Does your pharmacy offer antipsychotic injections?
May 1, 2018 by Smart Retailing Rx
Business and Operations
Business and Operations
How everyone can benefit when pharmacies administer LAIs
In brief:
- About 8.5 million American adults live with bipolar disorder or schizophrenia.1
- Failure to take medications as prescribed is a major problem in those populations.
- Long-acting injectable antipsychotics (LAIs) can help improve adherence.
- Pharmacies can provide LAIs in about the same time as a flu shot.
- Working with providers to deliver LAIs, a pharmacy can improve adherence and expand its customer base.
Administration authority for LAIs
While many states permit pharmacies to administer long-acting antipsychotic medications, some have been hesitant to allow non-vaccine injections. Reasons include it is a new practice and each medication has a different injection technique, which requires training.
Source: NASPA
Antipsychotic injectable medications provided by pharmacists
| Generic name | Brand name |
| Aripiprazole | Abilify, Maintena |
| Aripiprazole lauroxil | Aristada |
| Fluphenazine | Prolixin |
| Haloperidol decanoate | Haldol |
| Olanzapine | Zyprexa |
| Paliperidone palmitate | Invega Sustenna, Invega Trinza |
| Risperidone | Risperdal Consta |
Source: JAPhA2
LAIs can be a win-win-win
A psychiatric clinic in Wisconsin approached Hayat Pharmacy owner Hashim Zaibak about administering LAIs. Zaibak saw an opportunity to provide benefits to patients and providers, and to grow his pharmacy’s business.
- Patients: Up to 60% of people with bipolar disorder may not take medications as prescribed.3 One study found that 74% of schizophrenics discontinued medications within 18 months.4 By offering a convenient way for these patients to receive medications, pharmacies can improve adherence and outcomes.
- Providers: LAI injections must be administered every 1 to 2 weeks, and some providers lack the capacity to deliver injections. In Wisconsin the wait time for new psychiatric patients is four months. Because of this, some providers are happy to have pharmacies handle these injections. In Hayat’s case, a clinic was looking to partner with an independent pharmacy to administer LAIs.
- Hayat Pharmacy: Within one year Hayat was providing 24 LAIs per month, plus filling other prescriptions and providing other services to these patients, such as medication synchronization. “It’s really good outreach,” Zaibak said. “It can open other doors for you.” Also, LAIs have a higher gross margin than other medications. While the national average is about $14, in his region margins on LAIs range from $30 to $125.
Keys to LAI success
If state law permits and you want to offer this service, three steps are crucial:
- Train the pharmacist. Hayat Pharmacy sent its pharmacists to training, and Zaibak noted that many manufacturers provide online video instructions. “The training is not hard,” he said. “There’s an initial investment in training, but for us it’s been a good investment.”
- Create a comfortable atmosphere. Hayat Pharmacy has private rooms for administering injections. If a pharmacist is uncomfortable providing an injection, that pharmacist can call Hayat’s medication therapy management (MTM) team for assistance. “If a patient is homebound, we’ll send a pharmacist to their home,” Zaibak said. For psychiatric patients who have a nurse, the pharmacy provides the medication, which the nurse administers.
- Coordinate care. Because of the high cost of the medications, the Hayat Pharmacy patient care coordinator who handles patients using specialty drugs also works with LAI patients. She works to sync the injections with the patients’ other medications, which allows the pharmacy to manage its inventory. She also handles any refill requests to providers and prior authorizations, which have been fewer than Zaibak expected.
Offering additional injections is just one more step in the continuing evolution of pharmacies into more comprehensive community healthcare providers. It benefits patients, provides a valuable service to assist providers and is a source of additional revenue for pharmacies.