Maximizing High-Cost Brand Medications (PrEP, HIV Treatments, Long-Acting Injectables) Without Building a Full Pharmacy
STD clinics participating in the 340B program face a unique challenge: their patients need immediate access to critical medications, their drug mix includes high-value products like long-acting injectables and PrEP, but their prescription volumes often don’t justify building and staffing a full-service pharmacy. Office dispensing offers the perfect middle ground.
The STD Clinic 340B Opportunity
STD clinics eligible for 340B have access to deeply discounted medications that are critical for their patient populations:
- PrEP Medications: Truvada, Descovy—high-cost medications with substantial 340B savings
- HIV Treatments: Biktarvy, Genvoya—high-cost brand medications
- Long-Acting Injectables: Cabenuva for HIV treatment
- Hepatitis C Medications: Mavyret, Epclusa—$30,000+ per treatment course
- STI Treatment: Doxycycline, Ceftriaxone, azithromycin at 340B pricing
The savings potential per prescription is enormous. A single Cabenuva injection can represent $4,000+ in acquisition cost. A month of Descovy for PrEP is $2,000+ at retail. The 340B discounts on these medications are substantial, but only if you can capture them efficiently.
The Volume Reality
Here’s the challenge: most STD clinics don’t dispense enough total prescriptions to justify a traditional pharmacy operation. Consider a typical STD clinic scenario:
- 50-150 patient visits per week
- Not every visit results in a prescription
- Maybe 5-15 prescriptions per day on average
- Annual volume: 1,500-4,000 prescriptions
That volume doesn’t support hiring full-time pharmacists, maintaining pharmacy licensure, managing inventory for hundreds of drugs, handling retail pharmacy regulations, or building dedicated pharmacy space. The overhead would consume your 340B savings.
But here’s the key: the per-prescription value is exceptionally high because of the high-cost brand and lite-specialty medication mix. You don’t need 30 prescriptions per day to make office dispensing financially viable when those 8-15 prescriptions include PrEP, HIV treatments, long-acting injectables, and hepatitis C medications.
Contract Pharmacy: Wrong Fit for STD Clinics
Many STD clinics turn to contract pharmacy by default, but it’s a poor fit for several reasons:
Fee Structure Destroys Value
These aren’t low-cost generic antibiotics. A month of Biktarvy costs over $3,800. Cabenuva is $4,200+ per dose. A month of Descovy for PrEP is $2,000+. The 340B discounts on these medications are substantial—often 40-60% off—making every prescription worth hundreds or even thousands of dollars in savings to your clinic.
But here’s the catch: you’re paying contract pharmacy fees (20% average plus $15-$25 per prescription), TPA fees (10-15%), and you’re losing 30-40% of your total program value. On a $500,000 annual program, that’s $150,000-$200,000 gone.
Manufacturer Restrictions
Many high-value HIV and hepatitis C drugs are restricted from contract pharmacy dispensing by manufacturer policies. Your most profitable medications may not be available through contract pharmacy at all, forcing you to write prescriptions at retail pricing—completely defeating the purpose of 340B.
Patient Experience Issues
STD clinic patients often face stigma, transportation barriers, and privacy concerns. Sending them to an external contract pharmacy means:
- They have to make a separate trip (often on different public transit routes)
- They may not pick up the prescription at all (adherence problem)
- They disclose their STD diagnosis to retail pharmacy staff
- They lose the continuity of care your clinic provides
For PrEP, this is a barrier to prevention. For HIV treatment, this impacts viral suppression rates. For hepatitis C, this means patients may not complete curative therapy.
Office Dispensing: Purpose-Built for STD Clinics
RxFusion Office Dispensing solves all these problems without requiring you to build a full pharmacy:
Minimal Infrastructure Required
- Works with your existing EHR system—no system changes needed
- No 340B TPA required (or continue with your current TPA)
- Uses your existing clinical staff with minimal training (1-2 days)
- No need for dedicated pharmacy space or full-time pharmacists
- Simple inventory management for a focused formulary
Massive Fee Reduction
RxFusion charges just 12% for comprehensive service including implementation, PBM contracting, compliance support, claims processing, software platform, and Beacon platform support for the 2026 rebate model. Instead of losing 30-40% to contract pharmacy and TPA fees, you keep 88% of your 340B savings.
For a $500,000 annual program, that’s $440,000 retained vs. $325,000 with contract pharmacy—an additional $115,000 per year.
Full Drug Access
Office dispensing is not subject to manufacturer contract pharmacy restrictions. You have access to:
- All PrEP medications at 340B pricing
- Cabenuva and other long-acting injectables
- All hepatitis C direct-acting antivirals
- Complete HIV treatment portfolio
- STI antibiotics and prophylaxis
Better Patient Outcomes
Same-visit dispensing means patients leave your clinic with medications in hand:
- Improved adherence rates for PrEP and HIV treatment
- Higher completion rates for STI treatment courses
- Reduced barriers to care for vulnerable populations
- Better viral suppression and lower transmission rates
- Maintained privacy and continuity of care
Real-World STD Clinic Example
Consider an urban STD clinic that dispenses approximately 8 prescriptions per working day (approximately 40 prescriptions per week), 5 days per week, with a high-cost brand drug mix:
- Annual Volume: 2,080 prescriptions (8 per working day)
- Drug Mix: 40% PrEP (Descovy, Truvada), 30% HIV treatment (Biktarvy, Genvoya), 15% Hepatitis C (Mavyret, Epclusa), 15% STI antibiotics
- Program Value: Approximately $3 million in total drug revenue (depending on drug mix)
With Contract Pharmacy:
- Total fees: 30-40% ($900,000-$1,200,000)
- Net retained: $1.8-$2.1 million
- Manufacturer restrictions may eliminate highest-value drugs
With RxFusion Office Dispensing:
- Total fees: 12% ($360,000)
- Net retained: $2.64 million
- Full access to all 340B drugs
- Additional annual value: $540,000-$840,000
That additional half-million to three-quarters-million dollars annually can fund expanded testing, additional clinical staff, enhanced patient services, or outreach programs to underserved populations.
Implementation is Straightforward
RxFusion handles the heavy lifting for STD clinics:
- Policy development and 340B compliance structure
- Staff training (typically 1-2 days for clinical team)
- PBM network contracting and credentialing
- Software platform implementation and integration
- 340B drug purchasing coordination
- Claims processing, split-billing, and reconciliation
- Ongoing compliance monitoring and support
- Beacon platform readiness for January 2026 rebate model
Most STD clinics are fully operational with office dispensing within 90-120 days.
The Strategic Case
For STD clinics, office dispensing isn’t just about money—though the financial advantages are compelling. It’s about:
- Mission Alignment: Maximizing 340B savings to serve more patients and expand services
- Patient Outcomes: Same-visit dispensing improves adherence and viral suppression
- Health Equity: Reducing barriers for vulnerable populations
- Program Sustainability: Keeping 88% of savings vs. 60-70% with contract pharmacy
- Clinical Control: Direct management of your 340B program and patient care
Don’t Leave Money on the Table
If your STD clinic is using contract pharmacy and losing 30-40% of your 340B savings to fees, or if you’re writing prescriptions at retail because contract pharmacy doesn’t give you access to restricted drugs, office dispensing deserves serious consideration.
You don’t need thousands of prescriptions per month or a full pharmacy infrastructure. With RxFusion’s proven model and comprehensive 12% service package, STD clinics can maximize their 340B value while improving patient care and outcomes.
Ready to explore how office dispensing can work for your STD clinic?
Contact: hello@rxfusion.com | www.rxfusion.com