{"id":26,"date":"2021-09-09T12:59:45","date_gmt":"2021-09-09T12:59:45","guid":{"rendered":"https:\/\/wp.media.unc.edu\/bupe\/?page_id=26"},"modified":"2024-06-14T14:05:57","modified_gmt":"2024-06-14T14:05:57","slug":"how-to-overcome-access-barriers-at-your-pharmacy","status":"publish","type":"page","link":"https:\/\/wp.media.unc.edu\/bupe\/how-to-overcome-access-barriers-at-your-pharmacy\/","title":{"rendered":"Overcoming Barriers"},"content":{"rendered":"\r\n<p>Several statements about the barriers facing patients with opioid use disorder are listed below. Decide whether each statement is true or false, and then click the button that corresponds with your response. Feedback is provided in the right column.<\/p>\r\n<figure class=\"wp-block-table is-style-regular barriers\"><table><thead><tr><th style=\"width: 40%\">Statement<\/th><th style=\"width: 20%\">True or False<\/th><th style=\"width: 40%\">Feedback<\/th><\/tr><\/thead><tbody><tr><td>Opioid use disorder patients who cannot get their buprenorphine prescription filled have an increased likelihood of obtaining a new opioid prescription.<\/td><td>\r\n<form action=\"#\" id=\"Q1\"><input type=\"radio\" id=\"t1\" name=\"TF1\" value=\"True\"><label for=\"t1\">True<\/label><\/><input type=\"radio\" id=\"f1\" name=\"TF1\" value=\"False\"><label for=\"f1\">False<\/label><\/>\r\n<\/form>\r\n<\/td><td><p id=\"fb1\" class=\"hide\"><span id=\"cross1\" class=\"hide\" color=\"#FF0000\"><img decoding=\"async\" src=\"https:\/\/wp.media.unc.edu\/bupe\/wp-content\/uploads\/sites\/16\/2021\/12\/cross.png\" class=\"img-cross\"\/><\/span><span id=\"check1\" class=\"hide\" color=\"#FF0000\"><img decoding=\"async\" src=\"https:\/\/wp.media.unc.edu\/bupe\/wp-content\/uploads\/sites\/16\/2021\/12\/check.png\" class=\"img-check\"\/><\/span>This statement is true. OUD patients who lose access to buprenorphine are more likely to obtain a new opioid prescription.<sup id=\"popoverMMM\" class=\"citation\" title=\"Citation\" data-toggle=\"popover\" data-html=\"true\" data-placement=\"bottom\">13<\/sup><\/td><\/tr><tr><td>Opioid use disorder patients who cannot get their buprenorphine prescription filled are at increased risk of discontinuing treatment.&nbsp;<\/td><td><form action=\"#\" id=\"Q2\"><input type=\"radio\" id=\"t2\" name=\"TF2\" value=\"True\"><label for=\"t2\">True<\/label><input type=\"radio\" id=\"f2\" name=\"TF2\" value=\"False\"><label for=\"f2\">False<\/label><\/form><\/td><td><p id=\"fb2\" class=\"hide\"><span id=\"cross2\" class=\"hide\" color=\"#FF0000\"><img decoding=\"async\" src=\"https:\/\/wp.media.unc.edu\/bupe\/wp-content\/uploads\/sites\/16\/2021\/12\/cross.png\" class=\"img-cross\"\/><\/span><span id=\"check2\" class=\"hide\" color=\"#FF0000\"><img decoding=\"async\" src=\"https:\/\/wp.media.unc.edu\/bupe\/wp-content\/uploads\/sites\/16\/2021\/12\/check.png\" class=\"img-check\"\/><\/span>This statement is true. Pharmacists can encourage patients to stay engaged in treatment.<\/p><\/td><\/tr><tr><td>Opioid use disorder patients who cannot get their buprenorphine prescription filled are at increased risk of using non-prescribed substances.