For thousands of Wisconsinites living with severe mental health conditions, getting to a clinic every few weeks for treatment can determine whether they remain stable, employed and out of the hospital.
Milwaukee-based Hayat Pharmacy is trying to remove access barriers by bringing psychiatric care directly to patients’ homes. The pharmacy chain has recently expanded its in-home long-acting injectable medication program beyond Milwaukee County into Waukesha, Washington, Ozaukee, Racine and Kenosha counties as demand surges from healthcare providers and patients.
The service pairs patients with nurses who travel directly to patients’ homes to administer complex psychiatric medications used to treat schizophrenia, bipolar disorder, autism-related behavioral conditions and substance use disorders, among others.
Long-acting injectables (LAIs) are designed to address a longstanding challenge in psychiatric treatment: medication adherence, according to Hashim Zaibak, CEO of Hayat Pharmacy.
Most medications started as tablets that are taken by mouth daily, which, for individuals already struggling with their mental health, can be challenging.
“Doctors would prescribe a once-a-day pill, for instance, and the patient may come back a month later and only have taken half of them,” Zaibak said. “Adherence is definitely an issue.”
In response, pharmaceutical companies developed injectable versions of the medications that may only need to be injected every few weeks or months. Unlike medications such as insulin or some biologics that patients can administer themselves, however, psychiatric injectables require multiple preparation steps and must be administered by healthcare professionals under FDA guidelines.
Hayat has offered in-pharmacy administration of LAIs for years, but the company launched home visits during the COVID-19 pandemic when many patients became homebound or were afraid to leave home.
The program has continued to grow since then. Hayat now administers roughly 70 to 80 injections per week and serves between 300 and 400 patients monthly through the in-home program, which has been limited to Milwaukee County, according to Zaibak.
Zaibak said Hayat is the only pharmacy in the region that offers an in-home LAI program, and is one of few pharmacies that will administer the treatment at the pharmacy. In many cases, physicians want to prescribe the medications but lack a reliable way to ensure patients could receive the injections regularly.
“We were hearing from providers in other areas like Waukesha or Cedarburg saying, ‘I have a patient, he or she has adherence problems, I want to put them on these (LAIs), the chains are saying that they won’t do it in their pharmacy. Can Hayat help us?’” Zaibak said. “Previously, our answer was no. We realized we really needed to expand to help more patients.”
To support the expansion, the company has invested in additional nurses, vehicles and employee training.
Hashim Zaibak
“It does require a big investment,” Zaibak said. “You have to invest into training because not everybody can do this. …We’ve been so lucky that we have a team of pharmacists and nurses who really want to take care of the patient, and they don’t care about the stigma around mental health care.”
The work can be unpredictable, too. Zaibak said nurses sometimes make multiple trips to a patient’s home after missed appointments or changing schedules. In some cases, nurses have met patients in parking lots or administered the injection through a window.
“But we know that if these patients don’t receive consistent care, many end up back in the hospital,” Zaibak said.
For Hayat staff, Zaibak said the impact of the program becomes visible when patients regain stability and independence.
“The patients in Milwaukee and surrounding areas are very lucky because they have access to Hayat Pharmacy, and I’m not saying this arrogantly,” Zaibak said. “They’re lucky because they have access to this service, regardless of whether it’s offered by us or anybody else. Our nurses can share a lot of stories about patients who maybe couldn’t find work because of their condition, but once they have consistent medication, they are working at the restaurant, and they have a normal life. There’s also a big impact on caregivers. We have had a lot of parents of children (on the autism spectrum) say consistent medication changed their child’s life and their life.”
Despite demand, the economics remain difficult.
LAIs are expensive, and reimbursement structures often do not cover the cost of travel and clinical labor associated with home visits.
Private insurers frequently do not reimburse for in-home administration time at all, Zaibak said, while pharmacy benefit managers can reimburse less than the acquisition cost of the medication itself. Wisconsin Medicaid has been comparatively supportive, he said, offering reimbursement for administration services, though often not enough to fully offset all labor expenses.
“I’d be lying if I told you this program makes a lot of money,” Zaibak said. “It covers expenses, but margins are very tight.”
Still, he believes the long-term opportunity is substantial.
“There’s a need that won’t be going away, and in business, if there is a need for it — and you can do it very well and it makes money — then that’s a no-brainer,” Zaibak said.