Community Pharmacist Collaboration Expands Access to Long-Acting Injectable Antipsychotics

As part of a concerted effort to combat nonadherence to antipsychotic medications—a leading cause of symptom relapse and hospitalization among individuals with serious mental illness—a multidisciplinary team within Yale New Haven Hospital in Connecticut has developed and implemented a collaborative practice agreement (CPA) to empower community pharmacists to administer long-acting injectable antipsychotics (LAIAs). This innovative care model was presented at the American Society of Health-System Pharmacists (ASHP) 2025 Pharmacy Futures meeting.¹

Nonadherence to antipsychotic therapy remains a major barrier to continuity of care for individuals with schizophrenia, bipolar disorder, and related psychiatric conditions. LAIAs have proven effective in improving medication adherence and reducing relapse rates, yet access to these therapies remains uneven, particularly in outpatient settings.² Recognizing this challenge, a project team consisting of an ambulatory pharmacy resident, clinical psychiatric pharmacists, and pharmacy leadership across ambulatory and community settings sought to bridge the care gap.¹

Laying the Groundwork: Training, Infrastructure, and Compliance

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The team identified 2 integrated community pharmacies within their health system as ideal pilot sites due to their accessibility and the readiness of pharmacy staff to engage in the project. Site visits were conducted to evaluate workflow logistics and ensure the availability of private spaces for injection administration.¹

Pharmacists selected for participation completed specialized training provided by the American Association of Psychiatric Pharmacists, which included instruction in both administering LAIAs and conducting brief mental status evaluations. The training was delivered either in person or virtually to accommodate staff schedules and site needs.¹

Compliance with state regulations was a critical component of the workflow design. In Connecticut, CPA-based treatment requires patients to sign informed consent forms prior to receiving services. Additionally, a standardized Notes on Injection Clinical Encounter (NICE) form must be completed at each visit to monitor patient response and flag any treatment-emergent adverse events. These forms, along with other documentation requirements, were incorporated into the electronic health record (EHR) system as customized note templates to streamline tracking and provider communication.¹

Results: Building a Sustainable, Scalable Model

The project resulted in a fully operational CPA, allowing community pharmacists to administer 5 LAIAs commonly used within the health system’s formulary. Authorization is based on a valid prescription issued by a clinician signed onto the CPA with the participating pharmacist. Three pharmacists across the 2 community pharmacy locations completed the training and are now actively participating in the program.¹

To improve workflow efficiency, pharmacy technicians were trained and integrated into several non-clinical aspects of the service, including patient scheduling, conducting follow-ups for missed appointments, and entering demographic and prescription information into the EHR. These changes allow pharmacists to focus more fully on clinical care and patient engagement.¹

The EHR was further optimized with scheduling templates and clinic-specific contexts that support medication filling, dispensing, documentation, and billing—ensuring that all components of the LAIA administration process are captured and coordinated within the broader health record.¹

A Collaborative Win for Patient Care and Pharmacy Practice

This initiative marks a significant advancement in community pharmacy practice, demonstrating how interprofessional collaboration can improve access to vital psychiatric care. By equipping community pharmacists with the tools, authority, and infrastructure needed to administer LAIAs, the program addresses a critical adherence issue while reducing barriers for a vulnerable patient population.¹

As the mental health needs of patients continue to rise and the demand for innovative care models grows, this project offers a replicable framework for health systems nationwide. It exemplifies the evolving role of pharmacists as frontline providers capable of delivering high-impact interventions in partnership with the broader care team.¹

REFERENCES

1. Orellana ZT, Monestime S, Morrow G, Renauer M. Development of a long-acting injectable antipsychotic (LAIA) collaborative practice agreement within an integrated community pharmacy at an academic medical center. Presented at: American Society of Health-System Pharmacists (ASHP) 2025 Pharmacy Futures. June 9, 2025.

2. Kaplan G, Casoy J, Zummo J. Impact of long-acting injectable antipsychotics on medication adherence and clinical, functional, and economic outcomes of schizophrenia. Patient Prefer Adherence. 2013;7:1171-1180. doi:10.2147/PPA.S53795