Evaluation of naloxone access, pricing, and barriers to dispensing in Tennessee retail community pharmacies

Spivey, Christina A.; Wilder, Angelica; Chisholm-Burns, Marie A.; Stallworth, Sara; Wheeler, James

doi:10.1016/j.japh.2020.01.030

Cited by 30 publications

(21 citation statements)

References 22 publications

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“…Another solution to reduce stigma and increase privacy associated with naloxone was to have naloxone pamphlets available for patients to present to a pharmacist to reduce the need of verbally asking for a naloxone kit [ 52 ]. From the pharmacists’ perspective, another solution to reduce stigma would be to increase advertising and marketing of naloxone inside pharmacies, to raise public awareness of the benefits and to increase patient comfort in asking for a naloxone kit [ 54 ]. While some pharmacists produced solutions for overcoming stigma, others still endorsed negative beliefs about naloxone, such as that it allows for riskier opioid use and that it allows people who use opioids illicitly to avoid seeking substance use treatment [ 46 ].…”

Section: Resultsmentioning

confidence: 99%

“…These are further discussed in the “Knowledge Gaps” section, where potential areas of training interest were noted by pharmacists [ 55 ]. In addition to the top three mentioned barriers, other common barriers from the pharmacist perspective include a lack of patients asking for naloxone, concerns in pharmacy workflow, lack of time, lack of support from management, and patient refusal ( Table 3 ) [ 11 , 24 , 25 , 54 , 55 , 56 , 57 ].…”

Section: Resultsmentioning

confidence: 99%

“…Although less frequently mentioned, there were a variety of facilitators identified in the studies ( Table 3 ). These included education and training for both pharmacists and patients, standardization of training, comfort in discussing naloxone, and interprofessional collaboration [ 25 , 36 , 37 , 48 , 54 , 56 , 57 , 58 , 59 ]. Pharmacists noted how practice and experience in dispensing naloxone with the opt-out model made it easier to perform [ 25 ].…”

Section: Resultsmentioning

confidence: 99%

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What Is Known about Community Pharmacy-Based Take-Home Naloxone Programs and Program Interventions? A Scoping Review

2021

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A variety of new sources describing community pharmacy-based take-home naloxone (THN) programs have emerged recently in the literature. There is a need to define the types of take-home naloxone programs being offered to support future research designs in implementing and evaluating standardized programs that fill pharmacist and patient knowledge gaps and lift current barriers for optimal community pharmacy naloxone provision. The objective of this paper is to summarize the literature on community pharmacy-based THN programs, including specific program interventions used to increase naloxone dispensing, naloxone availability and dispensing patterns, facilitators and barriers for the THN programs, and knowledge gaps. Online databases such as PubMed, EMBASE, Scopus, and International Pharmaceutical Abstracts (IPA) and a search of the grey literature were used to identify eligible sources. Sources were screened by two reviewers for eligibility in COVIDENCE software. Both reviewers compared screening results and resolved conflicts through discussion. A data extraction form for all identified full texts was completed by both reviewers and results were compiled through reviewer discussion. Fifty-two sources met the eligibility criteria. The top three barriers identified were: cost/coverage of naloxone, stigma, and education/training for pharmacists. THN program interventions included screening tools, checklists, pocket cards, patient brochures, and utilizing the pharmacy management system to flag eligible patients. Patient knowledge gaps included naloxone misinformation and lack of awareness, while pharmacists demonstrated administrative, clinical, and counselling knowledge gaps. Naloxone availability was found to be highly variable, where independent and rural pharmacies were less likely to stock or dispense naloxone. Further, pharmacies located in districts with higher rates of opioid overdose deaths and lower household income were also less likely to have naloxone available. This review identified multiple new programs, showcasing that the implementation and evaluation of THN programs are an expanding area of research. Future research should focus on implementing and evaluating a THN program through a randomized controlled trial design that incorporates solutions for the barriers and knowledge gaps identified in this study.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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What Is Known about Community Pharmacy-Based Take-Home Naloxone Programs and Program Interventions? A Scoping Review

2021

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“… 59 Several of these studies also assessed the cash price, finding the mean price of intranasal naloxone, often the only formulation available in community pharmacies, 50 to be in the range of $120–150. 43 , 45 , 46 , 51 , 52 , 54–56 While naloxone may be included on many insurance formularies, price remains a major barrier for uninsured or underinsured patients, 55 and there seems to be a lack of clarity among community pharmacists as to whether naloxone can be billed to insurance plans when dispensed via standing order. 44 , 50 Table 1 summarizes identified naloxone access barriers and potential solutions.…”

Section: Successes and Shortcomings Of Current Nals And Non-otc Appromentioning

confidence: 99%

Considering the Potential Benefits of Over-the-Counter Naloxone

Evoy¹,

Hill²,

Davis³

2021

IPRP

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Since 1999, annual opioid-related overdose (ORO) mortality has increased more than six-fold. In response to this crisis, the US Department of Health and Human Services outlined a 5-point strategy to reduce ORO mortality which included the widespread distribution of naloxone, an opioid antagonist that can rapidly reverse an opioid overdose. Increased distribution has been facilitated by the implementation of naloxone access laws in each US state aimed at increasing community access to naloxone. While these laws differ from state-to-state, most contain mechanisms to enable pharmacists to dispense naloxone without a patient-specific prescription. These laws have enhanced community naloxone distribution, both from pharmacies and overdose education and naloxone distribution programs, and produced positive effects on ORO mortality. However, a growing body of evidence has revealed that significant barriers to naloxone access from pharmacies remain, and annual ORO deaths have continued to climb. Given these concerns, there has been a push among some clinicians and policymakers for the US Food and Drug Administration to re-classify naloxone as an over-the-counter (OTC) medication as a means to further increase its accessibility. If an OTC transition occurs, educational outreach and funding for clinical innovations will continue to be crucial given the important role of health professionals in recommending naloxone to people at risk for experiencing or witnessing an ORO. Recognizing the severity of the ORO public health crisis, we believe transitioning formulations of naloxone approved for layperson use to OTC status would result in a net benefit through increased access. However, such a change should be combined with measures to ensure affordability.

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“…Small, emerging studies exploring pharmacists' attitudes toward dispensing are mixed 89‐91 . One study found that naloxone is inconsistently offered to patients receiving higher opioid doses 92 . Other factors that prevent pharmacists from becoming engaged in naloxone dispensing include drug cost, patient refusal, insurance barriers, difficulty determining which patients are at risk of opioid overdose, and keeping naloxone stocked 90‐95 …”

Section: Barriers and Challenges With Recommendationsmentioning

confidence: 99%

Medication access: Policy and practice opportunities for pharmacists

Sobeski

Schumacher

Álvarez

et al. 2020

J Am Coll Clin Pharm

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Medication access is critical to achieving optimal patient outcomes. The 2020 Task Force on Medication Access was charged with developing an ACCP white paper on improving medication access that addresses barriers such as cost, health disparities, and utilization management practices. This white paper outlines major barriers to medication access and provides pharmacists and professional organizations with policy and practice recommendations to help reduce barriers, enhance medication access, and fulfill the goal of optimal patient outcomes.

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Evaluation of naloxone access, pricing, and barriers to dispensing in Tennessee retail community pharmacies

Cited by 30 publications

References 22 publications

What Is Known about Community Pharmacy-Based Take-Home Naloxone Programs and Program Interventions? A Scoping Review

What Is Known about Community Pharmacy-Based Take-Home Naloxone Programs and Program Interventions? A Scoping Review

Considering the Potential Benefits of Over-the-Counter Naloxone

Medication access: Policy and practice opportunities for pharmacists

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