Academy Exchange

  • 1.  What are you seeing from the online PrEP programs like Nurx or Mistr?

    Posted 02-23-2021 15:43
    ​I'm curious if others have much experience bridging care for PrEP patients who have used Nurx, Mistr or other competitors to get PrEP online with home testing.  We have our own PrEP program (not with home testing) but sometimes our new patients come to us only after a clunky attempted start with those online services. Our pharmacy team has been a little puzzled as they often can't verify the online PrEP prescribers from these businesses.   

    Josh Rohr PA-C

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    Joshua Rohr
    Seattle WA
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  • 2.  RE: What are you seeing from the online PrEP programs like Nurx or Mistr?

    Posted 02-24-2021 15:13
    I've had some experiences with Mistr.  Would not recommend for a couple reasons.
    1. They don't treat the STI's they diagnos.
    2. The testing is expensive, and not always the best because patients do what is "cheapest"
    3. The telemedicine portion hasn't always been with a provider.  I've had patients complain that it's all text email, no provider face to face/telephone.
    4. They ship from out of state pharmacies, and at least 1 of the pharmacies they shipped from to Nevada, I can't find them as being licensed in Nevada, which is a Nevada board of pharmacy requirement.
    5. I've called the corporate office about these concerns, and they don't really care.  It's all about money.

    I think the concept is great, but the program thru Mistr isn't addressing the issue, risk!

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    John Phoenix
    Las Vegas NV
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  • 3.  RE: What are you seeing from the online PrEP programs like Nurx or Mistr?

    Posted 02-24-2021 16:17
    Thank you very much John for sharing the information, concerning Mistr.

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    Henry Bryant
    Pembroke Pines FL
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  • 4.  RE: What are you seeing from the online PrEP programs like Nurx or Mistr?

    Posted 02-25-2021 15:36
    I was not aware of points 1-3 but good to know, I strongly agree with your points 4 and 5, we are seeing the same.  They also advertise Descovy on their website and apparently all of the scripts we've received are Descovy only. When the pharmacy tech asked the Mistr customer service about Truvada first line, she said they just said a quick "no" and wouldn't put her in touch with their providers which of course raised red flags. 




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    Joshua Rohr
    Seattle WA
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  • 5.  RE: What are you seeing from the online PrEP programs like Nurx or Mistr?

    Posted 02-24-2021 16:56
    Agreed that this can be really challenging to figure out when patients last received PrEP and their last labs through NURX.  Unfortunately we have seen 1 patient who was getting his PrEP through NURX and showed up to us with HIV and M184V mutation.  It was unclear what follow-up he was getting from NURX and when he had last been tested or prescribed PrEP.  I want to be supportive of these programs to increase access for patients, but I am concerned for the same reasons as you!

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    Hillary Liss
    University of Washington
    Seattle WA
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  • 6.  RE: What are you seeing from the online PrEP programs like Nurx or Mistr?

    Posted 02-26-2021 12:51

    Not impressed.
    one patient came in with a paper stating he had syphilis. He was given 30 days of Descovy with no refills and needed a refill. I ordered an RPR and treated him. RPR turned out non-reactive, however, during the encounter I discussed just coming here for PrEP and it was a good thing because. The following week he developed diverticulitis, and I had to send him for a CT scan then put him on antibiotics. So needless to say, he is my primary care patient now.

    Another patient was put on Descovy and actually had HIV. He had been on Descovy for a couple of weeks before finding out he was positive.  That was a pretty sad ordeal. 

    There is something to be said about hands on care. It can't be replaced.

    Sorry



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    Amber Siegel
    Crew Health
    Oviedo FL
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  • 7.  RE: What are you seeing from the online PrEP programs like Nurx or Mistr?

    Posted 02-27-2021 01:50
    Wow, this is quite interesting- I only got to hear about this from my Descovy rep. He mentioned that there is a foreign Descovy in the market to be aware. I hope people will be more careful and I will have to discuss this with my patients to be aware. 

    Thanks

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    Lucy Efobi
    Linden NJ
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  • 8.  RE: What are you seeing from the online PrEP programs like Nurx or Mistr?