<\/td><td><form action=\"#\" id=\"Q3\"><input type=\"radio\" id=\"t3\" name=\"TF3\" value=\"True\"><label for=\"t3\">True<\/label><input type=\"radio\" id=\"f3\" name=\"TF3\" value=\"False\"><label for=\"f3\">False<\/label><\/form><\/td><td><p id=\"fb3\" class=\"hide\"><span id=\"cross3\" class=\"hide\" color=\"#FF0000\"><img decoding=\"async\" src=\"https:\/\/wp.media.unc.edu\/bupe\/wp-content\/uploads\/sites\/16\/2021\/12\/cross.png\" class=\"img-cross\"\/><\/span><span id=\"check3\" class=\"hide\" color=\"#FF0000\"><img decoding=\"async\" src=\"https:\/\/wp.media.unc.edu\/bupe\/wp-content\/uploads\/sites\/16\/2021\/12\/check.png\" class=\"img-check\"\/><\/span>This statement is true.&nbsp;When unable to obtain medications for opioid use disorder, OUD patients are more likely to return to use.<sup id=\"popoverN\" class=\"citation\" title=\"Citation\" data-toggle=\"popover\" data-html=\"true\" data-placement=\"bottom\">18,19<\/sup><\/td><\/tr><tr><td>Opioid use disorder patients who cannot get their buprenorphine prescription filled are at increased risk of an emergency department visit.<\/td><td><form action=\"#\" id=\"Q4\"><input type=\"radio\" id=\"t4\" name=\"TF4\" value=\"True\"><label for=\"t4\">True<\/label><input type=\"radio\" id=\"f4\" name=\"TF4\" value=\"False\"><label for=\"f4\">False<\/label><\/form><\/td><td><p id=\"fb4\"class=\"hide\"><span id=\"cross4\" class=\"hide\" color=\"#FF0000\"><img decoding=\"async\" src=\"https:\/\/wp.media.unc.edu\/bupe\/wp-content\/uploads\/sites\/16\/2021\/12\/cross.png\" class=\"img-cross\"\/><\/span><span id=\"check4\" class=\"hide\" color=\"#FF0000\"><img decoding=\"async\" src=\"https:\/\/wp.media.unc.edu\/bupe\/wp-content\/uploads\/sites\/16\/2021\/12\/check.png\" class=\"img-check\"\/><\/span>This statement is true. When OUD patients lose access to buprenorphine, they are at greater risk for needing care in an emergency room.<sup id=\"popoverMMMMM\" class=\"citation\" title=\"Citation\" data-toggle=\"popover\" data-html=\"true\" data-placement=\"bottom\">17<\/sup><\/td><\/tr><tr><td>Opioid use disorder patients who cannot get their buprenorphine prescription filled are at increased risk of overdose.<\/td><td><form action=\"#\" id=\"Q5\"><input type=\"radio\" id=\"t5\" name=\"TF5\" value=\"True\"><label for=\"t5\">True<\/label><input type=\"radio\" id=\"f5\" name=\"TF5\" value=\"False\"><label for=\"f5\">False<\/label><\/form><\/td><td><p id=\"fb5\"class=\"hide\"><span id=\"cross5\" class=\"hide\" color=\"#FF0000\"><img decoding=\"async\" src=\"https:\/\/wp.media.unc.edu\/bupe\/wp-content\/uploads\/sites\/16\/2021\/12\/cross.png\" class=\"img-cross\"\/><\/span><span id=\"check5\" class=\"hide\" color=\"#FF0000\"><img decoding=\"async\" src=\"https:\/\/wp.media.unc.edu\/bupe\/wp-content\/uploads\/sites\/16\/2021\/12\/check.png\" class=\"img-check\"\/><\/span>This statement is true. Access to MOUD reduces overdose death risk. Overdose death rates are measurably higher in counties where residents have less access to buprenorphine.<sup id=\"popoverP\" class=\"citation\" title=\"Citation\" data-toggle=\"popover\" data-html=\"true\" data-placement=\"bottom\">2,20<\/sup><\/p><\/td><\/tr><tr><td>Opioid use disorder patients who cannot get their buprenorphine prescription filled are at increased risk of all-cause mortality.<\/td><td><form action=\"#\" id=\"Q6\"><input type=\"radio\" id=\"t6\" name=\"TF6\" value=\"True\"><label for=\"t6\">True<\/label><input type=\"radio\" id=\"f6\" name=\"TF6\" value=\"False\"><label for=\"f6\">False<\/label><\/form><\/td><td><p id=\"fb6\" class=\"hide\"><span id=\"cross6\" class=\"hide\" color=\"#FF0000\"><img decoding=\"async\" src=\"https:\/\/wp.media.unc.edu\/bupe\/wp-content\/uploads\/sites\/16\/2021\/12\/cross.png\" class=\"img-cross\"\/><\/span><span id=\"check6\" class=\"hide\" color=\"#FF0000\"><img decoding=\"async\" src=\"https:\/\/wp.media.unc.edu\/bupe\/wp-content\/uploads\/sites\/16\/2021\/12\/check.png\" class=\"img-check\"\/><\/span>This statement is true.