Our Lady of Peace has become the first behavioral health care center in the country to open a retail pharmacist-operated, long-acting injection clinic — where patients will receive monthly shots of medication from a pharmacist to help treat opioid addiction and schizoaffective disorders.
The director of the new clinic is OLOP pharmacist Steve Cummings, who says they soon will begin to provide shots of Vivitrol to patients who have a prescription for the drug, which is increasingly being used as part of medication-assisted treatment for patients addicted to opioids like heroin.
Vivitrol contains naltrexone, which is a non-addictive drug that blocks opioids from attaching to brain receptors, thus blocking any euphoria from taking heroin or other opioids. The long-acting shot remains in the patient’s system for 30 days, allowing them to focus on the counseling or therapy aspects of their treatment during this crucial period of recovery.
“We’re excited about our new clinic and we’re hoping that we can make a difference in people’s lives who are undergoing addiction,” says Cummings. “And hopefully that 30 days of sobriety that the Vivitrol shot allows the patient to have will allow them to show up for behavioral health care outpatient therapy sessions sober and alert and more engaged with what they’re trying to do or not do.”
Cummings says pharmacists at the clinic also will be able to administer up to six different long-acting antipsychotic medications for patients with schizoaffective disorders. While some patients with such disorders stop taking daily oral medication when their auditory or visual hallucinations subside — leading to relapse and hospitalization — he says these monthly shots result in much greater compliance. The clinic also will provide immunization and vaccination shots, including for HPV, tetanus and Hepatitis B.
According to Cummings, the clinic will focus heavily on administering shots to patients receiving other behavioral health care services at OLOP, but they do plan on getting outside physicians and prescribers to send their patients to the clinic for injections, as well. He estimates that a pharmacist at the clinic will be able to administer around 20 to 25 shots in one eight-hour shift, and considering the escalating opioid epidemic in the region, he assumes that most of these patients will be receiving Vivitrol.
Approximately 40 to 45 patients are detoxing at OLOP at any given time, and Cummings says they typically are evenly split between patients detoxing from opioids or alcohol — the latter of which can also be treated with Vivitrol. He adds that the best time for opioid-addicted patients to receive the Vivitrol shot is upon discharge, as a relapse when their tolerance has lowered brings a very high chance of an overdose.
In addition to hiring a full-time pharmacist, the injection clinic will have a medication access coordinator, whose job is to essentially help patients and prescribers navigate the challenges of insurance coverage and reimbursement when it comes to medication-assisted treatment. Though one shot of Vivitrol can cost over $1,000 out-of-pocket, it is covered by Medicaid MCOs and certain private insurance companies in Kentucky. However, many patients and providers have run into roadblocks with insurance companies in recent years, as insurers deny claims or request prior authorizations, which can delay the administering of Vivitrol in situations where an addicted patient is desperately in need of help.
Cummings says the clinic’s medication access coordinator — who previously worked on such claims at Humana — will make sure that medication like Vivitrol is accessible and as affordable as possible by helping prescribers work through any red tape on reimbursement or the prior authorizations of insurance companies. This coordinator also will work with patients to make sure they are receiving accompanying therapy or counseling, in addition to helping them reschedule appointments for their next injection and following up to make sure they don’t miss it.
In cases where the clinic must wait for a prior authorization to go through, Cummings says the clinic does have sample products of Vivitrol available for patients “if we know it’s just a matter of time (for authorization), so we can do a sample shot and get them enrolled in the appropriate program to get reimbursement.”
In 2016, a number of local substance abuse treatment providers — including CenterStone Kentucky (formerly Seven Counties Services), Family Health Centers and the Morton Center — began to use medication-assisted treatment with Vivitrol, citing the growing body of research and organizations that hail its effectiveness in combating opioid addiction.
OLOP is part of the KentuckyOne Health system, which Cummings says started using medication access coordinators in recent years.