Pharmacists

Essentials for pharmacists on dispensing and prescribing naloxone in WA State.

Your role as a pharmacist Photo of white male pharmacist

Pharmacists play an essential role in preventing the misuse of opioids and opioid overdose in their communities. Specifically, pharmacists can:

  • Screen and identify patients at risk for opioid abuse and overdose by reviewing patient prescription histories in the state Prescription Drug Monitoring Program.
  • Counsel patients on how to use opioid medications safely and prevent adverse effects such as oversedation, overdose and addiction.
  • Participate in safe medication “take back” programs by offering temporary or permanent medication disposal receptacles.
  • Keep naloxone in current inventory and dispense to patients who have a prescription.
  • Prescribe naloxone directly to patients through a Collaborative Drug Therapy Agreement (CDTA) with a legal prescriber.

 

Providing naloxone at your pharmacy

Whether you are filling prescriptions from other providers or writing your own prescriptions directly under a collaborative practice agreement, this information will get you ready to dispense naloxone and provide appropriate opioid overdose education.

Steps to start a naloxone program:

PIcture of a checklist and pen

  1. Talk with other pharmacists who already provide naloxone. Your colleagues will have helpful tips and advice. All WA State pharmacies who currently provide naloxone are listed here.
  2. Decide if your pharmacy will only fill orders from other prescribers or also prescribe directly to the public with a collaborative drug therapy agreement (find a sample CDTA below).
  3. Select which form(s) of naloxone to carry (e.g., intranasal, intramuscular, or both).
    Order intramuscular naloxone HCL, either:

    • 2 X 1 ml single dose vial (NDC# 00409-1215-01)
    • 1 X 10 ml as one fliptop vial (NDC# 00409-1219-01)
    • 2-pack, 2mg/0.4ml prefilled auto-inject devices (Evzio™) (NDC# 60842-051-01)

    Order intranasal naloxone HCL, either:

    • 2 X 2 ml as pre-filled Needleless Luer Jet Prefilled Syringe (NDC# 76329-3369-01) plus 2 X intranasal mucosal atomizing device (MAD 300)
    • 2-pack, 4mg/0.1ml autospray devices (Narcan™) (NDC# 69547-353-02)

    This is a helpful naloxone product comparison chart for pharmacists.

  4. Photo of an overdose rescue kitPrepare an overdose rescue kit and set a price. A kit should include:
    • 2 doses of naloxone,
    • delivery devices if needed (e.g., nasal applicator or intramuscular syringe),
    • overdose education materials

    Some pharmacies also choose to include:

    • List of local social and health services providers
    • Rescue breathing mask
    • CPR Life Mask Face Shield, Healthcare Logistics, Item #7296‐01
    • Naloxone Overdose Rescue Kit Bag (recommended)
      • Kelley‐Ross Pharmacy, 206‐324‐6990
      • Sunny side utility pouch from www.anypromo.com, item #680291, customizable
      • Any other pouch/bag vendor
  5. Prepare a demonstration/practice kit so patients can demonstrate that they understand how to administer the medication properly. Hands-on practice is important.
  6. Develop in-store signage to let patients know you have naloxone. Samples can be found here.
  7. Determine how you will provide patient education. Some details to consider:
    • Which staff will do the training?
    • What materials will you use: handouts, videos, etc?

    Patient education should include:

    • Signs of an opioid overdose.
    • Importance of calling 911 and protections under WA State’s Good Samaritan overdose law
    • Steps to give rescue breathing.
    • How to administer the naloxone (based on the form you are dispensing).

    Resources:

  8. Let your local prescribers know that you are carrying naloxone.
  9. Put your pharmacy on the naloxone locator list (email: info@stopoverdose.org).
  10. Train the pharmacy team so all staff know that take-home naloxone is available, which pharmacists are authorized on the CTDA, the education to provide, and where to find answers to frequently asked questions.

Billing and Reimbursement

  • WA State Medicaid will reimburse for intramuscular and intranasal kits without pre-authorization for a person at risk of an overdose.
  • WA State Medicaid will not reimburse for naloxone kits for a potential bystander who is not at risk (e.g., a family member who does not use opioids).
  • There is a $1 Medicaid copay for generic naloxone. However, pharmacies may not deny the medication to patients who cannot afford the copay (COMAR 10.09.03.03 (M)).
  • WA Medicaid does not reimburse for the mucosal atomimizing device.
  • The EVZIO Auto Injector, which is significantly more expensive, requires pre-authorization. This type may be appropriate for people with limited motor skills or other disabilities.
  • Coverage for naloxone varies widely among commercial plans. It’s a good idea to call the most common carriers in your area to confirm coverage.

 

Collaborative drug therapy agreements for naloxone

Pharmacists can prescribe naloxone directly if they have a signed Collaborative Drug Therapy Agreement (CDTA, also known as a collaborative practice agreement) in place with a legal prescriber and on file with the Pharmacy Quality Assurance Commission.

Resources:

Instructions:

  1. Create a Collaborative Drug Therapy Agreement and identify a provider to sign off on the agreement. A sample CDTA may be downloaded here.
  2. Submit the CDTA for review by a pharmacist consultant at the Pharmacy Quality Assurance Commission.

    More information at the WA State Pharmacy Quality Assurance Commission

  3. Email info@stopoverdose.org to be placed on the WA State naloxone locator list.

 

More resources for pharmacists

These websites feature useful tools, sample prescriptions, CDTAs, patient education materials and information on naloxone ordering and billing:

Kelley-Ross logo Prescribe to Prevent logo

Kelley-Ross Pharmacy: Naloxone Provider Toolkit

Prescribe To Prevent: Pharmacy Basics

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