living with HIV who starts antiretroviral therapy today will have the same life expectancy as an HIV-negative person of the same age and people who use Pre-Exposure Prophylaxis Prevention (PrEP), which reduces the risk of contracting HIV from sex by 99% and by injection drug use by 74%. 

In 2019, the most recent year for reliable data, Nevada ranked 5th in the U.S. for new HIV diagnoses, and Clark County was identified as one of the 48 priority jurisdictions in the U.S. targeted for Phase I of America’s Ending the HIV Epidemic (EHE) initiative. Since 2012, the county has continuously seen an increase in new HIV diagnoses as well as the number of people currently living with HIV, according to the 2021-2026 Clark County Ending the HIV Epidemic Plan. 

But the cost of medication can be a deterrent for those in need of care. “A lot of these HIV prescriptions are thousands of dollars,” Gabriel said. 

Nearly 14% of people with an HIV infection used a prescription drug cost-saving strategy like skipping doses, taking less medication, and delaying filling the prescription.  People who do not adhere to medication plans to save on costs are more likely to be hospitalized and less likey to be virally suppressed, according to a 2019 report by the Centers for Disease Control and Prevention. 

The integration of the pharmacy and the clinic model has a medication adherence rate – the portion of patients who stick to a medication regimen – of 91%, compared to the 50% medication adherence rate of traditional pharmacy models, Gabriel said. 

Medication adherence can have a larger impact on patient outcomes than the specific treatment, can affect the quality and length of life, and either exasperate or lower overall healthcare costs, with nonadherence accounting for up to 50% of treatment failures, nearly 125,000 deaths and a quarter of hospitalizations annually in the U.S., according to a 2018 report published in the peer-reviewed clinical journal U.S. Pharmacist. Cost, access, and time constraints between having the medication prescribed and ready to be picked up at a pharmacy can all impact the likelihood of medication adherence rate, Gabriel said. 

“The nice thing about here is that people receive care in the clinic and then they can come right here and get their prescriptions right after, so they’re more likely to be adherent to their prescriptions, on their prescriptions regularly,” Gabriel said.