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Sustainable LA ART and LA PrEP
Keeping LA ART and LA PrEP on Track: Specialty Pharmacy Tips

Released: July 15, 2026

Sheila Montalvo
Sheila Montalvo, PharmD, CPh, BCPS, AAHIVP
Activity Information

Activity

Key Takeaways
  • Successful LA ART and LA PrEP programs depend on pharmacy workflows that identify access, scheduling, and insurance barriers before they interrupt therapy.
  • Pharmacists should educate and engage patients from the start: Set clear expectations about injection windows, emphasize the importance of keeping appointments, and ensure patients know who to contact when problems arise to promote adherence and minimize treatment interruptions.

Long-acting (LA) antiretroviral therapy (ART) and pre-exposure prophylaxis (PrEP) are changing the way we think about adherence support for our patients. With oral regimens, adherence largely happens outside the clinic once the prescription is issued and often discovered months later during laboratory follow-up. With LA injectable therapy, the clinic and pharmacy team need to become much more directly involved in making sure patients can receive each dose on time. For us, building a sustainable program meant looking beyond the clinical decision to start therapy and creating a process that could support patients month after month.

Tip 1: Create Workflows That Support Adherence
In the beginning, we thought the biggest challenge with LA ART and PrEP was going to be the clinical component, determining whether patients met the criteria to start LA therapy. However, we found that coordinating injection appointments was much more complicated. To streamline this process, we created teams to help navigate those processes and best support patient adherence.

Today, our process begins before therapy is initiated. A pharmacist meets with each patient to provide comprehensive counseling about their LA ART or PrEP, explain what to expect, and review how the medication will be obtained through their insurance. Once the patient decides to move forward, a patient care representative schedules injection appointments, often up to a year in advance, and reviews the patient's target injection windows so expectations are clear from the outset.

From there, the pharmacy team reviews upcoming injections each month. Approximately a week before the scheduled appointment, they verify benefits, resolve any insurance issues, adjudicate claims, and coordinate medication delivery. Having a dedicated team responsible for each step has been essential to creating a sustainable program.

This workflow has allowed us to maintain on-time dosing for patients receiving both LA ART and LA PrEP.

Tip 2: Educate Patients for Adherence Success
I believe our active participation in patient education is a major contributor to our successes with adherence to LA ART and PrEP. Specifically, we make sure one of our pharmacists within the specialty pharmacy or clinic dedicates time to patient education. This allows us to dive deeper into patient questions and nuances that they may not have time to discuss with their primary care provider. We review what patients can expect before each injection, including how the medication is dispensed, how it's administered, potential adverse effects, and any insurance considerations that could affect access.

The most important conversation, however, is about staying within the recommended injection window. We explain why timing matters and discuss what happens if an injection is delayed or therapy needs to be interrupted. For patients receiving LA ART, that includes when temporary oral ART may be needed to maintain viral suppression and reduce the risk of resistance. For patients receiving LA PrEP, we also reinforce the importance of required HIV testing before starting therapy, before every injection, and after discontinuation.

By having these conversations early, patients know what to expect and understand exactly what to do if something changes.

Tip 3: Address Insurance Barriers Before They Interrupt Therapy
In addition to educating patients about their medication, we also want to make sure that they understand their insurance. One of the most important things we emphasize is that they should notify us immediately if their insurance changes. This allows us to start the prior authorization process as soon as possible. If an appeal is needed, prompt notification enables us to work through those requirements with the pharmacy before the patient experiences any interruption in therapy.

Working proactively is essential. Rather than waiting until a patient is due for their injection, our specialty pharmacy team begins test claims, billing checks, and benefits verification 1-2 weeks in advance. This gives us time to identify and address potential barriers, such as insurance changes, lapsed authorization, or the need for a new prior authorization. We also closely track prior authorization approval and expiration dates, so we can begin the renewal process well before coverage expires, helping ensure patients receive their medication on schedule.

It is equally important to have a backup plan. We always discuss with each patient what we will do if we are unable to perform their next injection on time. That may mean temporarily using a fully suppressive oral ART regimen for a patient receiving LA ART, or using an appropriate oral PrEP strategy for a patient receiving LA PrEP, depending on the product, timing, and clinical situation. Having these conversations in advance helps ensure that there is a plan in place for unexpected challenges.

Tip 4: Start Small, Then Scale
For clinics that are just beginning to offer LA ART or PrEP, I would say start small to test the full pharmacy workflow. Start with a handful of patients, and see how the process works. You will quickly identify internal and external barriers. Starting small allowed us to identify our needs and helped us build a scalable process. Today, several hundred patients are receiving long-acting agents, but because we invested in the right team and workflows, the process is just as manageable as when we started with only 1 or 2 patients. 

Tip 5: Know Your Assistance Programs
Another critical component is staying current with available patient support resources, including copay assistance, patient assistance programs (PAPs), bridge programs, state AIDS Drug Assistance Programs, Ryan White resources, and local case management support. We keep track of these options so we can quickly connect patients with the support they need. When patients experience gaps in coverage, we enroll them in assistance programs whenever possible. If they encounter copay coverage issues, we help them navigate manufacturer assistance, PAPs, or state AIDS Drug Assistance Programs. We also work with case management through Ryan White Part A to address insurance barriers and ensure injection appointments remain covered.

Tip 6: Ask for Help!
My last piece of advice is to adopt a holistic approach and do not hesitate to ask for help. Other specialty pharmacies have people who are knowledgeable, and learning how to leverage their expertise will set you up for success. Building partnerships can make a tremendous difference in ensuring patients receive their medications on time and without unnecessary delays.

Your Thoughts
Which of the strategies described in this commentary might you try to successfully implement and sustain a LA ART or PrEP program? Leave a comment to join the discussion!