Pharmacy sales may not seem like the most thrilling topic of conversation. But when it comes to saving lives and connecting with the community, the ability of AHF pharmacies to connect directly with patients and providers transforms— and saves— countless lives.
Pharmacies: Our Bridge to Communities
Why it’s about more than filling prescriptions
GUEST BIO:
Jose Ramos is the National Director of Sales for AHF.
Cindy Markarian is Senior Director of Pharmacy, overseeing the strategic response team nationwide.
CORE TOPICS + DETAILS:
[2:09] - More than Medication
The vital role of AHF pharmacies
Cindy speaks on how AHF pharmacies serve as more than just places to provide medication— they’re also AHF’s link to the community, where we can spread the word about all our services and what our pharmacies can provide.
[5:34] - The Power of Credibility
Face-to-face interactions grow trust
Jose Ramos says that providers want to see pharmacists face-to-face, and he’s seen how visiting with pharmacists encourages them to send prescriptions to AHF pharmacies. This is contrast to many big pharmacies, in which both patients and pharmacists are simply numbers in a machine. With AHF, patients feel they can call up and speak to a human being and ask questions.
[15:22] - Starting with Education
Honest conversations are essential
Jose talks openly and frankly about a lot of the ways that PrEP can help serve people who may not know it— or feel comfortable with it. But he says that “education is really where we need to start with a lot of this. There’s so much that’s still not talked about— even just starting with sex education.”
[20:57] - Helping Patients Live Full Lives
Beyond HIV treatment
Cindy stresses that people are now living longer than ever with HIV, and that has meant AHF pharmacies are expanding to serve the full range of health needs of patients. They’ve become experts on dealing with diabetes, even oncology, kidney failure, heart disease, and much more. They’re holistic services, and it’s important that more patients are aware of that. It’s about more than just HIV.
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ABOUT AFTER HOURS:
The AIDS Healthcare Foundation is the world’s largest HIV/AIDS service organization, operating in 45 countries globally. The mission? Providing cutting-edge medicine and advocacy for everyone, regardless of ability to pay.
The After Hours podcast is an official podcast of the AIDS Healthcare Foundation, in which host Lauren Hogan is joined by experts in a range of fields to educate, inform, and inspire listeners on topics that go far beyond medical information to cover leadership, creativity, and success.
Learn more at: https://www.aidshealth.org
ABOUT THE HOST:
Lauren Hogan is the Associate Director of Communications for the AIDS Healthcare Foundation, and has been working in a series of roles with the Foundation since 2016. She’s passionate about increasing the public visibility of AIDS, the Foundation's critical work, and how everyday people can help join the fight to make cutting-edge medicine, treatment, and support available for anyone who needs it.
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Lauren Hogan:
Get unfiltered lessons from our leaders at AHF, as we uncover real raw stories of where we came from and where we are going. Join us for an unscripted look at the connections our senior leadership have to our mission, core values, and hot initiatives. AHF is the world's largest HIV/AIDS service organization operating in 45 countries globally, 16 states domestically, including D.C. And Puerto Rico. Our mission is to provide cutting-edge medicine and advocacy, regardless of ability to pay. Hello and welcome to the After Hours Podcast. I'm your host, Lauren Hogan, serving as your liaison to take you through this journey to learn more about AIDS Healthcare Foundation.
Lauren Hogan:
Before we start the show, please make sure to remember to check out the show notes so you can follow along. Now, let's get started. Hello, everyone and welcome back to another episode of the After Hours Podcast. As always, I'm your host, Lauren Hogan. And today, we've got some very special guests with us. Please introduce yourselves, because I'm excited to have this conversation today. Jose?
Jose Ramos:
Yes. Hi, everyone. My name is Jose Ramos. I am the national director of sales. I've been with AHF 14 years. People don't realize that I've been here for a while, six years as a volunteer and now employee six years.
Cindy Markarian:
Hi, I'm Cindy Markarian. I am currently in the role of the senior director of pharmacy overseeing the strategic response team nationwide. It'll be 10 years this September that I've been with AHF, and I've been lucky to have multiple hats and have different roles.
Lauren Hogan:
I'm going to start with a very basic question, what is pharmacy sales?
Jose Ramos:
Ooh!
Lauren Hogan:
Very simple.
Jose Ramos:
I call it a sales team with a soul. We are connecting people to our pharmacy. Many people get confused. The moment they hear sales, they think we just out there selling the medications left and right. We do not do that. We link people to our pharmacy services. That's the sale.
