Trends in Psychiatric Pharmacy Presented by Melissa Oxley

Trends in Psychiatric Pharmacy Presented by Melissa Oxley, Pharm. D Genoa Healthcare Pharmacy Manager

Genoa Healthcare Pharmacy • Mission: • To deliver outstanding value to consumers and partners by improving the quality of life for individuals living with behavioral health and other complex health issues through a higher level of pharmacy and telepsychiatry services • Dedicated to serving the needs of those in behavioral health and addiction treatment communities, and others who have complex, chronic health conditions.

Who We Are • Over 15 years of experience serving 47 states and District of Colombia • Genoa is the fifth largest drug chain in America with 524 full service pharmacies • We fill approximately 15 million prescriptions for over 800, 000 customers annually • All of our pharmacies are located within community mental health clinics to allow for direct interaction with our patients and providers

What We Do • Adherence packaging • Medication bubble-packing for group and long-term care housing • Prescription synching • Delivery services and 24/7 on-call support • Prior authorization assistance

Our impact on the community • Peer-reviewed research shows that Genoa: • Achieves more than 90% medication adherence rate • Decreases emergency room visits by 18% • Reduces hospitalizations by 40% • Achieves a savings of $700 person, per year in avoided care

Telepsychiatry • Genoa Telepsychiatry is the nation’s largest provider of outpatient telepsychiatry services • Focus on underserved and Medicaid populations • Our team of 250 psychiatrists and nurse practitioners provide high quality psychiatric services across 35 states through approximately 125, 000 patient encounters every year • 83% of patients return for follow up visits • Evaluation of patient data showed that patients in rural areas are seen 7 days sooner and 34% more likely to have regular visits when telepsychiatry is combined with in-person care.

Psychiatric Pharmacy Today • Long-acting Injectable Antipsychotics • New Oral Psychiatric Medications • Treatments for Tardive Dyskinesia (TD)

Long-Acting Injectable Antipsychotics (LAIAs) • Abilify Maintena (aripiprazole) • Aristada (aripiprazole lauroxil) • Invega Sustenna (paliperidone palmitate) • Invega Trinza (paliperidone palmitate)

Aristada (aripiprazole lauroxil) • Aristada Initio- one time dose to start or restart ARISTADA • May also use 21 days of oral aripiprazole • Given IM in gluteal muscle (441 mg dose may be given in deltoid muscle) https: //www. aristadahcp. com/dosing

Invega Trinza (paliperidone palmitate) • 3 month schizophrenia symptom control in one injection • Must use Invega Sustenna for at least 4 months https: //www. invegatrinzahcp. com/dosing-pharmacokinetics/switching-antipsych

Vraylar (cariprazine) • Approved in adults to treat bipolar depression and short-term treatment of manic or mixed episodes of bipolar I disorder. Also indicated for the treatment of schizophrenia • Once daily dosing improves adherence and reduces pill burden • Atypical antipsychotic which works to rebalance dopamine and serotonin in order to improve thinking, mood and behavior • Metabolized by the liver; Monitor for drug interactions https: //www. vraylarhcp. com/

Trintellix (vortioxetine) • Treatment for Major Depressive Disorder (MDD) in adults • Used off label for generalized anxiety disorder (GAD) • Shown to improve processing speed and cognitive function impairment due to MDD • Comparisons to SSRIs showed superiority of Trintellix for improving SSRIinduced sexual dysfunction • Dose related adverse effect of nausea in 10 -20% of patients, which usually improved after 1 -2 weeks of treatment • No significant effect on body weight in short and long-term studies https: //www. trintellixhcp. com/

Spravato (esketamine) • First NMDA receptor antagonist for Major Depressive Disorder • For use in conjunction with an oral antidepressant for treatment-resistant depression in adults • Class III controlled substance and limitations by BNDD for dispensing • Must be administered in clinical setting and monitored for at least 2 hours due to adverse effects of dissociation and sedation, and increase in blood pressure https: //www. spravatohcp. com/

Caplyta (lumateperone) • Approved for treatment of Schizophrenia in adults • Once daily dosing • Available in 42 mg capsules – no dose titration required • Considered to be metabolically neutral • Common side effects – somnolence (24%), dry mouth (6%)

Treatments for Tardive Dyskinesia (TD) • • • Tardive Dyskinesia is involuntary movement caused by long term blockage of dopamine receptors • • Typically affects face and mouth Can affect trunk and extremities Some severity of symptoms may reduce with discontinuation of offending medication • Can be permanent New treatment options: • • Ingrezza (valbenazine) Austedo (deutetrabenazine)

Ingrezza (valbenazine) • Ingrezza 80 mg capsules provided rapid and significant reduction in tardive dyskinesia severity by 6 weeks • ~30% reduction in AIMS scoring with Ingrezza 80 mg within 6 weeks • Provides sustained reductions in TD severity • ~39% reduction in AIMS scoring with Ingrezza 80 mg at 48 weeks • Concerns for somnolence, QT prolongation and parkinsonism https: //www. ingrezzahcp. com/

Austedo (deutetrabenazine) • Indicated for involuntary movements (chorea) of Huntington’s disease and tardive dyskinesia • Take Austedo with food • Concerns for cause QT prolongation, neuroleptic malignant syndrome (NMS), akathisia or parkinsonism • Sedation is most common adverse effect. In TD treatment, nasopharyngitis and insomnia are also prevalent. • 33% reduction in AIMS scores at week 12, with improvement observed beginning at 2 weeks of therapy https: //www. austedo. com/tardive-dyskinesia/treatment/clinical-trials

Thank you! Questions?