This is an exclusive BHB+ article
The behavioral health ecosystem is typically framed as a three-part system: patient, provider, and payer. But this model leaves out a crucial partner, particularly for patients with serious mental illness (SMI) and substance use disorder: the pharmacy.
Adherence rates for medications across behavioral health are low. And missing medication, especially for those with SMI, could lead to poor outcomes, inpatient readmission and more health care spending.
Still, picking up medication poses serious barriers for many individuals, including cost, transportation and education. The challenges are even greater for those with substance use disorder (SUD), as many pharmacies don’t stock medication-assisted treatment (MAT) drugs.
There may be an opportunity for providers and pharmaceutical companies to partner with pharmacies to help ensure that medications are picked up and patients are educated.
“There’s a lot of unnecessary cost in behavioral health care and a lot of attempts to reduce that cost and improve outcomes, but it’s all very fragmented. I think it would be excellent if we could see more outcomes-based models,” Mary Ann D’Angelo, lead of behavioral health accounts at Johnson & Johnson Innovative Medicines, told me at INVEST. “I think [pharmacies] are the piece that’s missing.”
Johnson & Johnson Innovative Medicine is a pharmaceutical company that has developed medications for a range of physical and behavioral health conditions, including depression, schizophrenia and bipolar disorder.
“There’s an increased demand for behavioral health services, and [the system] can’t meet that demand,” D’Angelo said. “Pharmacies are embedded in the community. They know a lot of these patients. They’ll end up caring for them anyway. So if we could accelerate when pharmacies are brought into trying to help payers and providers achieve those outcomes, that, to me, would be a breakthrough innovation.”
Pharmacies can also play a more active role in behavioral health by expanding access to innovative therapeutics, such as long-acting injectables and digital therapeutics.
But it’s not just providers and payers who should be paying attention to the potential use case for pharmacies; there could be an opportunity for investors to fund innovative new models.
In the exclusive BHB+ Update, I will explore:
– What role pharmacies could play in the behavioral health ecosystem
– The barriers patients face in picking up behavioral health medications
– How pharmacies could help enable innovation in behavioral health
Behavioral health medications are essential for many individuals, particularly for those with a serious mental illness or substance use disorder.
Yet medication adherence is still a challenge in the industry.
Research published in The American Journal of Managed Care found that almost half of patients with major psychiatric disorders were non-adherent to their psychotropic medications.
Challenges such as transportation, cost and support have been factors in patients not picking up and subsequently taking their behavioral health medication.
There are additional barriers in the SUD space, too.
In 2023, virtual SUD provider Bicycle Health published a study that found 42.1% of the 5,3000 unique retail pharmacies its team contacted on behalf of patients didn’t stock buprenorphine.
“Although the number of prescribers willing to provide buprenorphine was identified as a barrier to this evidence-based OUD treatment in the past, pharmacy availability of buprenorphine may be an additional barrier, particularly in the post–COVID era in which telehealth can be used for patients in areas with few or no prescribers,” the authors of the study wrote. “The government’s recent elimination of a special waiver needed to prescribe buprenorphine to increase access also highlights the importance of pharmacy availability.”
New models of care
Deals between pharmacies and providers have been in the news recently. Earlier this year, virtual behavioral health provider Talkspace (Nasdaq: TALK) introduced a new integration with Amazon Pharmacy, aiming to simplify medication management for its providers.
Several specialty pharmacies are working to address access issues in behavioral health.
One example is specialty behavioral health pharmacy Advantage Healthcare Services. The pharmacy collaborates with various stakeholders, including pharmaceutical companies and health care providers, to provide care navigation services and comprehensive support to patients.
For instance, Advantage has a partnership with J&J on a program that is focused on supporting individuals diagnosed with schizophrenia and who are on the pharmaceutical’s Invega medication, exactly the kind of SMI where medication adherence is critical and gaps in care can be dangerous.
“We have invested in hiring a community health worker, or what we call community health liaison (CHL) workforce,” Henna Asad Zaidi, senior vice president of strategic partnerships at Advantage Healthcare Services, told me on stage at INVEST. “These are paraprofessionals that have lived experience that come from the communities of the patients that we serve, and we deploy our CHLs to facilities, to hospitals, to support patients from when they’re transitioning from hospital to community.”
Conceptually, it’s kind of like a transition of care program, Asad Zaidi continued.
“It’s sponsored by J&J, and it’s really given us the bandwidth to be able to provide this needed support to patients,” she said.
Advantage Healthcare Services is a California-based specialty pharmacy company focused on treating mental health and SUDs. It is backed by private equity firm Nautic Partners.
The outpatient pharmacy collaborates with discharge teams as patients transition from hospitals, partial hospitalization programs and prisons.
“The national average wait time to get in front of an outpatient psychiatrist is 67 days. If a patient is being discharged from a hospital who just had a psychiatric break, they are in no condition to handle all of that for 67 days [alone],” said D’Angelo, who has worked with Advantage on the program. “So pharmacies, like Advantage, are providing that necessary support, education, coordination of other services they need, and they collaborate with other services that exist in the community.”
While value-based care contracts have often been touted as a means to provide comprehensive services, such as care navigation support, funding challenges persist for these offerings.
Tapping into partnerships with pharma companies is a potential new funding source to offer wrap-around medication management services to patients.
Pharmacy’s role in propelling innovation
Pharmacies are also uniquely positioned to help fuel innovation in the behavioral health sector.
Desiree Priestley, chief health experience officer at Otsuka Precision Health noted at INVEST that there simply aren’t enough therapists or behavioral health providers in the country, making digital solutions necessary for the future.
At the same time, figuring out the implementation and adoption of these digital behavioral health tools, such as digital therapeutics, can be challenging.
“I think implementation and reaching patients is one way where we can absolutely collaborate with our pharmacy partners,” Priestley told me at INVEST. “Pharmacies are in those communities. They understand, especially how behavioral health works locally. And understand that behavioral health is very different in California than it is in Pennsylvania, and partnering with those systems where they can actually reach [patients] is vital.”
Otsuka Precision Health is the innovation subsidiary of Japanese pharmaceutical giant Otsuka. The organization is dedicated to using high-tech solutions to personalize care.
In 2024, Otsuka Pharmaceutical and Click Therapeutics landed FDA clearance for their digital therapeutic Rejoyn, focused on treating major depressive disorder (MDD).
Historically, digital therapeutics have faced challenges in terms of both physician and patient adoption, as well as reimbursement. Yet, pharmacies could play a role in the future of the technology.
“We’re really excited to partner with Otsuka Precision Health on supporting access to Rejoyn and digital therapeutics in general,” Zaidi said. “And I think the biggest thing when I think about the role of pharmacy is really thinking about how we can be the connective tissue between patients and providers and payers.”
Digital therapeutics could become a larger part of the behavioral health ecosystem as payers begin to reimburse for these services.
But digital therapeutics aren’t the only tool that pharmacies could help support. While long-acting injectables have been on the market for decades, adoption of these types of medications remains low.
D’Angelo noted pharmacies are an underutilized tool in the education of these medications. Additionally, in some states, pharmacists can prescribe a small number of medications, and she noted the potential benefits of allowing them to prescribe antipsychotic medications.
“They spend a lot more time with the patient than a provider,” D’Angelo said. “They can see the whole patient’s medication history. They can really look for opportunities to make sure that they’re selecting the right treatment plan to stabilize the patient and then look at those comorbid conditions to reduce polypharmacy, like just optimize medication utilization so that we optimize outcomes.”
For all of these reasons and others, in my view, pharmacies may be the under-the-radar key to the adoption of technologies and medications that have been struggling to gain widespread adoption.