Impact of Outpatient Pharmacist Dispensing in an Opioid Use Disorder Clinic

Emma Piehl; Stevie Veach; Amanda Powers; Rachel Otting; Jess Smith; Linnea A Polgreen; Kaley Wolff; Matthew J Witry

doi:10.1016/j.japh.2024.102094

Impact of Outpatient Pharmacist Dispensing in an Opioid Use Disorder Clinic

J Am Pharm Assoc (2003). 2024 Apr 9:102094. doi: 10.1016/j.japh.2024.102094. Online ahead of print.

Authors

Emma Piehl¹, Stevie Veach², Amanda Powers³, Rachel Otting³, Jess Smith³, Linnea A Polgreen², Kaley Wolff², Matthew J Witry⁴

Affiliations

¹ MercyOne Pharmacy; The University of Iowa College of Pharmacy.
² The University of Iowa College of Pharmacy.
³ MercyOne Pharmacy.
⁴ The University of Iowa College of Pharmacy. Electronic address: Matthew-witry@uiowa.edu.

PMID: 38604475
DOI: 10.1016/j.japh.2024.102094

Abstract

Background: Medications for opioid use disorder (MOUD) are effective in reducing opioid deaths, but access can be an issue. Relocating an outpatient pharmacist for weekly buprenorphine dispensing in an outpatient clinic may facilitate coverage for buprenorphine and mitigate access and counseling barriers.

Objectives: To evaluate if staffing an outpatient resident pharmacist to dispense in the buprenorphine clinic had a positive impact on 1) mean cost-per-prescription charged to charity care and 2) basic elements of patient satisfaction with the on-site pharmacist.

Methods: Patient demographics, buprenorphine formulation, insurance type, and uncovered costs were abstracted from dispensing records in the 16 weeks before the pharmacist clinic presence and 16 weeks with the pharmacist present. The difference in insurance types across the two periods was tested using a Chi-square test and the mean uncovered prescription costs charged to charity care for the two periods was compared using an independent samples t-test. A brief survey was administered while the pharmacist was on site to evaluate satisfaction which was analyzed with frequencies of "yes" responses and free-text comments.

Results: A total of 38 patients received buprenorphine during both the pre- and post-periods. Once the pharmacist was on-site, more patients used Medicaid or private insurance, decreasing the mean uncovered cost per prescription from $55.00 (sd 68.7) to $36.97 (sd 60.1) p=.002. Patients reported high levels of satisfaction with most reporting they were more likely to ask questions, pick up their prescriptions, and take their medicine with the pharmacist in clinic.

Conclusions: The pharmacist successfully transitioned a portion of prescriptions previously covered by charity care to Medicaid or private insurance. This shift led to a decrease in charity care costs by $2,950.20 and a reduction in the average uncovered cost per prescription. The pharmacist's presence in the clinic appeared to reduce barriers especially related to inconvenience.

Keywords: Insurance; Medicaid; Medication Assisted Treatment; Pharmacist; satisfaction.