Long-acting injection medications are not always easy for patients to access. But a pharmacist-operated clinic in Kentucky, part of KentuckyOne Health’s Our Lady of Peace behavioral health hospital, has been trying to improve access for area patients.
Since the clinic opened its doors in February of this year, pharmacists have been administering long-acting injections to both psychiatric patients and to patients with opioid and alcohol addiction. They also provide vaccines.
“Patient compliance was a driving factor for opening this clinic, as well as costs and increasing accessibility to these medications,” said Steve Cummings, PharmD, pharmacy manager at Our Lady of Peace, which is based in Louisville.
Several long-acting medications for second generation atypical antipsychotics that are only given once or twice a month exist on the market to help psychiatric patients better comply with their medications. For instance, the clinic stocks risperidone (Risperdal Consta—Janssen), paliperidone palmitate (Invega Sustenna—Janssen), and aripiprazole (Abilify Maintena—Otsuka Pharmaceutical), among others.
Then there are patients like the 30-year-old woman who was the first to receive an injection of naltrexone (Vivitrol—Alkermes) at the clinic to treat her heroin addiction. Cummings said she’s been back for her third injection and, through the process of recovery, has regained custody of her two children.
Naltrexone is a once-a-month, long-acting injection to treat opioid and alcohol use disorders. It blocks opioid receptors and prevents the feeling of getting high—which can help if a person in recovery relapses, for example.
In the inpatient setting at Our Lady of Peace, Cummings said naltrexone had become cost prohibitive.
“We wanted to recognize the issue of access and compliance and also stay in business financially, so we came up with this model of a retail clinic offering long-acting injections,” said Cummings, who is also recognized for founding the clinic.
So far, the clinic has seen more patients with substance use disorders than psychiatric patients. The clinic averages three to six patients per day, a mix of Medicaid and commercially insured, and they have had 49 repeat patients come through the door—which to Cummings signals success for the model.
In creating the model, Cummings took advantage of Kentucky’s pharmacy practice law that allows “administration of medications or biologics in the course of dispensing or maintaining a prescription drug order.” Two PRN pharmacists work in the clinic administering long-acting medications and counseling patients who receive them. Just like at any pharmacy, pharmacists receive a prescription for the long-acting medication and can bill for it.
For the pharmacy profession overall, there is a push for injectable medication administration services beyond immunizations. A recent report published online in the Journal of the American Pharmacists Association summarized an APhA Stakeholder Conference on the topic, where more than 150 strategies were laid out for the profession to establish pharmacists as providers of injectable medications.
For the full article, please visit www.pharmacytoday.org for the August 2017 issue of Pharmacy Today.