1. Naloxone: Cost, Logistics, and Supply Issues Community Pharmacy Perspective Krystalyn Weaver, PharmD National Alliance of State Pharmacy Associations

2. Pharmacists Can Increase Access Pharmacists’ accessibility and qualifications for increasing naloxone access Uniquely accessible - WHO: “the health professionals most accessible to the public” Doctoral level training with a focus on medication safety, monitoring, and selection Access to prescription records from all of the patients’ prescribers Regularly use PDMPs Priority for the profession “APhA supports… laws and regulations that permit pharmacists to furnish opioid reversal agents to prevent opioid-related deaths due to overdose.”

3. Logistical and Legal Barriers Pharmacist prescribing of naloxone Statewide protocols Prescriptive authority Dispensing without a prescription Other challenges to address legislatively Dispensing to a third party (caregivers, first responders, others) Protection from civil and criminal liability

4. Pharmacists & Naloxone HI AK DC MO WV MS NH NC FL KY WA SC OH CA MD DE TN MANY RI* IL CT VT NJ MI* ME MN OR ID MT ND SD NV* UT AZNM TX WY CO NE* OK KS IA WI IN PA VA AR ALGA LA Based on data collected by NASPA (updated June 2015) Statewide naloxone protocol or prescriptive authority for pharmacists Broad** collaborative practice provisions *Broad collaborative practice provisions but need a separate agreement for each pharmacist Pharmacists are authorized to dispense without a prescription Statewide protocol or prescriptive authority bill proposed in 2015 session **Broad = Allow initiation of therapy, community pharmacists authorized to participate, no drug restrictions (may need to specify within the agreement), laws/regulations silent regarding the relationship between the prescriber and the patient

5. Access Challenges and Potential Solutions Nasal Kits Off-label status Recent price increases Minimum ordering quantity Counseling time Auto-Injector Unit cost Insurance coverage policies Primary non-adherence

6. Questions? Krystalyn Weaver, PharmD Director, Policy and State Relations kweaver@naspa.us