Public Health Matters Video: Walmart is Elevating Specialty Pharmacy Services and Enriching HIV Care

In this episode, host Dr. Christina Madison interviews Aleata Postell, group director of pharmacy business development, Walmart, to discuss the significance of specialty pharmacy services—particularly related to HIV care—in public health. Postell highlights how Walmart has initiatives that support HIV care and testing.

Christina A. Madison, PharmD, FCCP, AAHIVP: Hello everyone, and welcome to another episode of Public Health Matters, part of the Pharmacy Times Pharmacy Focus podcast series. I am your host, Dr. Christina Madison, and I'm super excited to bring another incredible guest to you all today. So, without further ado, I'm going to let my incredible guest introduce herself. But before that, I just want to acknowledge that we are recording this episode during Pride Month, [and] we are on the precipice of HIV National Testing Day. So, that is a little bit of a snippet of how we're going to conduct today's interview. So, Aleata Postell is my guest today, and I'm going to let her go ahead and introduce herself and her current role, then we're going to dive into some questions. Welcome, Aleata.

Aleata Postell: Thank you, Dr. Madison. I'm Aleata Postell—as you shared—and I lead our Specialty Pharmacy Business Development at Walmart. Within my role, I have the responsibility of driving our strategy for how we show up in specialty pharmacy, especially with our community pharmacies, as well as working with our operations to make sure that we are supporting our pharmacy teams, and really allowing them to work at the top of their license. So [I'm] really excited to have a conversation with you.

Madison: And actually, right before we started recording, you were telling me a little bit about the fact that you aren't a pharmacist. But the fact that you support pharmacies and pharmacists is pretty amazing considering that you have a law background. So, with that being said, if you could tell us a little bit about your leadership journey and how you got to where you are today. Obviously, as another woman of color, I'm always interested to see folks' professional trajectory and how they get to leadership positions.

Postell: Sure, I started in specialty pharmacy back in 2004. There was a time that I really wanted to be a cop, so when I got into specialty pharmacy, it was really just a job, I didn't think about making it a career. And I had an amazing leader that said, "You don't want to be a cop, you really are good at specialty pharmacy," [and I was] like, "No, I really want to be a cop." But as I started to really lean into specialty and embrace it, I learned so much, and then around that time I started having impacts in my family as well with specialty. [I] didn't know a lot there was learning [involved]. When I first started in specialty, I was verifying benefits and I would sit on the phone, just listening to the teams or the customer service agents that would share with me here's what the benefits are, here's what you need to do to get approved, and I remember sitting there like, "Who has time for this? If I'm sick, is this what I really want to be spending my time on?" And so, as I started to really understand how complex specialty was...I was sitting on the gun range, and I was at the academy—and I will tell you, I'm a horrible shoot, so there's that, that's the reason I'm not a cop.

Madison: If it makes you feel any better, I am too. I went through the FBI Citizens Academy, and so, I've shot like every weapon possible...so I'm definitely not put up for that either. I'm good in pharmacy.

Postell: ...I'm a more effective communicator, so give me something to talk about, I could talk. But when I was sitting there, I was like, "Is this where I really want to be impactful? How can I change how specialty pharmacy is done?" And so, I took that back, and thankfully, he allowed me to keep my job part time—so I was still working in specialty as I was going through the academy—and I flipped my degree to law, and then focused on what were all the areas of specialty that I thought that I could make an impact. And so, there hasn't been a role that I haven't held that's nonclinical. What I did is really learned how can I support our clinicians by building the programs, providing the tools, working back with clients [and] really understanding what their needs were, and then incorporating that into our business.

So, I've enjoyed my ride. I've been at many places, I've worked at 3 of the largest PBM-owned pharmacies, and now at Walmart pharmacy. I feel like my journey has led me here today.

Madison: Wow, that's such a such an interesting story...obviously I've worked with folks infected with a positive status and, obviously, specialty pharmacy includes way more things than just HIV care, but I know that that's something that is of particular interest for you. And we know it's Pride Month as we're recording this episode, we're on the precipice of National HIV Testing Day...I'm just curious, how did you come through the process of understanding that you really felt like HIV care services was super important, and in particular, having HIV care services available within pharmacy?

