Long Acting Injectable Antipsychotic Medication Presented by Carol Nati MD, MS, DFAPA Medical Director, MHMR of Tarrant County

Overview Long Acting Injectable Antipsychotic Medications are underutilized in Texas. They have been proven to work well. They help to prevent relapse. They are cost effective when you consider the financial cost of hospitalization and the human cost of decompensation. Long Acting Injectable Medications

Journal of the American Medical Association Article Expanding Therapy With Long-Acting Antipsychotic Medication in Patients With Schizophrenia William T. Carpenter Jr, MD; Robert W. Buchanan, MD Maryland Psychiatric Research Center, University of Maryland School of Medicine, Baltimore JAMA Psychiatry. 2015;72(8):745-746. doi:10.1001/jamapsychiatry.2015.0485. Long Acting Injectable Medications

Major Points from the Article From 04/01/2014 to 09/30/2014 there were 1,549 members that were naïve to treatment with Long-Acting Injectable antipsychotics (LAI) and had continuous eligibility from six months prior and six months post first treatment with a long acting injectable medication. Inpatient utilization in total dropped from 1,202 visits during the pre-period to 839 visits in the post period, a decrease of 30.20%.   Long Acting Injectable Medications

Major Points from the Article Mental Health Inpatient utilization dropped from 801 visits during the pre-period to 534 visits during the post period, a decrease of 33.33%. Emergency Room (ER) utilization in total dropped from 1,660 visits during the pre-period to 1,460 in the post period.  Long Acting Injectable Medications

Major Points from the Article Mental Health ER utilization dropped from 520 visits during the pre-period to 378 during the post period. Long Acting Injectable Medications

Reasons Why People Do Not Use these Medications First Some sites do not do injections routinely Some think they are only for acute patients in crisis Some believe they are only for aggressive or non-adherent patients Stigmatization Lack of head to head trials of patients comparing oral meds versus injectable meds Prescribers often believe their patients when they say they are taking their medications. Long Acting Injectable Medications

Older Medications Long Acting Injectable Medications Medication Name Approximate Cost per Injection Fluphenazine Decanoate 25 mg/ml $14.10 every 3 to 6 weeks Haldol Decanoate 100 mg/ml $39.60 one time per month Haldol Decanoate 50 mg/ml $19.80 one time per month Long Acting Injectable Medications

Newer Brands Available Medication Name Approximate Cost per Injection Invega Sustenna 117 mg $1044.00 one time per month Invega Sustenna 156 mg $1392.00 one time per month Invega Sustenna 234 mg $2038.00 one time per month Risperdal Consta 25 mg $368 every 2 weeks Risperdal Consta 50 mg $737.00 every 2 weeks Aristada 441 mg/1.6 ml $1,060.00 every 6 weeks Aristada 662 mg/2.4 ml $1,600.00 every 6 weeks Aristada 882 mg/3.2 ml $2,120.00 every 6 weeks Long Acting Injectable Medications

Newer Brands Available Abilify Maintena 300 mg $1283.40 one time per month Abilify Maintena 400 mg $1710.90 one time per month Invega Trinza 273 mg/0.875 ml $2,100.00 every 3 months Invega Trinza 410 mg/1.315 ml $3,160.00 every 3 months Invega Trinza 546 mg/1.75 ml $4,210.00 every 3 months Invega Trinza 819 mg/2.625 ml $6,320.00 every 3 months Long Acting Injectable Medications

Conclusions Long acting injectable medications could probably benefit more patients over time. Cost of newer medications is high. Older medications may be considered as an option. We still need more data to compare patient responses over longer periods of time. Long Acting Injectable Medications

Questions Carol Nati, MD, MS Distinguished Fellow American Psychiatric Association Medical Director, MHMR of Tarrant County    3840 Hulen Street Fort Worth, Texas 76107 817-569-4430 Fax 817-569-4499 Carol.nati@mhmrtc.org Long Acting Injectable Medications