Long-Acting Injectable Antipsychotics (LAI)

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Despite being available for over 45 years, long-acting injectable antipsychotics (LAIs) remain an underutilized treatment option for people with serious and persistent mental illness. These injectable medications can help patients better manage their condition and improve long-term outcomes by preventing relapses and improving medication adherence.

• New APA Schizophrenia Guidelines

LAIs are used primarily for individuals who struggle with adherence to antipsychotic medications. LAIs 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 an LAI, others 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 an LAI 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 the 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 the therapeutic range
• More clinical tips from the American Association of Community Psychiatrists (AACP)

Addressing Patient Barriers

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 the 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.

Patient Considerations

While there are many advantages to using LAIs, there are some factors to consider that may be unfavorable to some patients:

• Slow dose titration and longer time to achieve steady state levels
• Delayed relief of distressing or severe psychiatric side effects
• Pain at the injection site, leakage into surrounding tissue, and potential for irritation and lesions
• The burden of needing frequent, reliable travel to outpatient clinics to receive injections
• Possible perception of stigma

For reference, please read Long-Acting Injectable Antipsychotics: A Practical Guide for Prescribers.

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, except for the newly released Invega Hafyera.

Please Note: Invega Hafyera is non-preferred until it is reviewed by the P&T Committee in September 2022.

• Fee-for-Service Pharmacy Prior Authorization General Requirements and Procedures (contains details about when a clinical prior authorization is necessary)

FDA-Approved LAI Medications and Corresponding Care Coordination with Pharmaceutical Companies

Certain pharmaceutical companies offer care coordination services.

• Zyprexa Relprevv
  1-800-545-6962
• Invega Trinza
  1-800-526-7736
• Haldol Decanoate
  1-800-526-7736
• Fluphenazine Decanoate
• Invega Hafyera*
  1-800-526-7736
  * Invega Hafyera is non-preferred until it is reviewed by the P&T Committee in September 2022.

For additional information, see the LAI Antipsychotics PDL Crosswalk (Excel Spreadsheet).

Please see the LAI Fact Sheet for the Long-Acting Injectable Dosing Information.

Materials for Members

• CBH Antipsychotic Medication Guide
• CBH Member Medication Wallet Card
• CBH Tarjeta de Billetera de Medicación del Miembro

Additional materials to share with members are available on the Pharmacy Education and Resources page.