Exploring the Links Between Specialty Pharmacy and Mental Health

Specialty pharmacy is deeply engaged in providing treatment for conditions that are at high risk for mental health challenges.

Mental health and specialty pharmacy intersect in important, sometimes challenging, ways. To support further exploration of these connections, Shields Health Solutions (ShieldsRx) recently participated in a Thought Leadership Discussion on Mental Health as part of the Alliance for Health Policy’s 2022 Signature Series. Support for and participation in the nonprofit, non-partisan Alliance for Health Policy’s Signature Series is an opportunity to educate policymakers about ShieldsRx mission to elevate health outcomes for complex patients.

All year, the series will explore the breadth and depth of US mental health across 3 major areas—innovation, delivery, and access—while examining health equity implications across all domains.

At the series kickoff event, a Thought Leadership Discussion that took place via Zoom on April 14, ShieldsRx was represented by Chrissy Kendrick, SPHR, senior director of human resources, and Kristen Ditch, PharmD, BCCCP, manager of clinical outcomes, who spoke about the impact of integrated specialty pharmacy on mental health care. This invitation-only, interactive session for thought leaders, experts, and policymakers from across the health care ecosystem concentrated on high-level ideas and brainstorming as a basis for future discussions and recommendations.

The series will culminate in a public Congressional briefing in December and a written summary intended to be an action-focused guide for the greater health policy community.

In an integrated health system context, specialty pharmacy touches patients throughout their journey. Particularly in the case of high-risk medications or therapies, specialty pharmacy staff are engaged in screening patients for mental health issues and identifying when the medication itself can increase risk of mental health concerns and monitor for these risks as part of the process of caring for the patient comprehensively and holistically.

Specialty pharmacy is also deeply engaged in providing treatment for conditions that are at high risk for mental health challenges, including autoimmune diseases, cancer, HIV/AIDS, multiple sclerosis, Parkinson disease (PD), and opioid disorders. A diagnosis of PD itself puts the patient at higher risk for depression and psychosis, but the therapies alone can also increase the risk of psychosis if antipsychotics are not tapered correctly.

A study from Vanderbilt University Medical Center found that specialty pharmacist integration into a neurology clinic reduced median time to approval for pimavanserin, an anti-psychotic agent for treating PD-related psychosis, from 22 days preintegration to 3 days postintegration.1 The rate of third-party approval increased from 81% to 95%, and treatment initiation increased from 78% to 94%.

Access to pimavanserin requires navigating a limited distribution network and insurance approvals, which specialty pharmacy integration makes more manageable for patients, their family caregivers, and clinic staff. Once treatment is initiated, specialty pharmacy staff monitor for safety and efficacy to ensure adherence, and adverse effect management—including those that put the patient at higher risk for mental health concerns—and clinical benefit.

Mental health is also a human resources concern. Having been on the front lines of the COVID-19 pandemic, health system specialty pharmacists are at high risk of burnout and other mental health challenges.

Employers in the health care sector face new challenges in providing mental health benefits and services to their employees, who have experienced increased stress and isolation working in virtual environments, additional stress from the pandemic and exposure to loss and grief—not only in terms of the patients they treat and perhaps their own loved ones, but grieving the loss of colleagues, as so many in health care have experienced since early 2020.

As the premier specialty pharmacy accelerator in the United States, ShieldsRx recognizes that patients, pharmacists, and other health care workers all face mental health challenges. Our integrated care model focuses on access to better quality care for more patients through a dedicated team of specialty pharmacy experts, a proven collaborative care model which includes pharmacists, pharmacy liaisons and patient advocates, and integrated technology solutions.


1. Livezey S, Shah NB, McCormick R, DeClercq J, Choi L, Zuckerman AD. Specialty pharmacist integration into an outpatient neurology clinic improves pimavanserin access. Ment Health Clin [Internet]. 2021;11(3):187-93. DOI: 10.9740/mhc.2021.05.187.

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