&nbsp;OUD patients unable to access medications for opioid use disorder have higher rates of all-cause mortality.<sup id=\"popoverR\" class=\"citation\" title=\"Citation\" data-toggle=\"popover\" data-html=\"true\" data-placement=\"bottom\">21<\/sup><\/p><\/td><\/tr><\/tbody><\/table><\/figure>\r\n\r\n\r\n<div id=\"popoverMMM-content\" class=\"popover-content hide\">\r\n<div id=\"MMM\"><button id=\"MMM\" class=\"close\" type=\"button\">\u00d7<\/button><p><\/p>\r\n<ol start=\"13\">\r\n<li value=\"13\">Strickland DM, Burson JK. Sublingual absorption of naloxone in a large clinical population. <em>J Drug Metab Toxicol.<\/em> 2018;9(02):240.<\/li>\r\n<\/ol>\r\n<\/div>\r\n<\/div>\r\n<div id=\"popoverMMMMM-content\" class=\"popover-content hide\">\r\n<div id=\"MMMMM\"><button id=\"MMMMMM\" class=\"close\" type=\"button\">\u00d7<\/button><p><\/p>\r\n<ol start=\"17\">\r\n<li value=\"17\">Williams AR, Samples H, Crystal S, Olfson M. Acute care, prescription opioid use, and overdose following discontinuation of long-term buprenorphine treatment for opioid use disorder.<em> American Journal of Psychiatry.<\/em> 2020;177(2):117-124.<\/li>\r\n<\/ol>\r\n<\/div>\r\n<\/div>\r\n<div id=\"popoverN-content\" class=\"popover-content hide\">\r\n<div id=\"N\"><button id=\"N\" class=\"close\" type=\"button\">\u00d7<\/button><p><\/p>\r\n<ol start=\"18\">\r\n<li value=\"18\">Davoli M, Perucci CA, Forastiere F, et al. Risk factors for overdose mortality: a case-control study within a cohort of intravenous drug users. <em>International Journal of Epidemiology.<\/em> 1993;22(2):273-277.<\/li>\r\n<li value=\"19\">O\u2019Halloran C, Cullen K, Njoroge J, et al. The extent of and factors associated with self-reported overdose and self-reported receipt of naloxone among people who inject drugs (PWID) in England, Wales and Northern Ireland. <em>International Journal of Drug Policy.<\/em> 2017;46:34-40. doi:10.1016\/j.drugpo.2017.05.017<\/li>\r\n<\/ol>\r\n<\/div>\r\n<\/div>\r\n<div id=\"popoverMMM-content\" class=\"popover-content hide\">\r\n<div id=\"MMM\"><button id=\"MMM\" class=\"close\" type=\"button\">\u00d7<\/button><p><\/p>\r\n<ol start=\"13\">\r\n<li value=\"13\">Strickland DM, Burson JK. Sublingual absorption of naloxone in a large clinical population. <em>J Drug Metab Toxicol.<\/em> 2018;9(02):240.<\/li>\r\n<\/ol>\r\n<\/div>\r\n<\/div>\r\n<div id=\"popoverP-content\" class=\"popover-content hide\">\r\n<div id=\"P\"><button id=\"P\" class=\"close\" type=\"button\">\u00d7<\/button><p><\/p>\r\n<ol start=\"16\">\r\n<li value=\"2\">Carroll J, Green T, Noonan R. <em>Evidence-Based Strategies for Preventing Opioid Overdose: What\u2019s Working in the United States, 2018.<\/em> Centers for Disease Control; 2018:40. Accessed December 2, 2019. <a href=\"https:\/\/www.cdc.gov\/drugoverdose\/pdf\/pubs\/2018-evidence-based-strategies.pdf\">https:\/\/www.cdc.gov\/drugoverdose\/pdf\/pubs\/2018-evidence-based-strategies.pdf<\/a> <\/li>\r\n<li value=\"20\">Flavin L, Malowney M, Patel N, et al. Availability of Buprenorphine Treatment in the 10 States With the Highest Drug Overdose Death Rates in the United States. <em>Journal of Psychiatric Practice.<\/em> 2020;26(1):17-22.