Ask AI
Back Back
Implementing Long Acting PrEP and ART
Overcoming the Activation Energy: Actionable Strategies for Implementing Long-Acting PrEP and ART

Released: June 02, 2026

Dakota Price
Dakota Price, MD
Activity Information

Activity

Progress
1
Course Completed
Continue
Key Takeaways
  • Direct, proactive communication between your clinic, specialty pharmacies, and patients is the foundation of sustainable long-acting injectable delivery; build dedicated lines of contact before you need them.
  • Start with 1 patient, map every friction point in that first cycle, and build a repeatable workflow before scaling.
  • Long-acting injectable acquisition can be simplified with buy and bill, where your institution purchases the medication and bills medical benefits for reimbursement.

Once I understood that long-acting (LA) pre-exposure prophylaxis (PrEP) and antiretroviral therapy (ART) could reach patients who simply cannot sustain daily oral adherence—whether due to housing instability, stigma, or pill aversion—my motivation to implement them shifted. Every one of these patients who becomes suppressed or protected from HIV acquisition represents real movement toward ending the HIV epidemic. The implementation curve is real, but manageable. Here's what I wish I had known going in.

Getting Started: Proactive Communication
Before anything else, find someone who has been through this before. A colleague at a nearby FQHC or Ryan White–funded site, a pharmacy representative, or a drug manufacturer contact can save you months of trial and error in a single conversation. If you don't have a direct contact, your regional AETC is a great source to start with.

I recommend starting with a single patient. Run the entire cycle—prior authorization, specialty pharmacy coordination, delivery, administration, billing—and document every friction point. What took longer than expected? Where did communication break down? Build your workflow from what you learn before scaling.

Two practical moves to make immediately: designate 1 staff member as your LA injectable point person, and identify a direct contact at your specialty pharmacy, a specific person your medical assistant can call by name. Getting off hold and reaching the right person directly made a measurable difference in our clinic.

Early Issues
Insurance navigation was our most complex challenge. Verify coverage at every visit, not just at enrollment. A patient's plan changing the week of their injection is a crisis you want to avoid. Get your prior authorization templates built upfront; most submissions are similar, and templates save real time. For uninsured or underinsured patients, manufacturer assistance programs are worth building into your workflow proactively.

Timing Is Everything
On-time dosing is nonnegotiable. LA PrEP and ART have defined injection windows and missing them is a clinical risk. Flag patients 2 weeks before their next injection, not 1. That buffer gives you time to confirm the appointment, verify insurance, and coordinate pharmacy delivery before things become a crisis. Many specialty pharmacies also require the patient to personally confirm before releasing the drug; communicate this expectation to patients at enrollment.

Buy and Bill
One important option to consider upfront is the buy-and-bill model. If you can bill through medical benefits, buy and bill collapses the coordination problem: medication is already in-house when the patient arrives. Start small, even 2 or 3 units, to seed your inventory. Note that drugs obtained through a specialty pharmacy must be billed through pharmacy benefits and are not eligible for buy and bill, so confirm the pathway with your billing team upfront.

LA injectables are the future. Getting comfortable prescribing and administering them now is worth the activation energy.

Your Thoughts
What further questions do you have about getting started with LA PrEP and ART? If you have already implemented LA PrEP or ART, what advice would you give to clinics just getting started? Leave a comment to join the discussion!

Continue