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Michele Durham, Executive Director of BEAT AIDS, reflects on the organization's origins, her vision for the in-house pharmacy, and the experience of working with Alchemy as we mark the launch of Your Choice Pharmacy at BEAT AIDS.
Tell me about yourself and your path to BEAT AIDS?
I'm the Executive Director of BEAT AIDS, Black Effort Against the Threat of AIDS, here in San Antonio, Texas. I joined BEAT AIDS December of 1993.
I was at home raising my son when my brother, who was the program director at BEAT AIDS at the time, called and said, "Michele, will you please come and volunteer? We want to automate the accounting books for BEAT AIDS."
Once I became the accountant, one day I was cutting checks that were only for People Living with HIV. One of the checks was for my brother. That is how I found out that my brother was living with HIV. I was shocked, devastated and surprised. I confronted my brother, saying, "Why would you be living with HIV and not tell the family? Surely you know that we would all want to be here for you and be a support system."
Unfortunately, my brother turned out to be what we call triple diagnosed. He was diagnosed with HIV, but also with substance use disorder as well as mental health disorder because he suffered from massive depression. With those three diagnoses or comorbidities happening all at the same time, his needs were very unique and different than someone who may only have had one diagnosis.
When my brother worked hard to become clean and sober, unfortunately it was too late. He ended up getting cancer and passing away in 2003. But that's how I got started at BEAT AIDS. I've been there for 30 years as the Executive Director, and fell in love with the clients, the patients, and the work. I'm doing missionary work every single day for a paycheck, and I just don't think life gets any better.
Tell me more about the clinic and the patients you serve
BEAT AIDS opened our clinic for outpatient clinical care in 2018. At the time, BEAT AIDS had the only pediatrician in the region who specialized in HIV care. The San Antonio community really needed BEAT AIDS to be there for women, mothers, and babies living with HIV.
BEAT AIDS has the largest and longest-standing HIV prevention department, with over 15 employees dedicated to outreach and testing. We find between 45 and 75 people annually who are either newly diagnosed with HIV or have fallen through the cracks and need to get back to medical care. With our own clinic, we're able to walk folks straight across the hall from where they were tested into a clinic where they can see a medical professional and get on antiretroviral treatment immediately.
We have a "status neutral" approach where whether the person is diagnosed with HIV or they test negative, we can put them on the track to whichever clinical care they need.
The populations we find when we're looking for people living with HIV in the field happen to be primarily individuals who may not trust larger care systems, such as health departments or the government. They've got trust in our organization. It's more homelike, caring, smaller, not so intimidating. With that trust factor, we're able to bring in people and have them believe that they can live with HIV.
Prior to opening your in-house pharmacy, what was your experience like with contract pharmacies?
The experience with contract pharmacies is less intimate. Trying to get all the data and understand all the nuances can sometimes feel cumbersome or hard to do. With it coming in-house, it's great because it's our own data. From the administrative perspective from my desk, it feels a lot better, more transparent, and easier to navigate.
As for our patients, the trust is there. They're excited to be able to help BEAT AIDS acquire 340B savings and funds to provide services. The convenience is there to walk out of your clinical visit straight into the pharmacy window, just like we've seen for years in large hospital systems. Now you've got a one-stop shop with wraparound services. You don't have to go from building to building, use up gas, use up time. Everything you need is there.
What ultimately led you to decide to take the plunge to launch the in-house pharmacy?
Several spokes on the wheel had to come into play to make that final decision. The convenience for the clients is definitely one, but it also needed to make good business sense. We needed to see the forecast of the numbers, making sure that we wouldn't be at a negative income.
Having Alchemy as a partner who already has the expertise about acquiring licensing, getting insurances registered, interviewing and hiring a pharmacist was probably the biggest deciding factor. I didn't have to do all the research to figure out how to open the pharmacy. I just needed to trust the process and get my team and our board of directors on board so that we could move forward and make this work for all of us.
How did you decide to partner with Alchemy?
I met the Alchemy team at an exhibit at the 340B conference in Seattle, Washington in April 2023. We went to dinner, broke bread together, and talked about our families. They all had strong family values. You could tell they all had strong care of people and nonjudgmental attitudes. The values of the individuals I met that first day aligned with the values of BEAT AIDS.
It was easy. They told me that I was the first one to tell them yes that fast because if my gut says it's right, then I go with my gut. And my gut said it was right. It was a good fit. There weren't any red flags.
What has your experience been like working day in, day out with the Alchemy team?
The initial culture that I experienced seems to be a thread throughout the entire Alchemy organization.
Everyone is into customer service. All of the people seem genuine and committed. The pharmacist that came down from Colorado, Brian (Head of Pharmacy Operations) – I liked him so much that I asked him to come back for Christmas and be with us at our Christmas party. And he did. The reason I liked him so much was his humility.
There seems to be a certain degree of humbleness amongst the team, but at the same time, complete knowledge. Each person is truly an expert in their area. Will (Operations Manager) doesn't seem like he's ever seen a pharmacy that he couldn't open. Brian seems like he hasn't seen a compliance binder that he couldn't fill. Andy (Sr. Operations Manager) came down and didn't seem intimidated by the software, putting in the windows, the locks, nothing. It's like he totally knew his vision of where every item needed to go in that room.
As you look ahead over the next few years, what are your goals for BEAT AIDS?
I certainly want to see our pharmacy carefully net $1 million per year or more. I'd like to see our pharmacy go mobile – to be able to diagnose individuals in the field and give them medication from our RV mobile testing unit. I wouldn't mind seeing us expand beyond San Antonio into other cities within Texas and perhaps even other states.
I want to see every person who's living with HIV know their diagnosis. And every person who is living with HIV have the opportunity for viral suppression. I'd also like to see every person who may be at risk for contracting HIV get an opportunity to reduce risks and be able to stay without a diagnosis. That would be the dream come true.
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