<\/li>\r\n<\/ol>\r\n<\/div>\r\n<\/div>\r\n<div id=\"popoverR-content\" class=\"popover-content hide\">\r\n<div id=\"R\"><button id=\"R\" class=\"close\" type=\"button\">\u00d7<\/button><p><\/p>\r\n<ol start=\"21\">\r\n<li value=\"21\">Ma J, Bao YP, Wang RJ, et al. Effects of medication-assisted treatment on mortality among opioids users: a systematic review and meta-analysis. <em>Mol Psychiatry.<\/em> 2019;24(12):1868-1883. doi:10.1038\/s41380-018-0094-5<\/li>\r\n<\/ol>\r\n<\/div>\r\n<\/div>\r\n<h3>Endorsement of the American Pharmacists Association<\/h3>\r\n<p>The American Pharmacists Association (2020) endorses pharmacists\u2019 role in increasing access to and advocacy for medications for opioid use disorder.<\/p>\r\n\r\n\r\n<blockquote class=\"wp-block-quote\"><p>APhA supports the use of evidence-based medication as first-line treatment for opioid use disorder for patients&#8230; for as long as needed to treat their disease\u2026 APhA encourages pharmacies to maintain an inventory of medications of public health importance, particularly medications for opioid use disorder, to ensure access for patients. APhA encourages pharmacists and payers [to] ensure patients have equitable access to and coverage for at least one medication from each class of medications used in the treatment of opioid use disorder, [for example by] making medications available on the payer\u2019s lowest cost-sharing tier.\u201d<sup id=\"popoverS\" class=\"citation\" title=\"Citation\" data-toggle=\"popover\" data-html=\"true\" data-placement=\"bottom\">22<\/sup><span class=\"cite\">APhA 2020<span><\/p><\/blockquote>\r\n\r\n\r\n<div id=\"popoverS-content\" class=\"popover-content hide\">\r\n<div id=\"S\"><button id=\"S\" class=\"close\" type=\"button\">\u00d7<\/button>\r\n<p>\u00a0<\/p>\r\n<ol start=\"22\">\r\n<li value=\"22\">American Pharmacists Association. <em>Increasing Access to and Advocacy for Medications for Opioid Use Disorder (MOUD).<\/em>; 2020. Accessed August 10, 2020. <a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7440871\">https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7440871\/<\/a><\/li>\r\n<\/ol>\r\n<\/div>\r\n<\/div>\r\n<h3>&#8220;Red flags&#8221; &#8211; when not to worry<\/h3>\r\n<p>Some pharmacists report reluctance to dispense buprenorphine in specific scenarios, citing \u201cred flags.\u201d However, in many cases legislation and other guidance on controlled substance dispensing, for example, the NC STOP Act, outlines verification procedures for each scenario rather than directing pharmacists not to dispense.<\/p>\r\n<p>Detailed guidance from the NC Stop Act for each of these scenarios is shown below.<sup>23<\/sup> Click each scenario to learn more.<\/p>\r\n<div id=\"popoverW-content\" class=\"popover-content hide\">\r\n<div id=\"W\"><button id=\"W\" class=\"close\" type=\"button\">\u00d7<\/button><\/div>\r\n<\/div>\r\n<figure class=\"wp-block-table\"><div class=\"panel-group reflags\" id=\"oscitas-accordion-0\">        <div class=\"panel panel-default\">\n            <div class=\"panel-heading\">\n              <h4 class=\"panel-title\">\n                <a class=\"accordion-toggle collapsed\" data-toggle=\"collapse\"\n                data-parent=\"#oscitas-accordion-0\"\n                href=\"#details-0-0\">\n                New Patient\n                <\/a>\n              <\/h4>\n            <\/div>\n            <div id=\"details-0-0\" class=\"panel-collapse collapse \">\n              <div class=\"panel-body\"><table width=\"100%\" class=\"table \" style=\"\"><thead><tr><th>Guidance for Targeted Controlled Substances (including buprenorphine)<\/th><\/tr><\/thead><tbody><tr><td>\r\n<p>\u2705<em>The STOP Act does not require checking CSRS for a newly prescribed patient\/new script. You may choose to do so and document if you wish.