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Despite being available for over 45 years, long-acting injectable (LAI) antipsychotics remain an underutilized treatment option for people with serious and persistent mental illness.
LAI antipsychotics are used primarily for individuals who struggle with adherence to antipsychotic medication, these medications have been demonstrated through research to help:
- Improve adherence
- Reduce the occurrence and frequency of symptom relapse
- Reduce rehospitalization
- Improve treatment outcomes for this population
Transitioning to an LAI
While some patients start right away on a long-acting injectable, some patients start treatment on oral medications and may prefer using an injectable medication so they do not have the burden of taking daily medications. Below are some tips to keep in mind when considering transitioning a patient to or initiating treatment with an LAI.
- Transition with oral medications to make sure the patient can tolerate it
- Start at lower doses and slowly increase dose as tolerated
- Maintain necessary oral medications for extra-pyramidal symptoms (EPS)
- Attempt to taper anti-EPS medications after starting the LAI
- Consider checking plasma levels (when indicated) to make sure they are within therapeutic range
- More tips from the American Association of Community Psychiatrists (AACP)
Patients with behavioral or mental health conditions face additional barriers to self-managing their conditions. Below are some considerations to keep in mind when dealing with this patient population.
- Discuss treatment plan with patient’s family members or others involved in their care
- Ensure that the patient has a plan on how they will get to the office for their injections
- Offering transportation or reminder cards and involving family in the care can help prevent missed appointments
- Avoid use of stigmatizing language
- Educate patients to prevent a negative perception of long-acting medications
- Employ a trauma-informed approach where you engage the patient in conversations and highlight that they are able to express their choices and preferences
- Read the informative guide to long-acting medications issued by the National Council for Behavioral Health.
Clinical Prior Authorization
Starting on January 1, 2020, the Pennsylvania Department of Human Services instituted a single statewide Preferred Drug List (PDL). All LAI antipsychotics are preferred on the PDL.
- Fee-for-Service Pharmacy Prior Authorization General Requirements and Procedures (contains details about when a clinical prior authorization is necessary)
- PA DHS Medical Bulletin: Prior Authorization of Antipsychotics – Pharmacy Services
Current FDA-Approved LAI Medications and Corresponding Care Coordination with Pharmaceutical Companies
- Aristada Initio,
- Abilify Maintena
- Invega Sustenna
- Risperdal Consta
- Risperidone Perseris
- Zyprexa Relprevv
- Invega Trinza
- Haldol Decanoate
- Fluphenazine Decanoate
For additional information, see the LAI Antipsychotics PDL Crosswalk.
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