Increasing the use of long-acting injectable behavioral health medications in the community - A pharmacist-psychiatrist collaborative model.

BACKGROUND

Persons with severe mental illness or substance use disorder (SUD) benefit from long-acting injectable behavioral health medications (LAMs), which improve treatment adherence, reduce hospitalizations and emergency visits, and mitigate long-term biopsychosocial decline. LAMs remain underutilized due to multiple barriers across patients, pharmacies, providers, and payors.

OBJECTIVE

The primary objective of this study was to conduct a time study and workflow analysis to inform a scalable and equitable payment model for community pharmacy-based administration of LAMs.

METHODS

Six community pharmacies documented five tasks involved in the LAM patient management process: informed consent, gathering supplies/preparing injection, assessing clinical appropriateness, administering LAM, and provider communication. Time spent per task, injection administration site, product administered, and role of the personnel performing the task were recorded. Overall cost estimates were calculated using Time-Driven Activity-Based Costing (TDABC).

RESULTS

Across 633 patient LAM pharmacy encounters, the mean time per task ranged from 4.9 to 5.5 min. Pharmacists averaged 24 min to complete all tasks. Estimated costs per encounter were $40.89 for pharmacist-only management, $25.94 for nurse/technician teams, and $27.32-$38.06 for pharmacist/technician teams, depending on tasks completed.

CONCLUSION

Using a time-and-motion study of community pharmacists in one state, a scalable and equitable payment model for community-pharmacy-based LAM administration and patient management in collaboration with psychiatric providers was identified. Given the persistent barriers that limit patient access to evidence-based and cost-effective LAM treatment, payors should consider reimbursement of community pharmacies for behavioral health LAM administration at rates that accurately reflect the time, resources, and costs required.