1140 Implementation and Evaluation of a Naltrexone Extended-Release Injectable Administration Service in an Independent Pharmacy

E. Heggen; K. Pegump; M. Witry; S. Veach

doi:10.1016/j.japh.2025.102622

Objectives: 1. Develop and implement a process that addresses the logistical barriers to administering naltrexone extended-release injectables in a community pharmacy 2. Describe the demographics of the patients who are eligible and receive naltrexone extended-release injectables at a community pharmacy and their use of the program 3. Administer a patient satisfaction survey including open-ended data about patient experience with the program Naltrexone, an opioid antagonist, is available as an extended-release injectable and can be used to treat alcohol use disorder. This long-acting injection can support enhanced adherence and outcomes but faces logistical barriers to administration. These accessibility barriers are partly due to the requirement for healthcare professional administration, high cost, and a practice known as “white bagging”. White bagging grants insurance companies control over medication purchase, preparation, and administration. White bagging can hinder care coordination, requiring healthcare providers to navigate complex processes and often prioritize insurance requirements over patient needs. Many health institutions have policies against white bagging creating further challenges in administering such medications. This can result in therapeutic decisions that favor policy and logistics rather than the most effective treatment for the patient. To address these challenges, a potential solution involves partnerships between health-system prescribers and non-affiliated, community pharmacies. Patients' insurance-preferred specialty pharmacies can dispense and deliver the medication directly to local pharmacies, which can be administered after verification. The implementation and success of this patient care service will be evaluated by detailing the processes and conducting patient satisfaction surveys. These outcomes will enhance current research on pharmacist-administered long-acting injectables, while also outlining how pharmacists can expand their skills to administer a wider variety of medications. Methods This is a single group, prospective evaluation of a naltrexone for extended-release injectable administration service at an independent community pharmacy. The pharmacy will accept referrals from a local academic medical center. Currently, the pharmacy offers administration of long-acting antipsychotic medications for a cash-based administration fee. Pharmacists will be trained on administering the naltrexone extended-release injection. The pharmacy has a private consultation room to provide this service. Inclusion: • Patients indicated for treatment of alcohol use disorder with naltrexone for extended-release injectable • Patients unable to receive administration of long-acting injectable medications at provider’s office due to insurance dispensing requirements and provider facility policies Exclusion: • Patients contraindicated for use or administration of injectable naltrexone A process diagram will be created to depict the flow of the encounter visually. Barriers, facilitators, and other learnings will also be documented throughout the process. A patient satisfaction survey will be developed using guidance from other published evaluations of long-acting injectable programs in community pharmacies. The proposed domains include overall experience, administration process, insurance & cost, convenience & transportation. A combination of scaled and open-ended questions will be used to gather qualitative information on the patient’s experience with this pilot program. The survey will be administered in person at the patient’s first monthly follow-up injection after care has been established and documented. Following administration of the injection, patients must be monitored in the pharmacy for potential adverse reactions. During this time surveys will be administered to the patient. Incentive for completion of the survey will include gift cards. Descriptive statistics will be used to analyze and summarize survey variables. Open-ended responses will be coded using a basic qualitative approach that groups similar comments for quantification. Results Research in progress. Conclusions/Implications This project is expected to identify strategies to improve the service and better meet the needs of patients with substance use disorders. This project will also provide guidance on how to best approach and support collaborations between healthcare providers and community pharmacies. Additionally, the findings of this project will contribute to existing research on pharmacist-administered medications and encourage the expansion of medication types delivered in community settings.

1140 Implementation and Evaluation of a Naltrexone Extended-Release Injectable Administration Service in an Independent Pharmacy

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