Cindy Markarian:
What is pharmacy sales to me? I think it's our bridge to the community to really spread the word about all the wonderful services that our pharmacies provide. And that's really the basis of today's podcast.
Lauren Hogan:
You touched on something just now with your role. You said strategic response team. What does that entail?
Cindy Markarian:
Strategic response team is a group of outstanding pharmacists and technicians that are willing to go the extra mile day in and day out. They have taken multiple licenses, out of state licenses, so that they can travel and keep the pharmacies open. This was incredibly relevant and showed us how important it was during COVID when everybody was out sick for COVID. They keep the pharmacies open. And then while they're there, they also do any training that needs to happen, whether it's phlebotomy, HIV testing, or just as basic as understanding the workflow with the softwares that we use.
Lauren Hogan:
How do your two teams kind of work in tandem? I know we asked the question, what is pharmacy sales, but there's a lot of arms and legs to this it seems like. How do you guys integrate and work together?
Jose Ramos:
Our relationships work really well in a couple ways. Obviously the pharmacists, they're in location, right? We are not. On my team nationwide, we don't have offices. Yes, we might settle in some healthcare centers to support them, but we are supposed to be out in the field really talking to community members, doing events, talking about the services that we have in the pharmacy. If we bring out the awareness, we bring people back in and hopefully then Cindy and her team kicks in.
Cindy Markarian:
I mean, you're describing what we're doing and it just brings back so many events to mind, whether it's something like the holiday gifts for the community in East Los Angeles or testing or the vaccine explosion that happened in Hollywood not too long ago. I mean, we're there at a moment's notice just to help draw up the vials with PhD, wellness, the testers, and even the daddy issues, parties, and things like that. I don't know if that's outdated and we don't call it that anymore.
Jose Ramos:
Outside of really showcasing our services, we do join forces in our community. Sometimes the most impact that we have as a sales team is when we go somewhere and we have a pharmacist with us. Her team has allowed us to have a flexibility of pharmacy technicians around the United States that my team and I can say, "Hey, Cindy, we want to go talk to a provider. I need somebody to support me." As a sales team, yes, we are educated around HIV medication and prevention, but we don't know all the nitty-gritty pharmacy education that they do.
Jose Ramos:
It's a really great force to have a sales rep and a pharmacy or pharmacy technician show up to a clinic, to a partner and talk about our services because we compliment each other extremely well.
Cindy Markarian:
It could be as basic as facts versus myths about HIV. We'll do a little inservice and it makes, I think, the public feel a little bit better that we have this experience and knowledge base. And then at the end of some of these presentations, we'll give a certificate to any participants that attended. And it's fun. We make it fun.
Jose Ramos:
But it definitely does increase the credibility. I've been to those meetings where the providers because now they see a face with the pharmacist, they're like, okay, if you're the pharmacist, I'll send my prescriptions because I want the care for my patients to be one-on-one. And a lot of the big pharmacies out there, you don't get that. You're a number in a machine. Here, you're an individual where they can call the pharmacy. They can call the technician. That is that uniqueness and that small kind of mom-pop type of mentality really serve, especially when you deal with infectious disease medication and treatment.
Lauren Hogan:
I want to kind of touch on something that you guys both mentioned is the educational piece. That comes into my next question of, why do we need the SRT teams? I think that's kind of tied into the education piece.
Cindy Markarian:
I mean, there's never a shortage of crises as of late, it seems. There's constantly opportunities. I don't want to jump the gun and go forward too far, but what is the difference between an abortion medicine versus a preventative medicine? What's the step after birth control medication? We need people to clarify and really put it in layman's terms and be able to know the audience and educate people. Knowledge is power. Everybody knows that. But if people don't know where to go and what's available, all the services, everything we want to do at AHF is for nothing if we can't reach the audience.
Jose Ramos:
And then also for our clients, our patients, many of them have been taking the same medication for years, not knowing that we have newer medications with better side effects or hardly any side effects, right? I mean, Truvada as a first PrEP medication is not the same as a newer medication approved by the government for PrEP. A lot of people, they just get used to what they're just been taking for a while, not knowing that there are better choices for their health. That's where we come in, right?
Jose Ramos:
Not every individual is meant to take the same HIV medication. Hence, we have so many or different medications. There's a medication based on who you are, your bone density, your history, other conditions. Not everything fits all. I feel like within her team and mine, we kind of close the gap, but we try to educate them so that our patients make the right decision that works for them.
