Overcoming Barriers and Unlocking Clozapine: A Panel Shares Clinic, System, and State-wide Strategies
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Credit Offered
No Credit Offered

The US Food and Drug Administration (FDA) indications for clozapine use include treatment-resistant schizophrenia (TRS) and reducing suicidal behavior in patients with schizophrenia or schizoaffective disorder. Although approximately one-fourth of people with schizophrenia experience TRS (defined as the failure of two antipsychotic trials at an adequate dose and duration), clozapine is only prescribed to 4% of people with schizophrenia in the US.   

Barriers for clozapine’s more widespread use can be divided into patient, prescriber, and administrative barriers.  Administrative barriers include challenges with clozapine REMS,  coordination issues from inpatient to outpatient settings, difficulties with reimbursement, and a lack of specialized clinics. Studies have highlighted the importance of developing clozapine clinics, which could expand access and include experienced clinicians that would effectively manage adverse events.  A recent survey from SMI Adviser that included 32 clozapine clinics found there was significant variation in the staffing models and services offered.  Over half of clozapine clinics surveyed included psychiatrists, pharmacists, nurses, psychiatric nurse practitioners, and case managers.  The median caseload of patients on clozapine in the clinics was 45. 

In this webinar, we will first present an overview of the barriers of clozapine use in the US, summarize possible advantages of organizing services into clozapine clinics, and discuss the current literature what is known about these clinics.  The webinar will then move to a panel discussion of three system leaders to discuss how their programs are organized, successes, challenges, and future directions.  Finally, we will explore what wider solutions may increase clozapine utilization across individual states. 


Recorded webinar, non-interactive, self-paced distance learning activity with post-test.

This presentation was recorded on November 10, 2022.

Learning Objectives

  • List three barriers that complicate more widespread clozapine adoption. 
  • Critically evaluate the current literature on what is known about clozapine clinics in the US. 
  • Describe three possible advantages for using a clozapine clinic model in contrast to care as usual. 
  • Describe two efforts that have increased clozapine utilization throughout a system. 

Target Audience

Nurse/Nurse Practitioner, Pharmacist, Physician (Non-psychiatrist), Physician Assistant, Psychiatrist  

Instructional Level

Introductory, Intermediate

Estimate Time to Complete

Estimated Duration: 1.0 hour
Program Start Date: November 17, 2022 
Program End Date: July 08, 2023

Ongoing Interdisciplinary Discussion Board

After completing the course, engage with colleagues in the mental health field through SMI Adviser's Webinar Roundtable Topics discussion board. This is an easy way to network and share ideas with other clinicians who participate in this webinar. Access through the discussion tab.

How to Earn Credit

Participants who wish to earn AMA PRA Category 1 Credit™, nursing continuing professional development contact hours (NCPD, formerly CNE), CE credit for psychologists, CE credit for social workers, or a certificate of participation may do so by viewing the live presentation and completing the evaluation. Participants claiming CE credit for psychologists and those claiming CE credit for Social workers, must have full attendance to claim credit. After evaluating the program, course participants will be provided with an opportunity to claim hours of participation and print an official CME certificate (physicians), CE certificate (psychologists), CE certificate (social workers) or certificate of participation (other disciplines) showing the event date and hours earned.

Continuing Education Credit


The American Psychiatric Association (APA) is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians. 

The APA designates this live event for a maximum of 1.0 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Nurses/Nurse Practitioners

The American Psychiatric Nurses Association is accredited with distinction as a provider of nursing continuing professional development by the American Nurses Credentialing Center’s Commission on Accreditation.

Faculty and Planner Disclosures

The American Psychiatric Association adheres to the ACCME’s Standards for Integrity and Independence in Accredited Continuing Medical Education. Any individuals in a position to control the content of a CME activity — including faculty, planners, reviewers or others — are required to disclose all relevant financial relationships with ineligible entities (commercial interests). All relevant conflicts of interest have been mitigated prior to the commencement of the activity.


