Naloxone Availability and Pharmacy Staff Knowledge of Standing Order for Naloxone in Pennsylvania Pharmacies

Abstract

Objective: To assess the availability and price of naloxone as well as pharmacy staff knowledge of the standing order for naloxone in Pennsylvania pharmacies. Methods:We conducted a telephone audit study from 12/2016 to 4/2017 in which staff from Pennsylvania pharmacies were surveyed to evaluate naloxone availability, staff understanding of the naloxone standing order, and out-of-pocket cost of naloxone.Results: Responses were obtained from 682 of 758 contacted pharmacies (90% response rate). Naloxone was stocked (i.e. available for dispensing) in 306 (45%) pharmacies surveyed. Of the 376 (55%) pharmacies that did not stock naloxone, 118 (31%) stated that they could place an order for naloxone for pickup within one business day. Responses by pharmacy staff to questions about key components of the standing order for naloxone were collected from 581 of the 682 pharmacies who participated in the survey (85%). Of the 581 pharmacy staff members who stated that they either stocked or could order naloxone, 64% correctly answered all questions pertaining to understanding of the naloxone standing order. The respective median out-of-pocket prices stated in the audit varied by formulation and ranged from $50 to $4000. Staff from national pharmacies were significantly more likely than staff from regional/local chain and non-chain pharmacies to correctly answer that a prescription was not required to obtain naloxone (68.5%, 57.7%, and 52.4% respectively, (p=0.0045). Conclusions:Multiple barriers to naloxone access exist in pharmacies across a large, diverse state, despite the presence of a standing order to facilitate such access. Limited availability of naloxone in pharmacies, lack of knowledge or understanding by pharmacy staff of the standing order, and variability in out-of-pocket cost for this drug are among these potential barriers. Regulatory or legal incentives for pharmacies or drug manufacturers, education efforts directed

Pharmacist roles, training, and perceived barriers in naloxone dispensing: A systematic review

“…Despite the standing orders, a widespread issue of pharmacists not stocking naloxone is reported. 36,[59][60][61] Given the need and potential for this role, an important question is how to facilitate a more complete actualization of the role.…”

Impact of student pharmacist–led naloxone academic detailing at community pharmacies in Texas

“…However, significant barriers to access remain, and naloxone is routinely not available at community pharmacies without an outside prescription. [6][7][8][9][10] A recent survey of community pharmacists identified a significant knowledge gap regarding naloxone (only 30% scored 90% on a knowledge-based portion of the survey), and half of the pharmacists acknowledged they were not very comfortable dispensing naloxone without a prescription. 20 A correlation was observed between pharmacists' knowledge regarding naloxone and comfort dispensing it (r ¼ 0.268; P < 0.001), and 95% of responders stated that additional training would be useful.…”

“…Despite these naloxone access laws, recent studies indicated that naloxone was inconsistently available via standing order and frequently not stocked in community pharmacies. [6][7][8][9] In 2018, our research group conducted a telephone audit of all CVS, Walgreens, H-E-B, and Walmart pharmacies in Texas to assess the accessibility of naloxone under standing order. The results have been previously published, but briefly, of the 2317 pharmacies audited, 1607 (69.4%) were willing to dispense naloxone without an outside prescription and currently had naloxone in stock.…”

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

“…20 Similarly, Guadamuz et al, 21 in a survey of pharmacies in Philadelphia, PA, after implementation of a statewide standing order, found that only 34.2% of surveyed pharmacies had naloxone in stock. 22 Another study of Pennsylvania pharmacies found that 45% of participating pharmacies stocked naloxone, and 55% did not, although 31% reported they could order the drug for pickup within a business day. 30 Although the current study did not specifically inquire about naloxone products in stock versus needing to be ordered (although we noted that approximately 42% of surveyed pharmacies offer home delivery of naloxone), previous studies raise an important question: what are the potential ramifications for patients of delays in receiving naloxone because it is not kept in stock by their pharmacy?…”

“…17,18 However, the barriers to naloxone access enumerated in the literature are concerning, and previously published studies have not explored naloxone access issues in Tennessee, although such issues have been examined in other states such as Texas, Pennsylvania, and New Jersey. [19][20][21][22]…”