    Posted 02-27-2021 15:41
    I haven't heard about this until now! Maybe, it's a bogus company and should be investigated. Wow, thanks for all the information posted!


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    Vickie Cobb-Lucien, APRN, FNP-BC, AACRN
    Orlando, FL
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  • 9.  RE: What are you seeing from the online PrEP programs like Nurx or Mistr?

    Posted 03-03-2021 10:05

    Morning all. 

    I wanted to chime in. I am the Director of Clinical Operations for Nurx and I oversee our PrEP program. 

    I appreciate the concerns that you all have posted so I wanted to clarify our process. 

    All Nurx patients complete a health survey that is evaluated by a clinician. If appropriate a lab kit is sent to the home to test for HIV Hep B sAg creatinine syphilis and GC/CT of all three sites.  

    Once results are in and if HIV Hep B and creatinine are normal PrEP is prescribed. We prescribe generic Truvada unless there is a renal concern/risk and we move to Descovy. Although some insurances are still using Brand Truvada and Descovy as preferred. 

    If there is a positive, we treat if it is oral treatment. If injection is required we assist the patient  with getting linked to care. 


    if syphilis is positive we send to local
    lab for confirmation testing and titers. And then warm handoff  


    if we find an HIV positive patient we notify via phone and offer rapid start and confirmation labs. We have a case manager that helps to link to appropriate care and we stay connected until they are completely in care and on treatment.

    Our patients are tested every three months! 

    Medication  and labs are sent directly to their homes. 

    if you are ever having trouble getting records on a patient please let me know. 


    I am always happy to hear how we can improve so please feel free to reach out. 

    emily.rymland@nurx.co

    Josh, thanks for posting the question.  



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    Emily Rymland
    [Director of Clinical Operations Nurx
    [SF] [CA ]
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  • 10.  RE: What are you seeing from the online PrEP programs like Nurx or Mistr?

    Posted 03-03-2021 17:12
    Edited by Quinton Rasberry 03-03-2021 17:20
    Hello all,

    I am the CEO of a program called Q Care Plus.  Q Care Plus offers telemedicine services to patients through at-home testing and Community Based Organization partnerships.  While we understand the hands on approach, providers have to adapt to meet patients where they are.  Many times stigma still pays a major role in where and how patients access care.  Through at-home testing and virtual doctor appointments, Q Care Plus is able to see patients who may have never stepped foot in a clinics door. 

    Through partnerships with Community Based Organizations (CBO), Q Care Plus is able to offer 100% free services to patients including at-home comprehensive labs, virtual doctor appointments and case management.  Patients have direct access to their provider if they have any questions or need any additional resources.  Care is delivered directly to the patient using video consults, phone consults and questionnaires.  Medications are delivered directly to the patient's door through specialty pharmacy partners.

    Q Care Plus's provider team are all AAHIV certified providers.  If a patient does test positive or has an abnormal lab, the patient is linked into care at a primary care facility or at the CBO.  If a patient test positive for an STI, Q Care Plus providers can provide care through prescription medication and/or link the patient directly to a provider who can administer treatment.  

    Q Care Plus's provider protocols are written by HIV providers with 20+ years experience in providing care for HIV patients.  Protocols are reviewed and strict guidelines are followed between our provider team, pharmacy partners and CBO partners.  If there are any issues or outliers, these are addressed directly by our Medical Director and Senior Medical Advisor.

    When it comes time for follow-up visits, these visits are completed virtually.  The patient doesn't need plan out their schedules 3 month in advance.  Our patient navigation team works very closely with the patient to ensure they have coverage for their medication, have their labs complete and are comfortable with their prevention strategy.  

    In today's age we have to continue to improve the way we reach patients.  By using technology, marketing and outreach, we are able to make an impact and increase access to care for many patients. 

    Q Care Plus also adheres by all Corporate Practice of Medicine laws for the states that they currently operate in.  Provider licenses are on file and are all in excellent standing with all Boards of Medicine and Boards of Nursing. 

    I'd be happy to answer any questions anyone may have directly.  My email is qrasberry@qcareplus.com

    Thank you, 

    Quinton Rasberry.

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    Quinton Rasberry
    Atlanta GA
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