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

2. 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

3. 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): doi: /jamapsychiatry
Long Acting Injectable Medications

4. 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 %.  
Long Acting Injectable Medications

5. 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

6. 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

7. 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

8. 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

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

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

11. 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

12. Questions Carol Nati, MD, MS
Distinguished Fellow American Psychiatric Association
Medical Director, MHMR of Tarrant County   
3840 Hulen Street Fort Worth, Texas 76107
Fax
Long Acting Injectable Medications