Experiences to date with the logistical management of long-acting cabotegravir and rilpivirine

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The logistical management of an injectable therapy for the treatment of HIV can be expensive, time consuming, frustrating and riddled with barriers. In this Commentary, we describe our experiences to date with acquiring, storing, handling, administering and billing for long-acting cabotegravir and rilpivirine through four scenarios, each of which have presented their own unique obstacles and learning curves. At the time of writing, we have successfully transitioned four patients from the CUSTOMIZE trial to long-acting cabotegravir and rilpivirine. In doing so, we encountered a variety of barriers to acquiring, handling and administering the medication for both insured and uninsured patients; it is expensive, on a limited number of insurance formularies, and often requires a prior authorization from the provider. Cold-chain handling of the injectable therapy, along with individual patient characteristics, present barriers to management and administration of this therapy. Whilst a seemingly very attractive option for the treatment of HIV-1 infection in adults, long-acting cabotegravir and rilpivirine present a variety of challenges to pharmacists, providers and clinic staff on how to obtain it for and administer it to the patient. We plan to continue documenting our experiences, progress and successes, or lack thereof, in order to fine-tune our process and share with others.

Keywords: antiretroviral agents, antiretroviral therapy, clinical management, highly active, HIV, long-acting antiretroviral, practice management.

Citation: Johnson K, Sawkin MT. Experiences to date with the logistical management of long-acting cabotegravir and rilpivirine. Drugs Context. 2022;11:2021-9-2. https://doi.org/10.7573/dic.2021-9-2

Contributions: All authors contributed equally to the preparation of this manuscript. All named authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship for this article, take responsibility for the integrity of the work as a whole and have given their approval for this version to be published.

Disclosure and potential conflicts of interest: KJ reports personal fees from Janssen Pharmaceuticals, outside the submitted work. MS will be serving on a ViiV Post-CROI Advisory Board from January 2022. The International Committee of Medical Journal Editors (ICMJE) Potential Conflicts of Interests form for the authors is available for download at: https://www.drugsincontext.com/wp-content/uploads/2022/01/dic.2021-9-2-COI.pdf

Acknowledgements: None.

Funding declaration: There was no funding associated with the preparation of this article.

Copyright: Copyright © 2022 Johnson K, Sawkin MT. Published by Drugs in Context under Creative Commons License Deed CC BY NC ND 4.0 which allows anyone to copy, distribute and transmit the article provided it is properly attributed in the manner specified below. No commercial use without permission.

Correct attribution: Copyright © 2022 Johnson K, Sawkin MT. https://doi.org/10.7573/dic.2021-9-2. Published by Drugs in Context under Creative Commons License Deed CC BY NC ND 4.0.

Article URL: https://www.drugsincontext.com/experiences-to-date-with-the-logistical-management-of-long-acting-cabotegravir-and-rilpivirine

Correspondence: Mark T Sawkin, University of Missouri – Kansas City School of Pharmacy and Clinical Pharmacist, KC CARE Health Center, Kansas City, MO, USA. Email: sawkinm@umkc.edu

Provenance: Invited; externally peer reviewed.

Submitted: 22 September 2021; Accepted: 17 January 2022; Publication date: 1 March 2022.

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