Postell: Yeah. So for me, when I was just early on in my journey...I had a best friend and her nephew passed away from HIV. And that was sobering, right? So you're sitting there in specialty pharmacy, and you're realizing, "I can't even help those that are around you. How did I not know?" because I'm still early on. And he passed away a month after his 23rd birthday, so we actually buried him a month after his birthday, which was hard...watching the family go through that, watching her care for his needs, and it really was about it was the stigma, right? "Don't talk about it," or "Why do you have it?" There was so much stigma around it, and he was also protecting those that were in his life that were also infected. And so, going through that, and realizing that...just seeing that, going to visit him in a nursing home—especially when he was getting hospice care—being the youngest person on the floor, is traumatic. And so, going back to work, for me, it triggered [this idea of] "how do I help more." And then from there, it was also other people in my family that were also impacted by specialty needs, and so I decided that I wanted to do something about it.

For me, I don't take roles just because it comes with promotion. I take roles to learn; I have an inquisitive personality, I want to learn more, I want to understand why. I don't take "no" [as an answer]. I want to understand how do I help others, and so I will take 1000 "nos" if it means that there's a path to get to a "yes: or tell you, "Hey, how do you help me understand what it is we can do?"

So fast forward when I came to Walmart, there was a number of initiatives around how [to] eradicate HIV in the United States...and so when I came on [we were figuring out] how are we doing that, how are our pharmacies positioned to do that, what tools and resources are we providing them? And so, everything that I learned along the way from how are the drugs covered, benefits, what is the role that the pharmacies can play, [then] taking that and being able to implement strategies within Walmart has been rewarding for me, especially now...going from where I had a friend that we couldn't help because it was too late [and] he didn't know what was available, to now, I can educate as many people as I can to help them know what services are available because you don't have to die from HIV, you can live a healthy, long life. And so, that drives me as well, being able to share that.

Madison: I think that's incredibly important in understanding your "why" and we all have a story—especially those of us who've worked in HIV care for a really long time—and I say that with a grain of salt, because I've been a pharmacist for 20 years, but of those 20 years, 17 of those years, I spent caring for those affected and infected with a positive status, and I remember, you know, rotating on a floor that was just full of patients in the hospital that...were probably going to die or had very limited life expectancy. And so, having that "why" be what drives you, I think is extremely important. I'm very sorry that that happened to a friend of yours, but you're not alone, there are many stories just like that of folks that unfortunately are impacted negatively by stigma, and much more importantly, impacted by the cultural challenges and religious issues around HIV and how [it] is contracted. And particularly in the Black community, there is a lot of stigma around that and not wanting to talk about our sexual orientation and our sexual identity. And so, I'm glad that you have a "why," which is what's driving you< I'm sad that that had to happen to your to your friend's nephew. But this is why we do the work, because we don't want to have people that look and sound like us being another statistic.

I didn't know if there was anything else you wanted to add about your motivation to the work that you do?

Postell: I think even tapping into something you said...where specialty pharmacy has come around HIV care to where it is now, it has changed. I felt like back then, [HIV] was a death sentence, right? Because you didn't really know what was available in an access...it wasn't easily accessible in a community setting. And so, seeing the moves and changes that have been made, seeing what is going on now versus where it was 2004, there's been tremendous strides. Being a part of that and being a part of that change is also motivating, and I'm particularly proud of what we are doing within Walmart—and we'll talk more about our testing initiatives—but seeing that evolution over time, I know there's even more that we can do.

Madison: Yeah, and that leads me to my next question...I wanted to ask what your company is currently doing, considering it is Pride Month, and that it is almost National HIV Testing Day [at the time of this recording], what initiatives are you guys spearheading and how do you think that's gonna impact the community?

Postell: Absolutely. So, with it being Pride Month, we have a number of initiatives where we encourage our associates to celebrate who they are. That's 1 thing I appreciate working at Walmart, we really do believe come as you are, right? It's not just a thing, it is a culture. And so, from the top down, we're encouraged to make sure that everyone feels included, and that you can come to work and embrace your true self.

And then for Testing Day, I'm really excited because we are launching an additional 18 sites for testing across Virginia and Colorado. We've been working very closely with Elton John's AIDS Foundation to really inform us [of] what are the things we need to do and lean in as a pharmacy, also, who our community partners should be. Before we started, we were talking about the work you were doing with Gilead, [they] have been an amazing partner in enabling our program, so tomorrow, when we launch, we'll be launching with services for free [that are] enabled by Gilead [and] in partnership with the Elton John's AIDS Foundation at our pharmacies in Virginia and in Colorado. So, I am here to do tours of the pharmacy for National Testing Day and the teams are really proud. Just seeing how they've stepped up to the charge and how Walmart has really supported us through this, going from 2 pilot locations [for HIV] back in 2022, to now having over 90 locations that specialize in HIV care, and now adding 20 more testing sites, that's been an amazing journey for us.