<\/em><\/p>\r\n<ul>\r\n<li>Scripts from new patients will increase as eligible prescribers increase.<\/li>\r\n<\/ul>\r\n<\/td><\/tr><\/tbody><\/table><\/div>\n            <\/div>\n        <\/div>        <div class=\"panel panel-default\">\n            <div class=\"panel-heading\">\n              <h4 class=\"panel-title\">\n                <a class=\"accordion-toggle collapsed\" data-toggle=\"collapse\"\n                data-parent=\"#oscitas-accordion-0\"\n                href=\"#details-0-1\">\n                New or Out-of-Area Prescriber\n                <\/a>\n              <\/h4>\n            <\/div>\n            <div id=\"details-0-1\" class=\"panel-collapse collapse \">\n              <div class=\"panel-body\"><table width=\"100%\" class=\"table \" style=\"\"><thead><tr><th>Guidance for Targeted Controlled Substances (including buprenorphine)<\/th><\/tr><\/thead><tbody><tr><td>\r\n<p>\u2705<em>Review the CSRS and document.<\/em><\/p>\r\n<ul>\r\n<li>Scripts from new patients will increase as eligible prescribers increase.<\/li>\r\n<li>Telehealth prescribing may lead to increased access, particularly in rural areas. <\/li>\r\n<li>Many patients must travel outside their local community to fill their prescription when local pharmacies encounter wholesaler thresholds on buprenorphine ordering.<\/li>\r\n<li>Some patients may cross a state border due to state-specific restrictions on a particular formulation (e.g. mono product restrictions in TN).<\/li>\r\n<\/ul>\r\n<\/td><\/tr><\/tbody><\/table><\/div>\n            <\/div>\n        <\/div>        <div class=\"panel panel-default\">\n            <div class=\"panel-heading\">\n              <h4 class=\"panel-title\">\n                <a class=\"accordion-toggle collapsed\" data-toggle=\"collapse\"\n                data-parent=\"#oscitas-accordion-0\"\n                href=\"#details-0-2\">\n                Request early fills\n                <\/a>\n              <\/h4>\n            <\/div>\n            <div id=\"details-0-2\" class=\"panel-collapse collapse \">\n              <div class=\"panel-body\"><table width=\"100%\" class=\"table \" style=\"\"><thead><tr><th>Guidance for Targeted Controlled Substances (including buprenorphine)<\/th><\/tr><\/thead><tbody><tr><td>\r\n<p>\u2705 Review CSRS and document<\/p>\r\n<ul>\r\n<li>Patients with OUD commonly express that buprenorphine makes them feel like they can function and have a normal life. Consequently, the thought that they could run out of their medication can result in considerable anxiety and concern about experiencing withdrawal from buprenorphine, which can cause them to seek a refill early so they know that they will have their buprenorphine on hand.<\/li>\r\n<li>Patients prescribed buprenorphine may request an early fill when anticipating travel or anticipate difficulty getting to the pharmacy (transportation issues), to avoid experiencing withdrawal due to dispensing delays.