Cindy Markarian:
It shouldn't be a hard sell, right? There's two things. In my speech class, my teacher once told me, there's two things that everybody will listen to, one is money and the other one is health. AHF honestly deals with both of those things, whether it's providing services to the community that's included with all the other services like our calendar pack, our go pack, adherence packaging to help people remember when to take their medication.
Jose Ramos:
I want to go back to... I made kind of a funny comment, but I do want to explore a little bit more why I say it. I do say we're the sales team with a soul. When I first joined AHF, I had a hard time jumping into this role, because all of a sudden, my role and my likelihood and my salary, my bonus will depend a lot on new HIV patients or literally make money out of HIV. For me, I had to really look deep and say, "Why am I going to go into this role that literally I'm just selling?" But to your point, Cindy, I'm selling life. We're selling life for people, right? I'm not selling you something that is a luxury. That medication that we give you is either to keep you healthy or to make you live.
Jose Ramos:
That make me feel at ease. Unfortunately, HIV infection still happen. Unfortunately, the pharma industry is huge and it's just there for business and profit. But all those things are still happening. I'm like, who do you want to get the money out of it? CVS, Walgreens, they're great pharmacies, I'm sure, but we are a nonprofit. I also know that the money that comes in goes back out to the community. It helps pay for programs. It helps pay for testing, and it funds most of our program globally. That's why we have a soul. Yes, we sell, but we're selling life and we're helping prevent other people from dying.
Lauren Hogan:
I think that's beautiful, Jose. I also kind of want to go back because you mentioned Truvada and PrEP. I think there's a lot of misconceptions about AHF's feelings of PrEP due to a certain article. I won't mention, but we are actually the largest providers of PrEP to the community. Why is PrEP education so important?
Jose Ramos:
I agree with you. PrEP has been... I've been involved with AHF for 14 years. At the beginning when I started volunteering for AHF, our stance around PrEP were different, and rightfully so. It was a new drug. We didn't have all the data. We didn't have all of the qualitative information that we have now. AHF through the years, we were never against it. People think that we... How can we be against something that you and I don't have the authority? Our founder can't go and tell a doctor, "Don't give them this. Don't give them that." That is not a right. Even though people like to give us a lot of credit and that we are so powerful, we do not have power between a patient and a doctor and their relationship.
Jose Ramos:
We were never against it. We were skeptical, rightfully so. And as the data came strong supporting it, we changed our views. And now to your point, people always tell me that. I'm like, it's not true. Wow, how do you know? Because I run pharmacy and I can tell you, we prescribe every single day because we don't control that. It's the doctor and the patient. We've done it for seven years since I've been employed with AHF, and now we do it more and more and more. When people say that to me and they refer to the article that you're saying, 1990, who knows when, about what Michael Weinstein said, I'm like, "Do you have something else? Update your argument because this is old."
Cindy Markarian:
I'm going to use that little window when you said prescribed PrEP. Since SRT is a national team, one of our biggest challenges is how to navigate all the laws and regulations. In California, there was a law passed several years ago where a pharmacist can actually prescribe PrEP. That's another example of how knowledge is power. You can walk into any AHF pharmacy in California and get PrEP. We have it on hand. We understand how to navigate insurance billing. We have benefits counselors at our clinics, and we are the go-to. We should be the go-to.
Lauren Hogan:
Absolutely. Just want to debunk some things about PrEP, because we're talking about education here, is PrEP specifically for men or can women also take PrEP too?
Jose Ramos:
PrEP is for anyone who might consider themselves at high risk. High risk is whether you have a lot of partners, whether you don't like to use a condom, whether you do sex work, or you're queer of color who tend to have higher infection rates, right? If you're high risk, it doesn't matter who you are. But even if you're not as high risk, if you have sex once in a while and once in a while you drink a little too much and you don't want to have that in the back of your mind, this is also for you. It's really a self-awareness and education that regardless of your risk taking and what you do, because we don't shame at AHF, we encourage and support and just be exactly who you want to be.
Jose Ramos:
But there's a way for us to stop HIV and AIDS. And that's what my biggest frustration comes is, okay, I get it. If you don't want to use a condom, get it. If you want to have a lot of partners, good for you. But that doesn't mean you have to be HIV positive anymore. And that's where PrEP comes in. Whether you're female, trans, or male, straight or gay or non-binary, there's something for you.
