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Year Supply of ARTs

  • 1.  Year Supply of ARTs

    Posted 12-27-2021 23:09
    I had a patient request a year supply of their Biktarvy via their Mail Order pharmacy. I usually do 90 day supply as preferred by the insurance company and patient, but got the request for 90 days with 4 refills!

    The patient is stable and undetectable; considering maybe a 6 month supply. I am seeing the patient for HRT/Transgender therapy every 3 months, so I will still be seeing them likely. They have typically been consistent with care. 

    Does anyone have any patients they do 1 year or 6 months supply, or do you stick to 3 months no matter the patient. What are your exceptions?

    Elizabeth Horvath
    Avenue360 Health & Wellness
    Houston TX

  • 2.  RE: Year Supply of ARTs

    Posted 12-28-2021 15:12
    Hi Elizabeth,
    For me, it depends on the patient.  Patients who never miss an appointment and are consistent with labs, etc., I give 6 months of refills, and if needed, will extend that.  On the other hand, patients who are in need of labs, etc., I keep tighter control of the meds to make sure that patient stays engaged in care and not merely taking meds without appropriate STI screening, labs, etc.  I have some patients that I see every 6 months, so have no problem giving them enough meds to last until they, and perhaps with a little overlap.  

    Gary F. Spinner PA,MPH,AAHIVS
    Medical Director
    Ryan White HIV/AIDS Program
    Southwest Community Health Center
    Bridgeport, CT

  • 3.  RE: Year Supply of ARTs

    Posted 12-29-2021 18:26
    Our clinic cares for nearly 700 PLWH. I have maybe 5 that I see once a year. I see stable HIV no differently than stable HTN. As a Ryan White Clinic most of our patients are seen every 6 months and our most fragile patients may be seen monthly. As with everything in medicine it just depends on so many other factors.

    Sent from my iPad
    Stephen R Adams, MD

  • 4.  RE: Year Supply of ARTs

    Posted 12-29-2021 19:07
    I am surprised that the pts' insurances allow for 6 months - awesome.

    Sara Back
    North Central Bronx Hospital
    New York NY

  • 5.  RE: Year Supply of ARTs

    Posted 12-28-2021 16:20
    I think every 6 months is fine for stable pts; vl twice per year, cd4 once per year + other routine labs and sti checks.

    James Adams
    Rancho Mirage CA

  • 6.  RE: Year Supply of ARTs

    Posted 12-28-2021 16:27
    Every 6 months is fine

    Sent from my iPhone

  • 7.  RE: Year Supply of ARTs

    Posted 12-28-2021 16:54
    90 days supply with 3 refills to complete 1 year is very common practice in very stable patients. No prescription can go beyond 1 year. I doubt any insurance would approve 6 month or 1 year supply given to a patient in one fill of prescription.

    Talal Zraik
    Mableton GA

  • 8.  RE: Year Supply of ARTs

    Posted 12-28-2021 19:03
    Hi - I have never given anyone a year's worth - to be honest - it is even hard to get them a 90 day supply due to insurance issues.  The most I would give is 6 months if insurance would allow it and the pt was really adherent.

    I hope this helps.

    Best - Sara Back FNP

    Sara Back
    North Central Bronx Hospital
    New York NY

  • 9.  RE: Year Supply of ARTs

    Posted 12-28-2021 21:17
    For most folks I refill their meds six months at a time and see them twice a year. I have a few very trusted patients that I see once a year, and refill their meds a year at a time. I feel that if a patient has demonstrated adherence and ongoing viral suppression for years, that they deserve the privilege of having a longer leash. 


    Peter Shalit, MD, PhD, FACP, AAHIVS 
    Cabrini Tower, 901 Boren Ave Suite 850, Seattle, WA 98104 
    P 206-624-0688 F 206-624-2432  

  • 10.  RE: Year Supply of ARTs

    Posted 12-29-2021 15:28
    Agree with the general consensus of this thread as most of us have been doing 6 months visits for several years as the standard of car.
    Outliers are some of my long-term patients who were rather insistent that once a year (after many years and many clinic visits)
    was fine and I would usually acquiesce to this request. That being said as our aging patient accumulate co-morbidities I found that 
    a 30-minute visit every 6 months was not adequate time to address 4 or more clinical issues - so sometimes back to 3 months for a short follow up to discuss a single problem.

    Jeffrey Kirchner
    Lancaster PA

  • 11.  RE: Year Supply of ARTs

    Posted 12-30-2021 15:57
    Interesting discussion here.

    In my part of the world where the HIV/AIDS program is majorly donor funded (so we don't have to worry about insurance issues), 6months dispensing - MMD6 as its commonly called - is fast becoming the norm for all stable patients. For now our program does not allow beyond 6months. However, on a personal level, as most contributors have noted, I do believe if a patient has been on therapy for many years, is virally suppressed with excellent adherence, I see no reason why - in exceptional cases, of course - a years' supply cannot be considered. 

    Ekpen Amadasu