  • Robert O. Cotes, MD is an Associate Professor at Emory University School of Medicine in the Department of Psychiatry and Behavioral Sciences. He serves as Co-Director of the PSTAR Clinic (Persistent Symptoms: Treatment, Assessment and Recovery), Director of Project ARROW (Achieving Recovery through Resilience, Optimism, and Wellness) and Co-Director of Open Dialogue Atlanta at Grady's Outpatient Behavioral Health Clinic. Dr. Cotes discloses research funding from Alkermes and Roche, and consultant roles with Clinical Care Options and Saladax Biomedical.  
  • Anna Costakis, MD, MBA is the as the Adult Ambulatory Psychiatry Director at Northwell Zucker Hillside Hospital, where she also serves as faculty at Hofstra Zucker School of Medicine. Dr. Costakis reports no financial relationships with commercial interests. 
  • Jessica Goren, PharmD, BCPP is a Senior Clinical Pharmacist at Psychiatric Pharmacist at Cambridge Health Alliance. Dr. Goren reports no financial relationships with commercial interests.  
  • Mindy Asbury, MD, PhD is Assistant Profressor at University of North Carolina School of Medicine. She also serves as Medical Director of UNC Wake ACT Team and UNC Encompass First Episode Psychosis Program, as well as Director of North Carolina Clozapine Network. Dr. Asbury reports no financial relationships with commercial interests.  


  • Teri Brister, PhD, LPC, National Alliance on Mental Illness. Dr. Brister reports no financial relationships with commercial interests.
  • John Torous, MD, Beth Israel Deaconess Medical Center. Dr. Torous has no relevant financial relationships to disclose.
  • Donna Rolin, PhD, APRN, University of Texas at Austin. Reports no financial relationships with commercial interests. 
  • Donna Rolin, PhD, APRN, University of Texas at Austin. Reports no financial relationships with commercial interests. (Reviewed on 6/15/2023)

Accessibility for Participants with Disabilities

The American Psychiatric Association is committed to ensuring accessibility of its website to people with disabilities. If you have trouble accessing any of APA’s online resources, please contact us at 202-559-3900 for assistance.

Technical Requirements

This internet-based CME activity is best experienced using any of the following:

  • The latest and 2nd latest public versions of Google Chrome, Mozilla Firefox, or Safari
  • Internet Explorer 11+

This website requires that JavaScript and session cookies be enabled. Certain activities may require additional software to view multimedia, presentation, or printable versions of the content. These activities will be marked as such and will provide links to the required software. That software may be:  Adobe Acrobat Reader, Microsoft PowerPoint, and Windows Media Player.

Optimal System Configuration:

  • Browser: Google Chrome (latest and 2nd latest version), Safari (latest and 2nd latest version), Internet Explorer 11.0+, Firefox (latest and 2nd latest version), or Microsoft Edge (latest and 2nd latest version)
  • Operating System: Windows versions 8.1+, Mac OS X 10.5 (Leopard) +, Android (latest and 2nd latest version), or iOS/iPad OS (latest and 2nd latest version)
  • Internet Connection: 1 Mbps or higher

Minimum Requirements:

  • Windows PC: Windows 8.1 or higher; 1 GB (for 32-bit)/2 GB (for 64-bit) or higher RAM; Microsoft DirectX 9 graphics device with WDDM driver; audio playback with speakers for programs with video content
  • Macintosh: Mac OS X 10.5 or higher with latest updates installed; Intel, PowerPC G5, or PowerPC G4 (867MHz or faster) processor; 512 MB or higher RAM; audio playback with speakers for programs with video content

For assistance: Contact educme@psych.org for questions about this activity | Contact SMIadviserhelp@psych.org for technical assistance

Funding for SMI Adviser was made possible by Grant No. SM080818 from SAMHSA of the U.S. Department of Health and Human Services (HHS). The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement by, SAMHSA/HHS or the U.S. Government.
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