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morning, white for noon, orange
for evening, blue for bedtime). This
approach ensures that individuals
receive the correct dose at the
appropriate time. It is also designed
to increase medication adherence.
Multi-dose packaging is one
way to support medication
adherence. Another way that
long-term care (LTC) pharmacies
can help CCBHC’s and the
patients they serve is through
a combination of prompt drug
reviews and efficient medication
adjustments (such as repacks),
which increases adherence and
reduces hospitalizations. CCBHC’s
also benefit from collaborations
with LTC pharmacies that
incorporate Quality Improvement
(QI) programs, hold quarterly
coordination meetings with
medical and nursing teams,
and provide consultations for
specific challenging cases.
Who is Horizon Pharmacy
and how are we unique?
It’s been established that Rhode
Island has a significant need
when it comes to mental health
services. Horizon Pharmacy
seeks to be part of a solution
to serve our constituents.
Horizon Pharmacy’s motto is,
Your Pharmacy, Our Community.
We live it every day.
Founded in 2014, we are a
statewide closed-door long-term
care pharmacy providing packaged
medication for complex care
patients. Owned by Community
Care Alliance, Thrive Behavioral
Health, and Newport Mental
Health, Horizon Pharmacy aims to
enhance medication services and
treatments, and generate revenue
for its non-profit owners so they can
continue to support their combined
mission of quality behavioral
healthcare in Rhode Island.
Horizon offers customized training,
including mental health first aid
to all staff, board certification
for pharmacists, and advanced
pharmacy technician training,
at no cost. This ensures best-in-
class medication management
for patients while enabling access
to behavioral and substance use
healthcare at free or reduced costs
for over 1,000 individuals annually
(via our nonprofit partners).
Does the program really
make a difference?
Since its founding in 2014,
Horizon Pharmacy has enhanced
therapeutic outcomes in long-
term care through the delivery
of customized pharmaceutical
services. Our initiatives have also
advanced the quality of behavioral
health services throughout
Rhode Island. This is evidenced
through our proven results.
Recently, Horizon Pharmacy
commissioned a comprehensive
review of claims data with
Integrated Healthcare Partners, an
Accountable Care Organization.
Our goal was two-fold: assess
our work in supporting the
CCBHC programs’ goal of
increasing behavioral health
utilization across the state; and
establish specific pharmacology
benchmarks for CCBHCs. The
findings were compelling.
For the calendar years 2022-
2024, Horizon Pharmacy and the
patients served demonstrated the
results below. Of patients engaged
with Horizon Pharmacy vs. other
retail and LTC pharmacies:
• 14.3-28.5% were more likely
to achieve compliance with
the CCBHC depression
medication measure.
• 9.1-10.7% would achieve
compliance with the
CCBHC Schizophrenia
medication measure.
• 22-36% less likely to use the
emergency department (ED).
• 38-45% less likely to use
inpatient services for diabetes
or hypertension.
• 5-7% better compliance with
blood pressure medication.
These impressive benchmarks
quantitatively show that close
collaboration between Horizon
Pharmacy and CCBHC’s
results in significant reductions
in the Total Cost of Care
(TCC) for both individuals as
well as insurance providers.
Where do you see future
opportunities?
Among the required services
of CCBHC are evidence-based
practices such as Medication
Assisted Treatment (MAT) and care
coordination for Opioid Treatment
Program (OTP) that are intended to
engage individuals outside of an in-
patient or emergency service setting.
These treatment modalities often
include short term medications
provided to patients to stabilize
and provide comfort. For example,
a patient experiencing withdrawal
who is stable and comfortable
will more likely agree to enter a
30-day detox treatment program.
At Horizon Pharmacy, we believe
we can help patients get access
to these short-term medications
in a safe and efficient way by
implementing Automated Storage
and Distribution Devices (ASDD).
These devices can be in licensed
facilities operated by licensed
healthcare professionals.
The benefits of using automated
dispensing onsite at these facilities,
where the ASDD machine is
controlled by the pharmacy servicing
that facility, is that it provides security,
increased accountability, and
overall cost savings on medications.
In addition, the ASDD machine
facilitates immediate access to
life-saving addiction treatment,
truly meeting patients where they
are now. This model has facilitated
the growth of new medications
for opioid use disorder treatment
that often starts in addiction
treatment clinical settings.4
However, despite these benefits,
there are obstacles in implementing
automated dispensing broadly.
Automated dispensing is regulated
by each state’s board of pharmacy
and that means 51 different policies
nationwide. Some states are very
permissive in the use of technology
while others are not. These states
cite patient safety, compliance,
and general lack of oversight as
the main reasons for not allowing
the machine to be used.
We hope this will change.
What can your LTC
pharmacy do?
Train pharmacy staff in empathy
and compassion to better engage
with individuals in the mental
health community. At Horizon
Pharmacy, all employees undergo
mental health first aid training for
adults and children, enhancing
their sensitivity and confidence in
these interactions. Our customer
service training is designed for
technicians to engage nursing,
residential, and prescribing staff
in long-term care settings.
Engage with your state behavioral
health and substance use authority,
as well as the community mental
health providers in your area.
Ask them if they are aware of
CCBHC and if so, ask if they
have a roadmap for its adoption.
Integrating CCBHC with LTC
pharmacy assets can reduce
costs for patients and community
health systems. This will be
critical as federal government
continues to review Medicaid,
SAMSHA, and other programs
for continuation and funding.
Regardless of the CCBHC
status in your community, LTC
pharmacies have tools available
for these communities of care.
It is advisable to establish these
connections and relationships.
Be curious and active.
References:
1 Mental Health America from 2024 ranks Rhode
Island as 31st in the percentage of adults with any
mental illness, with a percentage of 24.67%.
2 HHS TAGGS - https://taggs.hhs.gov/Detail/
AwardDetail?arg_AwardNum=H79SM081870&arg_
ProgOfficeCode=80
3 Alabama, Illinois, Indiana, Iowa, Kansas, Kentucky,
Maine, New Hampshire, New Mexico, Michigan,
Missouri, Nevada, New Jersey, New York, Oklahoma,
Oregon, Rhode Island, and Vermont.
4 Taylor JL, Laks J, Christine PJ, et al. Bridge clinic
implementation of “72-hour rule” methadone
for opioid withdrawal management: Impact on
opioid treatment program linkage and retention
in care. Drug Alcohol Depend. 2022;236:109497.
doi:10.1016/j.drugalcdep.2022.109497
20WAYS TO IMPROVE PATIENT CARE & PHARMACY PROFITABILITY