Madison: Yeah, I think I helped with the one that you guys started here in Nevada, and Vegas...I'm very involved in this space, and so, it's lovely to see that you guys took what you learned from those initial opportunities and that you're expanding it to other sites.

So, where do you really see the future of public health in pharmacy, and specifically within specialty care under Walmart, how do you guys see this sort of this? Is this a one-off, or is this a steppingstone to bring public health-related services?

Postell: I think this is definitely where we're headed, right? When we when we started with specialty pharmacy...so, going back, I started—like I shared before—in 2004, specialty pharmacy has always been more of a central model, and not that that's wrong, it's a very high-touch complex type of model because the patients within specialty need a different type of care. But there are certain conditions—like HIV—when you're talking about public health, a central model is not really going to get it there. And so for Walmart, when I came on, I realized how many patients were coming into our stores seeking services for specialty, the question was, do we disrupt them and move them to a central model, or do we meet them where they are? And we knew we needed to meet them where they are, because the patients...you don't know that you're on a specialty drug, you don't know that you're a specialty patient, what you know is you've been diagnosed with a condition and you need a medication that's either going to save your life or prolong your life, right?

And so, what we're doing is upscaling our pharmacy team. So, in partnership with the Elton John's AIDS Foundation, we have the Duke Training that teaches them about how to care for patients living with HIV, removing the stigma, but also normalizing it. To your point, we're in the communities, and when you're talking to someone that looks like you, you feel more comfortable, especially when there's that cultural barrier. And so, the number of stories that we hear from [our teams] is that we've had patients that have traveled over an hour and a half to go to a Walmart because it feels normal. And that's what I want to do, I want to see it done in a normal channel. You don't know what you're coming to Walmart for, you could come for your groceries, it could be coming for an immunization...so, I see us continuing to lean in in that area. And if you think about how we stood up for COVID, public health initiative, we trusted our pharmacists to be able to do immunizations for COVID for Americans. How do we take that and take it a step further?

So, where I see it is, I would love to see specialty pharmacy involved where we think about the role the pharmacists can play to maybe that first dose administration, and then working back with a patient's provider and connecting them to care. Those are the type of programs that we're working on with Walmart, because I really believe that community pharmacy is well-positioned to do that.

Madison: Yeah, we are the touch point that most folks have. When you look at how many times someone on average sees their primary care provider, it's maybe once, twice in a year, versus their community pharmacy, it's anywhere from 10 to 30. And that's probably small considering that sometimes people go multiple times to the pharmacy, not necessarily specifically to get pharmacy services, but maybe they get their groceries there, maybe they get their OTC products there, maybe they get their beauty products there, maybe they get their dermatology products, their skincare...there's so many different reasons why somebody comes to a pharmacy that may have other things, and why shouldn't we provide these additional services?

And I think from my standpoint—as somebody who's really had pretty much every job in pharmacy and to now working for myself—I feel like we were really at a precipice where we need to be able to provide support for these pharmacies and pharmacists. And that kind of leads me to my next question, which is what advice would you give to newer allied health professionals that maybe want to get more involved in specialty pharmacy, and specifically HIV care services, knowing that we're being asked to do more with less?

Postell: Yeah, I think it starts in school and learning about all the things that you can do as a pharmacist. I'm involved with an organization the National Association of Specialty Pharmacy, and I love what they do around education...but just being a part of that organization, we have a clinical education track where we work with students and we educate them on all the things [they] should know. I think what happens is you—and this is me working with clinicians—I have them coming to me and saying "I need tools, I need resources, help me," because I don't want to turn a patient away. And that's the worst feeling as a clinician, because to your point, you're seeing me more than you see your doctor. So, if I'm coming in to a pharmacy, I'm expecting you to be able to help me, and so, how do we position our students early on to be able to provide those services.

So, my advice is learn while you're in school, join organizations—especially if you know where you want to go—that is aligned with your mission and allow you to do that. I love, for example, we have an intern program within Walmart and we will allow our interns and our residents to come through and sit within our pharmacy program so that they can learn more and take that back. And a number of them come back and get a position with Walmart because they've already come in, they know where they want to be and go, so I love that. We need more of that and people within specialty that's willing to provide that education. I love anyone that wants to listen, like I told you have an inquisitive mind, if you ask me a question, I'm gonna go find out if I don't have the answer, so being able to have that dialogue with the students help them to understand what careers they can have in specialty pharmacy. Because it's more than just dispensing, it's also the clinical care, it's clinical trials, research, right? You need pharmacists to be able to inform what is needed for patients when it comes to their medication regimen.

