Medication Administration Scope Advancement

New LAI Training & Resource Toolkit for North Carolina Pharmacists

By: Cynthia Hicks, PharmD Candidate

Adherence is perhaps the quintessential factor tied to patient outcomes, medication management, and quality measures. Yet, adherence depends on human behavior; therefore, medication non-adherence remains a dangerous and costly healthcare issue. Long-acting injectable (LAI) medications are one option to improve adherence, and LAIs are especially important for behavioral health. However, according to plan administrators and pharmacists working for behavioral health local management entities, LAIs are woefully underutilized.

LAIs often go unprescribed, despite strong evidence of their ability to significantly improve patient functioning and quality of life. Why are LAIs underutilized? The primary reason is poor access to care. Other causes include providers not carrying inventory or having the staff to administer the injections; the driving distance to the provider’s office may be too great for the patient to return for their injections regularly. Furthermore, the shortage of behavioral health and primary care providers in our state compounds the problem. The underutilization of LAIs worsened during the COVID-19 pandemic when healthcare providers shifted to telehealth for care, making it nearly impossible for patients to receive injections. The accessibility and the incredible care that local community pharmacists provide were seen as a potential solution, but only if pharmacists were legally allowed to administer LAIs.

On October 1, 2021, a new law, SL 2021-3, allowed North Carolina pharmacists to administer LAIs. Section 2.9.(a) of G.S. 90-85.15B of the Pharmacy Practice Act will be amended to allow immunizing pharmacists to administer LAI medications to patients 18 years of age or older, pursuant to a prescription. The North Carolina Board of Pharmacy (NCBOP) has promulgated a temporary rule, 21 NCAC 46 .2514, to enact this new authority. Rather than provide a list of approved medications within this rule, LAIs were defined as “medications formulated to produce sustained release and gradual absorption of the active pharmaceutical ingredient over an extended period of time following subcutaneous or intramuscular injection.” This new law requires immunizing pharmacists to complete formal training on LAI administration and notify the NCBOP. The North Carolina Association of Pharmacists (NCAP) has developed an online, 24/7 accessible LAI training for pharmacists. The training is packaged to deliver content through smaller learning modules. Each module is 45 minutes or less in duration, allowing pharmacists to learn at their own pace and fit the training into their busy schedules. The training is ACPE-approved for 5 hours of continuing education credit. In addition to the learning modules, registrants gain access to an LAI Toolkit. The toolkit includes documents that address the importance of using LAIs, copies of the LAI law and rules, stigma resources, clinical service implementation guidelines, sample advertisements to promote this new service, and mental health educational materials for patients. The toolkit also contains supplemental information to help pharmacists establish an LAI clinical service. The toolkit also includes a convenient medication resource guide with administration demonstration videos, individual product medical science liaison contact information, drug package inserts, contact info to request demo kits, assessment forms, and patient/ provider satisfaction surveys. Are you interested in setting up an LAI service in your pharmacy or practice? Are you ready to help improve LAI utilization? Have you completed your training? To get started, click here.

Author: Cynthia Hicks is a PharmD Candidate at East Tennessee State University.