Cindy Markarian:
The only thing that I wanted to mention was injection drug users. This doesn't even have to entail sexual activities. Let's say you want to plan a pregnancy, since that is kind of the topic we're talking about later on, and your partner is HIV positive and you'd like to take measures to prevent your unborn child from having born to have living with HIV. There's lots of... It's for everyone, to answer your question. The short version of that is yes, it's for everyone.
Jose Ramos:
But I do think that we're not doing a good job with females, right? And right now we're starting to see infection rates on women of color, especially Latino and Black in the United States. We're seeing a lot of that due to cultural issues with both. And then also for women to go and ask for PrEP, there's a stigma. "Oh wow! She's doing the..." No. There's a stigma around men, but now we've maneuvered through that. There's a lot of stigma around women and especially around women of color. Right now I'm going to San Diego this week and it happens a lot where a lot of females there become HIV positive who are married.
Jose Ramos:
You still have a lot of the men who culturally, for whatever reason, don't come out. They get married down low, and then they go and play on the side. A female doesn't know that they need to be using protection because they're married. That is one of the number one infections that we're seeing in females right now. Educating them about PrEP, I've had females who said, "I can't take it because it's unethical, or I'm not that kind of person," even though they know that the husband is cheating.
Cindy Markarian:
In kind of the same vein, education is really where we need to start with a lot of this. There's so much that's still not talked about even just starting with sex education, talking about sexuality and interests and lifestyle choices. You hear about deaths and it's worldwide. This is one of the reasons I absolutely love this organization. We are not just limited to California, where one of our main offices is, or South Florida. We're all over the world. It's the best kept secret, I think, because 10 years, I'm still telling people I work for AHF. It's AIDS Healthcare Foundation. I get silly with excitement and I turn into this ambassador.
Cindy Markarian:
I was shopping for space for my brother's med spa the other day. One of the realtors or construction guys was telling me that, "Oh, my daughter just graduated from UCLA with a public health degree with social work." I'm like, "Does she need a job?" I want to recruit people with the heart and the talent. People don't know about it. When I first started, there was no Indeed. There was no LinkedIn. I got a call from a head hunter and going, "What is this?" And it's been right under my nose this whole time, on Sunset and Vine, in front of Hollywood Hills, Greek Theatre. I mean, it's amazing.
Jose Ramos:
It's interesting you say that because I also until I started doing the nonprofit work, I didn't realize AHF existed either. When my best friend got diagnosed with HIV, it was in out of the closet, the original one on Sunset. That was the first time I got introduced to AHF, and it was on a Saturday. I'm like, who opens on a Saturday and give you a test for free and then links you to medication? That was my first interaction 15 years ago. And then after that, I've been using my knowledge to education, especially gay men in the United States. I think in the United States, there's a lot and there's a lot of privileges by being in this country as a whole. Outside the United States, I think we are celebrated and known a lot more than the United States and I've seen it firsthand.
Lauren Hogan:
Well, I think to your point too is that it seems like on a domestic front, there's not as much urgency around HIV and HIV prevention anymore as it is on the global front. But I kind of want to touch a little bit more on you guys' experiences, because we did have a conversation prior to starting the podcast about how you guys both used to work at the same company, funny enough, but on the pharmacy and sales side and kind of how the differences of experiences when it came to stigma and actually allowing people that come into your pharmacy to just receive their drugs without judgment. Can you talk a little bit about the differences in terms of the work experiences being that you were at a major company versus being here at AHF now?
Cindy Markarian:
I'd like to preface it with the statement that conflict is healthy. Take it away, Jose.
Jose Ramos:
I oversee pharmacies before I came in my previous job. I remember we did a lot of $4 generics, right? A lot of these pharmacies, they didn't have the same knowledge of what it's like to be either somebody living with HIV or trying to prevent HIV. There was definitely not a lot of education. I remember we had three people on HIV medication in one of my pharmacies and everybody wanted to get more of those prescriptions, but not because we wanted to help them, but because we wanted the money. There was a whole strategy back then of we need to get medications, prescriptions that highly cost for our bottom line. Nothing to do with community and nothing to do with...
Jose Ramos:
That was a big thing, right? It was a driver as a financial gain for stakeholders. When I came here... And also there was stigma. Depending who you are and the medications that you were using, if you were prescribed a control medication, I saw it firsthand where pharmacists wouldn't want to fill it. They will tell the patient, "Oh, we don't have it in stock. Oh, you know what? We're not going to get it in a long time." I remember thinking, that is not your role. You didn't get hired to be a moral compass of the community. You were hired to look at a prescription. And if the prescription is valid, you fill it without stigma, without comments, without judgment.