Madison: Yeah, I mean, I couldn't agree with you more, especially being on the other side of that. But I think when I look at this as sort of the "whole person approach," because that's really where we're going—and it's kind of the new buzz term within HIV care—is this concept of status neutral. So, I don't know if you've heard of this before, but the concept of status neutral is basically providing quality care and linking folks to services right away. So [for example], before when we were talking about [2004] when you were mentioning your friend's nephew, we did not have good linkage to care at all. That's probably why we had as many folks being diagnosed so late stage as we did, because we're not providing that good access to linkage to care. But then also, the other side of this is that when you think about...ending the epidemic goals, really the key there is that you need to implement prevention, because even though we've had a medication since 2012 to prevent HIV, we still have a fraction of those folks that could benefit from being on PrEP. And so for me, I really feel like that status neutral approach should be a guiding force as you guys move forward with more services. So not just testing, but when you get that negative test, linking them to prep, and when you get that positive test, linking them to same day [antiretroviral therapy]. And I don't know if you have that infrastructure, but that is really where we need to get to, to allow pharmacists to be able to feel like they can practice at the top of their license, and be able to provide that care on the spot.

Postell: So I'll share with you a couple of things that we're working on. Community Pharmacy is hyper local, right? When we say retail pharmacy, it's so transactional, it's not "retail pharmacy," and I say that because you think about the pharmacists, they live in that community, they understand what is needed [from patients]—and to your point—[patients are] seeing them a lot more than they're seeing their primary care [providers]. So if I'm coming into the pharmacy, I may have a drug for 1 specialist, I have 1 for my primary care, and then I have other services that I need. Pharmacists are seeing that, so when you talk about treating the whole person, we believe in if we don't have the services, how do we connect you to that community partner? So with the Elton John's AIDS Foundation, we have them helping us identify who are those community partners that we need. We also have community health workers as part of our model. That was something I love it. So it was a pilot for me...because the community health workers, it goes beyond the dispensing. If I dispense a drug to you, and you don't have a place to live, or I don't have appropriate refrigeration because specialty meds [can be] time sensitive, they have special storage requirements, I need that help. Sometimes, it's just as simple as connecting you to someone to talk to, and so we have a team of community health workers that have done some—and I'm gonna use this word—miraculous things, because they will hunt in search for the right resources to connect patients to, and then they follow up. That's the other thing, they're following up...it's not a "one and done," it's continuous.

So, as part of our patient journey at any time the pharmacist can notify us that we need a community health worker to step in. We also in our central model, have a team of nurses that are so passionate about this as well, and I smile because they will do whatever it takes. So if it's virtual care follow-up...they will sit there with you, especially if you have patients and if they're getting an injection and they have a needle phobia, walking them through that, even if it takes 2 to 3 times to have that conversation. Again, pharmacists, they could do the same thing, so that connection to community resources to me is so important and then that follow-up care is also important. So, it had to be a part of the fabric of the program that we created, and then leaning in and having the right partners—such as the Elton John AIDS Foundation—helping to inform us the training that we have.

The other thing is that we are also looking at workshops, you have some changes that have come in the law. So think about Louisiana, they've recently changed the law that allows pharmacists to prescribe and also order labs, and so we'll be working in the near future to have implementation strategy workshops with community leaders. One thing, I think that's it's a brick-by-brick approach...

Madison: Let me know if you need help with that!

Postell: I will take you up on that!

Madison: I think that's literally the biggest challenge. It's not a crisis of competence, it's a crisis of confidence, because pharmacists don't know how to even get started, and it's like...I would love someone to just hold my hand through this, someone who's done it and someone who can say like, "It's not scary." I always say that PrEP care is not specialty care, it is "everybody care," and I know that we're having this conversation about specialty pharmacy, but really getting it down to its fundamentals, this is not like when I used to care for patients in the early 2000s, when I had to check resistance patterns, make sure that they didn't have class-wide resistance that would limit my use of their regimens...the meds are so much better now, you literally can pick like 1 of 3 things and you know they're gonna be undetectable, and they're gonna be happy, and they're gonna be healthy, and life is gonna go on, right? It's not like before where there was so much toxicity and issues with dosing, because you were having to take multiple pills different times a day, with a food requirement, without a food requirement. Folks, their life is just not suitable for that, and now that we've got all these issues around extreme heat—where are you going to store your meds?—we need to have that nimbleness to be able to allow folks to live their lives, but then also be able to be in care and make it as easy as possible.

