(109) Injectable OUD Medications via Telehealth Providers and Local Pharmacies

Background & Introduction: Medications for opioid use disorder (MOUD) are the gold standard of care for treating opioid use disorder (OUD), yet substantial barriers remain to MOUD access and retention. Long-acting injectable buprenorphine (LAIB) may offer advantages over sublingual formulations, including improved adherence and retention. However, the availability of LAIB remains more limited than other formulations. Since the COVID public health emergency, telehealth-based OUD care has emerged as a safe and high-quality service delivery modality that may extend access to MOUD by expanding geographic reach and increasing convenience, helping more patients opt into care. Integrating LAIB administration into local pharmacies as additional sites of care (ASOC) can further enhance MOUD access by operationalizing LAIB delivery for patients receiving telehealth-based OUD treatment. Pharmacies are more abundant and accessible than the limited specialized treatment settings that currently offer LAIB, and pharmacists are trusted healthcare providers who can play a pivotal supporting role in patient education, monitoring, and follow-up. This pilot aims to evaluate the feasibility of a novel collaboration between a telehealth-based OUD treatment provider and local ASOC pharmacies to prescribe and administer LAIB as part of a scalable, low-barrier model for comprehensive OUD care.

Methods: Patients in care for OUD from a telehealth-based OUD treatment provider were screened for inclusion in the LAIB pilot in two states (PA, VT). Eligible patients were maintained on ≥4mg sublingual buprenorphine, had insurance coverage, and access to a local ASOC pharmacy. Eligible patients were seen by one of seven clinicians participating in the pilot for a 30-minute virtual visit to confirm clinical suitability and patient interest and to provide medication counseling. LAIB prescriptions were sent to a REMS-certified fulfillment pharmacy; upon receipt, a pharmacy-based coordinator contacted the patient to confirm the preferred administration site, verify insurance coverage, and schedule the injection appointment (typically within 1-2 weeks). The pharmacy site administered injections, sent confirmation and visit documentation to the OUD provider, and scheduled subsequent injections. Patients continued to have virtual follow-up visits with the OUD provider at least once monthly. Baseline patient demographic and clinical characteristics are reported as well as rates of those receiving 1). a LAIB prescription, 2). a first LAIB injection, and 3). any subsequent LAIB injection. Key challenges are also characterized.

Results: A total of 38 patients attended an initial pilot consultation between November 2024 and December 2025. Among these, 33 patients (87%) received an initial LAIB prescription; among the 5 patients who did not receive an initial prescription, the most common reason (n=3, 60%) was the patient changing their mind about transitioning to LAIB. Among 28 patients with initial prescriptions through November 2025 (i.e., with sufficient follow-up to assess receipt of an injection), 20 (71%) received an initial injection at a local ASOC pharmacy. Among the 8 patients who did not receive an initial injection, the most common reason (n=5, 63%) was insurance barriers. The 20 patients who received an initial injection had a mean age of 38.6 (SD=6.8) and were mostly male (n=13, 65%) and non-Hispanic white (n=14, 70%), and nearly half (n=8, 40%) had an actively managed co-occurring behavioral health condition. At the time of their first LAIB prescription, patients had been in care with the telehealth OUD provider for an average of 350 days (SD=341), with most (n=11, 55%) on a maintenance buprenorphine dose of 16mg, (n=3 [15%] < 16mg and n=6 [30%] >16mg). All patients initiated injections at a monthly cadence, with most patients (n=18, 90%) receiving an initial LAIB dose of 300mg of SUBLOCADE®. Among 18 patients who received an initial injection through December 15, 2025 (i.e., with sufficient follow-up to assess administration of a subsequent injection), 15 (83%) patients were administered a subsequent injection. Key challenges in pilot implementation included limited availability of ASOC pharmacy sites across all regions (resulting in more patient demand than supply), significant variation in state restrictions and insurance plan policies that require extensive time to parse and navigate, and limited insurance coverage for LAIB.

Conclusion & Discussion: In this pilot study, we found that prescribing LAIB via a telehealth OUD care team and partnering with local ASOC pharmacies to administer the injections was a feasible strategy for providing LAIB formulations to patients receiving remote OUD care. Although long-term retention is yet to be assessed, the majority of patients were administered a second injection, suggesting that the clinical workflow involving multiple providers is acceptable to patients. While feasible, the varied legal, regulatory, and insurance landscape governing LAIB provision via ASOC pharmacies presents significant structural barriers that may impede this strategy from reaching maximum impact.

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