<\/li>\r\n<\/ul>\r\n<\/td><\/tr><\/tbody><\/table><\/div>\n            <\/div>\n        <\/div>        <div class=\"panel panel-default\">\n            <div class=\"panel-heading\">\n              <h4 class=\"panel-title\">\n                <a class=\"accordion-toggle collapsed\" data-toggle=\"collapse\"\n                data-parent=\"#oscitas-accordion-0\"\n                href=\"#details-0-3\">\n                Patient out of usual geographic area served by pharmacy\n                <\/a>\n              <\/h4>\n            <\/div>\n            <div id=\"details-0-3\" class=\"panel-collapse collapse \">\n              <div class=\"panel-body\"><table width=\"100%\" class=\"table \" style=\"\"><thead><tr><th>Guidance for Targeted Controlled Substances (including buprenorphine)<\/th><\/tr><\/thead><tbody><tr><td>\r\n<p>\u2705 Review CSRS and document<\/p>\r\n<ul>\r\n<li>Scripts will increase with the increase in eligible prescribers.<\/li>\r\n<li>Many patients must travel outside their local community to fill their prescription when local pharmacies encounter wholesaler thresholds on buprenorphine ordering.<\/li>\r\n<\/ul>\r\n<\/td><\/tr><\/tbody><\/table><\/div>\n            <\/div>\n        <\/div>        <div class=\"panel panel-default\">\n            <div class=\"panel-heading\">\n              <h4 class=\"panel-title\">\n                <a class=\"accordion-toggle collapsed\" data-toggle=\"collapse\"\n                data-parent=\"#oscitas-accordion-0\"\n                href=\"#details-0-4\">\n                Telehealth Provider\n                <\/a>\n              <\/h4>\n            <\/div>\n            <div id=\"details-0-4\" class=\"panel-collapse collapse \">\n              <div class=\"panel-body\"><table width=\"100%\" class=\"table \" style=\"\"><thead><tr><th>Guidance for Targeted Controlled Substances (including buprenorphine)<\/th><\/tr><\/thead><tbody><tr><td>\r\n<p>\u2705 The STOP Act predates the ruling that allows prescribers to prescribe buprenorphine via telehealth. Therefore, there is no distinct requirement to check the CSRS; however, pharmacists may review the CSRS prior to dispensing. <\/p>\r\n<ul>\r\n<li>The Substance Abuse and Mental Health Services Administration issued a final rule (add date) that permanently allows patients to be prescribed buprenorphine via telehealth.<\/li> \r\n<li>Starting buprenorphine treatment for OUD through telehealth was associated with an increased likelihood of staying in treatment compared to starting treatment in a non-telehealth setting.<sup>25<\/sup><\/li> \r\n<li>Telehealth providers are licensed providers qualified to care for patients with opioid use disorder. If there are concerns about the legitimacy of the script, pharmacists are welcome to reach out to the prescriber, as they would any other medication, and document this on the script.<\/li> \r\n<\/ul>\r\n<\/td><\/tr><\/tbody><\/table><\/div>\n            <\/div>\n        <\/div>        <div class=\"panel panel-default\">\n            <div class=\"panel-heading\">\n              <h4 class=\"panel-title\">\n                <a class=\"accordion-toggle collapsed\" data-toggle=\"collapse\"\n                data-parent=\"#oscitas-accordion-0\"\n                href=\"#details-0-5\">\n                Prescription Duration\n                <\/a>\n              <\/h4>\n            <\/div>\n            <div id=\"details-0-5\" class=\"panel-collapse collapse \">\n              <div class=\"panel-body\"><table width=\"100%\" class=\"table \" style=\"\"><thead><tr><th>Guidance for Targeted Controlled Substances (including buprenorphine)<\/th><\/tr><\/thead><tbody><tr><td>\r\n<p><em>\u2705 There is no requirement for pharmacists to review the CSRS based on length of buprenorphine prescription.