Guidance for Vermont Pharmacists
Voucher for Post Exposure Prophylaxis (PEP)
Pursuant to Vermont State statute Title 13 § 3256, the Voucher for Post Exposure Prophylaxis is provided to victims of sexual assault who present to a medical facility for treatment and are subsequently prescribed medications to treat sexually transmitted infections. Including HIVPEP, antibiotics and antiemetics prescribed with HIV PEP.
(g) Upon request of the victim at any time after the commission of a crime involving a sexual act under subsection (b) of this section, the State shall provide any of the following services to the victim:
(1) counseling regarding human immunodeficiency virus (HIV);
(2) testing, which shall remain confidential unless otherwise provided by law, for HIV and other sexually transmitted diseases, including gonorrhea, herpes, chlamydia, and syphilis;
(3) counseling by a medically trained professional on the accuracy of the testing, and the risk of transmitting HIV and other sexually transmitted diseases to the victim as a result of the crime involving a sexual act; and
(4) prophylaxis treatment, crisis counseling, and support services.
(13 V.S.A. § 3256)
Processing the Voucher for Post Exposure Prophylaxis (PEP)
1. Accept the voucher from the patient; verify the provider section is completed.
2. Submit charges to insurance ONLY if the patient agrees. There may be a safety or confidentiality concern related to billing insurance. Reassure the patient that the voucher will cover any patient portion due after insurance. If the patient DOES NOT want insurance billed, Center for Crime Victim Services will be the primary payor.
3. Complete the pharmacy section on the Voucher.
4. Fill the prescription(s) and give it to the patient without a charge.
5. Mail or Fax the original or copy of voucher and medication receipt showing patient name, cost, and any insurance remittance advice to State of Vermont Center for Crime Victim Services.
6. Center for Crime Victim Services will process payment and the state will issue payment to the remittance address you provide on the voucher.
7. State of Vermont Center for Crime Victim Services Attn: SA Program, 58 South Main Street, Waterbury, VT 05676
Sexual Assault Program Phone: (802) 241-1250 x104 Fax (802) 241-1253
8. Do not send payment to the clinic addresses at the bottom of the Voucher. Clinic contact information is for patient information only.
You can access the voucher here.
If a patient discloses SA, how can the pharmacist best share information about the sexual assault nurse examiner(SANE) or Vermont Center for Crime Victim Services(VCCCVS)? If a patient discloses SA to the pharmacist, the pharmacist can recommend any or all of the following:
a. Advise the patient to contact the Vermont Network Against Domestic and Sexual Violence. An advocate will speak to the patient and advise them of their options. Vermont Network P.O. Box 405 Montpelier, VT 05601 phone 802-223-1302 email@example.com
b. Advise the patient to go to the emergency department and ask for a SANE. A SANE will meet with the patient and do as little or as much as the patient chooses. Anything from simply giving options to a full sexual assault forensic exam.
c. Report the assault to law enforcement. Law enforcement will take a report and inform the victim about a forensic exam at the hospital and the Victim Compensation Program at the VCCVS.
4. IMPORTANT- We are not a direct service provider. Vermont Center for Crime Victim Services does not come into play until the patient presents for care or reports to law enforcement. Once the patient does one of those two things, they are informed about VCCVS and we are able to open a claim for the victim. The victim is not eligible for payment of medications unless we have an open claim. If the pharmacist is receiving a voucher for the victim, that means the victim already presented for care and we would have an open claim.
5. Subsequent RX for HIV PEP- A scenario that came up recently was the patient presented the voucher to a pharmacy for 7 days of PEP. Insurance paid and we paid the copay due. Once the patient followed up with infectious disease they were given a prescription for the remaining PEP. This time they did not have a voucher and they were charged the copay. I’m working on making sure a voucher is given with subsequent prescriptions but I also wonder if there is a way for the pharmacists to flag a patient that was given HIV PEP so when they present with the remaining prescription the patient isn’t charged but instead the bill comes to VCCVS? Something to think about.