Postell: And to comment on that, too, I know we're talking specialty pharmacy...I also want to say specialty pharmacy needs to be reimagined. Because if you're dealing with HIV, with it being a public health initiative, it's not going to get solved by shipping across the United States. And I say that with love because I come from a specialty model, and there are some patients that cannot make it into the store, there's some patients that prefer that method.

But if we're going to meet patients where we are, we have to consider the role that community pharmacy can play—because to your point—there's so many things that goes along with it. So, we talked about nutrition...well, if I'm coming into Walmart and I need to have a nutrition conversation around what I need to take with my meds, I can actually show you. Or if you need a food program, I can actually help you with that. And so for me, when I came in, I was looking at everything that we had available to us and then having conversations with a pharmacist. That's why I love my role and being able to support the pharmacist and providing the tools, you need those that do and you need those that support. And so, I gladly stand up to support because if I can change how we're thinking about how specialty care is delivered, consider community pharmacy as an avenue for that care, sign me up.

Because—again, from a personal experience—sitting on the phone for an hour trying to figure out benefits is not how you want patients to spend their time. Sometimes I don't want to talk to you, I just want to be able to go see someone, a friendly smile as I pick up my meds and ask you a question on how do I take it, what are the things that I need to know? Sometimes it's not translated by phone, and so, I would love to see specialty pharmacy reimagined. There's some things that still need to go in that high-touch central model, but there are certain conditions that are best suited—in my opinion—for community pharmacy.

Madison: Well, I think that that is a fantastic place for us to end because this has been a wonderful conversation, and I'm excited to see the work that you will do in the future and [I] want to elevate and affirm the work that you've already done, because it is it is meaningful work and it's not just about the 1 patient. I always say this when it comes to public health, and when you're doing things within [that] space, it's about the health of the many and not necessarily the health of the 1. And so, when you're helping these individuals, you're really getting the community viral load down and potentially reducing the risk of transmission in entire communities. And so, the work that you do isn't just the 1 person, it really does make a ripple effect and a huge impact in the patient's lives and in the communities that you serve. So, I just want to elevate and highlight that before I ask you 1 more question before we leave.

I always ask my guests this question: if you could tell your younger self 1 thing, what would it be and why?

Postell: Don't be afraid of the unexpected, and I say that for a number of reasons. Sometimes you want to plan your life and know what's coming your way. I didn't expect to be here, I didn't expect to be in this seat, I just knew that there was something more that I wanted to do. And so, not being afraid of the unexpected, challenging myself to think differently...I will tell my younger self, "Go girl you did it!, You didn't just go with the status quo."

I love that I'm here and thank you for having me, this has been an amazing and wonderful conversation and I'm gonna take you up on the workshop.

Madison: You know where to find me. Well, I'm definitely going to make sure to include the links to some of the organizations that you mentioned, as well as to the Walmart Specialty Pharmacy program. If folks want to learn more, please tell us where they can find out more about the program, or if they want to reach out if they'd like to partner with Walmart in the future?

Postell: If you want to reach out, you can reach out to me, Aleata Postell (aleata.postell@walmart.com), you can reach out to me if you're looking to partner. And if you want to learn more about our spot locations, if you go to walmart.com and specialty pharmacies of the community, you could find us there with a number of information on where all of our spot locations are, education materials...and come into your local Walmart. I'm sure 1 of our premises will help you and I hope to see everybody on Testing Day.

Madison: Oh, wonderful. Thank you so much again, and like I said, I will include those links, so folks can go in and link to that information.

Again, my name is Dr. Christina Madison, also known as the public health pharmacist, and this has been another incredible episode of Public Health Matters, part of Pharmacy Times Pharmacy Focus podcast series. And remember, public health matters.

You can check out the following discussed resources:

• Walmart Specialty Pharmacy—HIV: https://www.walmart.com/cp/specialty-pharmacy-of-the-community/6730561?povid=OMNISRV_D_Cp_HW_HwSpecialtyPharm_4101489_HW_6730561_TileCardsService_HivSpecialtyPharmacy_LearnMore_1332399668
• International Association of Providers of AIDS Care: https://www.iapac.org/
• Elton John AIDS Foundation: https://www.eltonjohnaidsfoundation.org/what-we-do/what-we-fund/breakthrough/

Connect with Aleata Postell and follow Walmart Specialty Pharmacy on LinkedIn!