<\/em><\/p>\r\n<ul>\r\n<li>Buprenorphine scripts, similar to all other C III medications may be filled no more than 6 months after the date written date or refilled more than 5 times. Patients on stable doses of buprenorphine may have refills on their scripts, similar to other C III medications.<\/li> \r\n<li>Evidence-based guidelines recommend OUD treatment with buprenorphine for as long as beneficial. Some clinical guidelines state one year minimum and longer in pregnancy\/postpartum.<\/li>\r\n<\/ul>\r\n<\/td><\/tr><\/tbody><\/table><\/div>\n            <\/div>\n        <\/div>        <div class=\"panel panel-default\">\n            <div class=\"panel-heading\">\n              <h4 class=\"panel-title\">\n                <a class=\"accordion-toggle collapsed\" data-toggle=\"collapse\"\n                data-parent=\"#oscitas-accordion-0\"\n                href=\"#details-0-6\">\n                Medication requested by name, imprint, or description\n                <\/a>\n              <\/h4>\n            <\/div>\n            <div id=\"details-0-6\" class=\"panel-collapse collapse \">\n              <div class=\"panel-body\"><table width=\"100%\" class=\"table \" style=\"\"><thead><tr><th>Guidance for Targeted Controlled Substances (including buprenorphine)<\/th><\/tr><\/thead><tbody><tr><td>\r\n<p>\u2705 Review CSRS and document<\/p>\r\n<p>Patients may request a specific formulation for any of the following reasons:<\/p>\r\n<ul>\r\n<li>Insurance may only cover one formulation<\/li>\r\n<li>Patient assistance may only be available for a certain formulation<\/li>\r\n<li>Patient is more familiar and comfortable with a specific product<\/li>\r\n<li>Patient prefers to continue on a medication that they used in the past<\/li>\r\n<\/ul>\r\n<\/td><\/tr><\/tbody><\/table><\/div>\n            <\/div>\n        <\/div>        <div class=\"panel panel-default\">\n            <div class=\"panel-heading\">\n              <h4 class=\"panel-title\">\n                <a class=\"accordion-toggle collapsed\" data-toggle=\"collapse\"\n                data-parent=\"#oscitas-accordion-0\"\n                href=\"#details-0-7\">\n                Mono vs Combo Product\n                <\/a>\n              <\/h4>\n            <\/div>\n            <div id=\"details-0-7\" class=\"panel-collapse collapse \">\n              <div class=\"panel-body\"><table width=\"100%\" class=\"table \" style=\"\"><thead><tr><th>Guidance for Targeted Controlled Substances (including buprenorphine)<\/th><\/tr><\/thead><tbody><tr><td>\r\n<p><em>There is no requirement for pharmacists to review the CSRS based on buprenorphine formulation prescribed.<\/em><\/p>\r\n<p>Providers may prescribe mono vs. combo product for any of the following reasons:<\/p>\r\n<ul>\r\n<li>Prescribers determine the best option for a given patient\u2019s circumstances, for example, allergy\/intolerance, insurance limitation, et cetera.<\/li>\r\n<li>Insurance may only cover a certain formulation<\/li>\r\n<li>Patient assistance may only be available for a certain formulation<\/li>\r\n<li>As of late 2021, the DEA and the Department of Justice demonstrated a preference for pharmacies to document a reason for dispensing mono-product buprenorphine. The prescriber can provide rationale with the script, such as &#8216;Patient reported adverse reaction to naloxone.&#8217; If not, a pharmacist can inquire and document the response.