By David Brand

When money gets tight, M. can always sell a few of his HIV pills to make some extra cash. There is no shortage of pharmacies willing to buy the medication, he said.

Shady pharmacy owners and staff around New York City purchase the expensive pills for a pittance, repackage them, fill another customer’s prescription and bill Medicaid twice, or three times, or 10 times.

“A motherf----- who’s on crack or a motherf----- who’s just hungry, like me, we’ll do it,” M. said of selling the meds. “They’ll give $20 to a person on crack.”

M. doesn’t use hard drugs so he said he has the wherewithal and bargaining power to earn a little more money when he decides to sell. The $100 or so that he receives for a handful of pills is chump change to pharmacies that run large-scale buyback operations.

Last month, state Attorney General Letitia James announced the arrest of a pharmacy owner and three pharmacy managers — two from Queens — who allegedly earned $10.2 million in a Medicaid kickback and drug buyback scheme through First Choice Pharmacy in Harlem.

Prosecutors said an investigation determined that from Jan. 1, 2013 to Dec. 31, 2016, First Choice did not purchase enough HIV medication from licensed wholesalers to justify the amount of medication it claimed to dispense in its billing records. In essence, the enterprise allegedly billed for the same medication multiple times.

A ‘deeply damaging’ operation

James called the scheme “disturbing and deeply damaging to our society.” The pharmacists, she said, “exploit our most vulnerable patients to steal millions of dollars reserved to provide New Yorkers with essential health care.”

The schemes hurt individuals with HIV, cost taxpayers millions of dollars and drive up the viral load in communities, exposing others to the illness and spoiling the city and state’s mission to drive the number of new HIV diagnoses to zero.

In recent years, investigators have busted a $2.7 million medication buyback scheme in Queens, a $7.9 million fraudulent operation in the Bronx, a $15 million scam at a pharmacy in Manhattan’s Chinatown and a $274 million network based in Babylon, Long Island.

One Bronx pharmacist made $16 million by organizing a network of pharmacies in some of the Bronx’s poorest neighborhoods, including Mott Haven and Williamsbridge, to buy customers’ HIV treatment pills. In at least one site, the team of pharmacists convinced 70 percent of customers with HIV to sell their medication back to the pharmacies.

Roughly 125,000 New Yorkers were living with HIV as of 2017, according to city data, and the illness is closely associated with poverty. A map of the city’s poorest neighborhoods mirrors a map of the neighborhoods with the highest rates of HIV, aside from a few outliers, like Chelsea, where gay men contracted HIV at high rates in the 1980s and early 90s.

Today’s medication enables people with HIV to live healthy lives and suppress their viral load until it is undetectable in blood tests — though this does not mean they are cured.

“HIV is a weird disease where you have to have 90 to 95 percent maintenance. You can’t miss a day,” said Housing Works Chief Medical Officer Dr. Vaty Poitevien.

The virus can surge if the person stops taking their medication for an extended period, but sometimes skipping a few days and selling pills is a final option for people in need of other necessities

“I understand the pull for patients — it’s completely understandable,” Poitevien said. “What shocked me is that pharmacies are engaged in this business.”