The longer it takes for someone to follow their treatment plan after showing symptoms, the higher the risk of a bad result. Time is lives, as the saying goes.

Particularly in the field of behavioral health, medication adherence is a challenge. In the US, more than half of people with a mental illness receive no treatment at all.¹ Additionally, a survey conducted jointly by The Economist and YouGov in March of 2023 found that 37% of Americans had skipped filling a prescription due to cost.²

In most cases, physicians will write a prescription for those with severe mental illness, but the physician does not always know if the prescription is filled. In some situations, delaying medication can have catastrophic results, including self-harm or harm to others. Other scenarios are less drastic, but immediate treatment is still essential. For example, someone with a substance abuse disorder who has agreed to take medication may change their mind within days or even hours. Connecting them with those prescriptions at the point of care can make the difference between a new lease on life and a dismal outcome.

One strategy for increasing adherence and reducing the time it takes to get medication into the hands of those who desperately need it is to work with a pharmacy partner to ensure that medication is available, affordable, and delivered on time so doses are not missed.

This article will explore the synergistic relationship of a complete care team and the increased role that pharmacy must play in helping individuals struggling with behavioral health conditions. This includes facilitating access to the resources, medications and holistic care people need to successfully navigate their treatment plan.

Barriers to Medication Adherence in Behavioral Healthcare

The prevalence of behavioral health conditions and their consequences is increasing, drawing attention from the news and policymakers. Despite increased awareness and expenditure, many challenges persist.

We have made strides as a society in reducing stigma, and mental healthcare services are reaching more people than ever before.³ The increase in demand is straining an already overburdened system, so many individuals seeking care struggle to find in-network providers, leading to a rise in crisis situations. The growth in telehealth has enabled same-day access and psychiatric urgent care, but finding providers who can both prescribe and maintain ongoing care proves challenging.

A significant hurdle to adherence is the high-cost share associated with behavioral health medications, often reaching thousands of dollars per month. For the uninsured or those lacking funds for medications, the system faces limitations in allocating resources. When people cannot afford pharmacy costs, providers have limited options. Some use samples to fill short-term gaps. If the needed medication is not available, providers have to get creative. Seeking family support or connecting individuals to payment plans with pharmacies are the next line of defense.

While the stigma of years past is starting to fall away, we still have not reached true parity. It is not as easy to practice behavioral health medicine as physical medicine. Archaic rules and logistical hurdles still make it difficult to get equal access to medications. For example, minors cannot take an antipsychotic without prior authorization from insurance companies, and even inexpensive FDA-approved generic medications have to go through red tape simply because they are behavioral health drugs.

The challenges of behavioral healthcare, further complicated by the transient nature of clinic visits and the difficulty of catching individuals at the early stages of care, contribute to shortfalls in adherence. Despite improvements in the way mental health is culturally viewed and supported, the evolving demands on the system underscore the need for comprehensive solutions to ensure timely and accessible mental health services for those in need.

A Comprehensive Care Team

True collaboration between providers and pharmacy partners can ensure the seamless operation of a complete care team. In a person-centered approach, the physician and clinicians helping to facilitate treatment have the best interests of the individual in mind. Each step of the treatment plan is calculated to help the individual receive the most assistance and the best outcome. Given this perspective, providers should point those seeking care to a pharmacy partner as a guide through payment options, access to medications, scheduling and more. Both the physician and pharmacist are needed to provide comprehensive care.

Physician’s Role:

In a landscape where behavioral health specialists are in short supply, the psychiatrist assumes the role of a quarterback within the healthcare team. While not more critical than other team members, the psychiatrist directs the overall strategy. Models that efficiently distribute tasks and allow psychiatrists to focus on care are highly valued. The psychiatrist or physician should prioritize early management to help keep everyone safe. Various team roles can then work collectively to extend physician services.

Pharmacist’s Role:

The pharmacist’s role within the care team extends beyond dispensing medications. They serve as a vital link, connecting clinical needs with medication coverage requirements. This involves not only ensuring medication access but also managing transitions of care, particularly from inpatient facilities or emergency departments back into regular daily life. The focus on timely and reliable medication delivery, especially for those on long-acting injectables (LAIs), is crucial.

Breaking Down Barriers with Hybrid Pharmacy Care

Traditional pharmacies cannot always fill gaps in care within behavioral health. Instead, a hybrid model, which combines central-fill and onsite components of pharmacy care, offers a more flexible approach to meet the diverse needs of caregivers and individuals.

The central-fill aspect provides a comprehensive set of resources, including tracking refill schedules and managing assistance programs, which can be challenging to achieve with an onsite pharmacy alone. A central-fill pharmacy also facilitates access to limited-distribution drugs, medications critical to the well-being of individuals in this population that are only available through certain pharmacists.

The nature of behavioral healthcare makes broad access to medications a necessity. For instance, an individual suffering from paranoia might have a strong response if the pills they generally take suddenly change color or come in a different size. An agile central-fill pharmacy has the ability to find the right brand and packaging and have it delivered so that treatment is not interrupted and the individual feels comfortable.

In some cases, onsite pharmacies can help further the personalized touch that a central-fill pharmacy delivers. Recognizing the importance of this personal connection, the hybrid model integrates the strengths of both central and onsite pharmacies.

In the era of virtual care, the hybrid model becomes even more crucial. If individuals aren’t physically present in the office, the central pharmacy can ensure uninterrupted access to necessary medications through the central-fill, maintaining continuity of care. For example, individuals with behavioral health needs often have comorbidities. Someone contending with diabetes and neuropathy in addition to behavioral health concerns might be on 7 or 8 medications all at once. Providers that coordinate with a pharmacy partner can offer simplified options, like personalized blister packaging containing all medications meant to be taken simultaneously.

Onsite pharmacies are not always practical due to zoning regulations, cost considerations, patient population size, and other factors. In-house pharmacies sometimes function more like inpatient pharmacies, with limitations in fulfilling both roles effectively. To address these challenges, partnerships with external pharmacies can broaden service offerings.

Best Practices for Medication Access

Ensuring effective medication access in behavioral healthcare requires a thoughtful and collaborative approach. Here are key best practices to enhance access to crucial prescriptions:

Ask Questions:

Providers should avoid assuming that individuals are taking prescribed medications. Actively inquire about medication adherence, side effects, and any barriers they are facing. Creating an open and non-judgmental environment encourages people to disclose challenges, helping identify those who otherwise slip through the cracks.

Promote Collaborative Communication:

Encourage individuals to communicate major symptoms even outside of scheduled appointments. If someone discloses important information to a therapist or care manager, ensure seamless communication within the care team.

Value-Based Mindset:

Embrace a value-based approach in all aspects of healthcare delivery. Prioritize outcomes, affordability, individual experience, and provider satisfaction. This mindset becomes especially crucial as the healthcare landscape shifts towards value-based reimbursements.

Comprehensive Medication Management:

For those with complex needs and multiple medications, a comprehensive approach is essential. Beyond behavioral health, consider the physical components of care. Connect individuals with other healthcare providers, conduct referrals for mental and physical healthcare, and address mismanagement concerns promptly.

Implementing these best practices fosters a collaborative and person-centered approach to medication access in behavioral healthcare, promoting improved outcomes and a more comprehensive care experience.

Conclusion

In the realm of behavioral health, the importance of timely adherence to treatment plans cannot be overstated. While there will always be barriers to medication adherence in this vulnerable population, embracing a comprehensive care team makes a significant difference. When physicians and pharmacists collaboratively guide individuals through their treatment journey, they can better meet each person’s diverse needs.