<\/li>\r\n<\/ul>\r\n<\/td><\/tr><\/tbody><\/table><\/div>\n            <\/div>\n        <\/div><\/div><\/span><\/p>\r\n<\/figure>\r\n<p>References: NC Legislature. STOP Act.; 2017. <a href=\"http:\/\/www.ncbop.org\/PDF\/NCDHHSImplementationofCSRSSTOPActJuly2021.pdf\">http:\/\/www.ncbop.org\/PDF\/NCDHHSImplementationofCSRSSTOPActJuly2021.pdf<\/a><\/p>\r\n<p>and NC Board of Pharmacy. 2017. <a href=\"http:\/\/www.ncbop.org\/PDF\/GuidanceImplementationSTOPACTJuly2017.pdf\">http:\/\/www.ncbop.org\/PDF\/GuidanceImplementationSTOPACTJuly2017.pdf<\/a><\/p>\r\n<p>\u00a0<\/p>\r\n<p>\u00a0<\/p>\r\n\r\n\r\n<h3 class=\"wp-block-heading\">Did you know&#8230;<\/h3>\r\n\r\n\r\n\r\n<blockquote class=\"wp-block-quote\"><p> A district court judge ruling on a DEA enforcement action recently acknowledged that patients \u201cmay go out of their way\u2026 because there aren&#8217;t enough nearby doctors who prescribe it or pharmacies that stock it\u2026 they might pay cash because they&#8217;re uninsured or Medicaid won&#8217;t cover prescriptions written by an out-of-network doctor\u2026 they might prefer [mono product] because it&#8217;s often cheaper than [combo product].\u201d<sup id=\"popoverX\" class=\"citation\" title=\"Citation\" data-toggle=\"popover\" data-html=\"true\" data-placement=\"bottom\">16<\/sup><\/p><br>\r\n<div id=\"popoverX-content\" class=\"popover-content hide\">\r\n<div id=\"X\"><button id=\"X\" class=\"close\" type=\"button\">\u00d7<\/button><p><\/p>\r\n<ol start=\"16\">\r\n<li value=\"16\"> Williams AR, Samples H, Crystal S, Olfson M. Acute care, prescription opioid use, and overdose following discontinuation of long-term buprenorphine treatment for opioid use disorder. American Journal of Psychiatry. 2020;177(2):117-124.<\/li>\r\n<\/ol>\r\n<\/div>\r\n<\/div>\r\n<\/blockquote>\r\n\r\n\r\n<figure class=\"wp-block-table\">\r\n<div>&nbsp;<\/div>\r\n<div>&nbsp;<\/div>\r\n<\/figure>\r\n<div class=\"lowernav\"><a href=\"\/bupe\/why-me-role-of-the-pharmacist\/\"><button class=\"navbtn prev\" type=\"button\">\u2190 back<\/button><\/a><a href=\"#\"><button class=\"navbtn top\" type=\"button\">top<\/button><\/a><a href=\"\/bupe\/examples-faqs\/\"><button class=\"navbtn next\" type=\"button\">next \u2192<\/button><\/a><\/div>","protected":false},"excerpt":{"rendered":"Several statements about the barriers facing patients with opioid use disorder are listed below. Decide whether each statement is true or false, and then click the button that corresponds with your response. Feedback is provided in the right column. StatementTrue &hellip; <a href=\"https:\/\/wp.media.unc.edu\/bupe\/how-to-overcome-access-barriers-at-your-pharmacy\/\" aria-label=\"Read more about Overcoming Barriers\">Continued<\/a>","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"_links":{"self":[{"href":"https:\/\/wp.media.unc.edu\/bupe\/wp-json\/wp\/v2\/pages\/26"}],"collection":[{"href":"https:\/\/wp.media.unc.edu\/bupe\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/wp.media.unc.edu\/bupe\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/wp.media.unc.edu\/bupe\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/wp.media.unc.edu\/bupe\/wp-json\/wp\/v2\/comments?post=26"}],"version-history":[{"count":168,"href":"https:\/\/wp.media.unc.edu\/bupe\/wp-json\/wp\/v2\/pages\/26\/revisions"}],"predecessor-version":[{"id":1632,"href":"https:\/\/wp.media.unc.edu\/bupe\/wp-json\/wp\/v2\/pages\/26\/revisions\/1632"}],"wp:attachment":[{"href":"https:\/\/wp.media.unc.edu\/bupe\/wp-json\/wp\/v2\/media?parent=26"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}