Jose Ramos:
I came to AHF and, I mean, we have amazing pharmacists where a lot of my friends, when they don't want to switch... A lot of people get their prescriptions in the same pharmacy for years. Now that they have loyalty, that's just the way it's been done. When I ask them, "Hey, you should transfer all of our money, 96 cents," they go back to groups like impulse, like flocks, like spark, Black. This is what we do with our money, loud, global services. Why would you give it to a for-profit where you can help your own community by just doing the same thing you do every day? And then lastly, if that doesn't get them engaged, because there's people who don't, they need a little more help, I'm like, well, do you take any other medications?
Jose Ramos:
And then I find out what they take. I'm like, "How was it you getting this medication in this pharmacy?" "Oh, well, they always give me a hard time." I'm like, "We don't judge at AHF. And it's not just about HIV. It's about full care. We will help you get everything that you need. As long as you say in care and everything's valid, we will not shame. We will not give you a hard time. We will give you what you need to be healthy." I think there's no stigma and the fact that we know. We don't judge people. "Oh, you're HIV. You have to be A, B or C." No. We say, "How do we get you healthier? Or how do we prevent you so that you can stay healthy?"
Cindy Markarian:
I mean, people are living longer with HIV. Now we're dealing with polypharmacy and that's sort of what Jose's talking about. There's a big misconception, again, it's back to the education, that AHF pharmacists only know HIV, and we do. We do it well. We do have the American Academy of HIV Credentialing, which AHF provides. That's awesome, but we do everything else too. Now that people are living longer with HIV, we're dealing with diabetes. We're dealing, unfortunately, with oncology and cancer, chemotherapy and kidney failure, heart disease, even something as basic as smoking cessation or diabetes management in general.
Cindy Markarian:
These events that Jose and his team will put on when a pharmacist will come out, we'll educate the public. We'll use it as a springboard really to talk about how we're different, what we can provide that I haven't seen any other organization provide.
Jose Ramos:
Being a specialist, especially pharmacy, and focus mostly in HIV medication or treatment or prevention allows you to know how to navigate the system. The system for somebody that's newly diagnosed or wants to get help with or without insurance can be really overwhelming. I remember even when I used to work before in my old company, I did not know that if you are getting a medication, you have any kind of insurance, there's a program out there that can help you pay for copays. I never knew that until I came to AHF, where we know that because we know everything to deal with, how do we help you get what you need?
Jose Ramos:
If a doctor doesn't want to give you this prescription, because this one's more expensive, and you know how... I don't want to have to get into the bureaucracy of that. We do the calls. Our pharmacists do the calls. Our doctors do the best for the patient. You don't get that in most places, because over there, you're just a number in a production. It's a machinery. Here, you're an individual with specific needs. Sometimes people have insurance, sometimes people don't, and we specialize on that.
Cindy Markarian:
We make it a point to know what there is to know to navigate all the different plans. There's so many insurance plans and there's sub plans and then secondary copays. Don't get me started. We're at war with the insurance companies. It's like a battlefield every day, but we know the words, the verbiage, the forms. Sometimes you have to submit... When hep C had a cure, it was a bit of a game. It was a dance we had to perfect. You submit a form. It has to be rejected. Then you submit it again and then it's approved. There's all these recipes that no one really... There's no manual that exists for any of this. It's trial and error. But if you are persistent, you are going to advocate for the patient as they deserve.
Lauren Hogan:
I honestly can't think of a better way to end the episode. I appreciate both of you guys coming in. Overall, my main takeaway is make sure that you use an AHF pharmacy at the end of the day. If you want a pleasant experience, come to AHF pharmacy, right?
Jose Ramos:
You're not just going to get that individualized specialty care, and also your money goes somewhere good. It's a lot of money. It's a lot of money on these medications. Don't give it to a company. Give it to your community, whoever that community partner is.
Cindy Markarian:
You're giving back.
Lauren Hogan:
Well, thank you guys so much and join us for our next episode next time.
Jose Ramos:
Yeah, thank you.
Lauren Hogan:
Thank you so much for joining us. If you enjoyed this episode and you'd like to help support the show, please subscribe, share it with your friends, like, post about it on social media, or leave a rating and review. Follow us on Instagram @afterhours and see you next time.