HJAR Jan/Feb 2020

44 JAN / FEB 2020 I  HEALTHCARE JOURNAL OF ARKANSAS COLUMN MEDICAID RESEARCH has shown that the most effective treatment is a combination of psychother- apy and medication, so Arkansas Medicaid has developed methods to steer providers toward that practice. When the Medicaid Pharmacy Unit receives a Prior Authoriza- tion (PA) request for a psychotropic medica- tion, the prescriber is asked if individual or family therapy is being delivered. If not, the prescriber is asked for an explanation. For ex- ample, the diagnosis of Oppositional Defiant Disorder is best treated with evidence-based Parent-Child Interactive Treatment (PCIT) or its equivalent. Medications are not indicated for this diagnosis. In cases of trauma, assessment and thera- py often should be considered before medi- cation is prescribed. Children in foster care, and many not in foster care, have suffered from trauma. Those situations may include abuse and neglect, or a disruption in fam- ily relationships where grandparents are the designated caregivers because the biologi- cal parents are absent, which exacerbates trauma. When situations such as these are documented in progress notes, we ask about trauma screens, assessments, and documen- tation that show Trauma Focused Cognitive Behavioral Therapy (TF-CBT) is being de- livered. If there is a diagnosis of trauma that goes undetected or untreated, the incorrect medication may be prescribed, which could worsen the trauma. The Medicaid Pharmacy Unit has seen widespread use of psychotropic medications in the past, especially in the drug classes of stimulants and antipsychotic medications, primarily in children and adolescents. Children were prescribed more than twice the FDA-approved dose of stimulants, often PSYCHOTROPIC MED I CAT I ONS for Medicaid Clients to Improve Outcomes Impacting Prescribing Practices of Arkansas Medicaid continually strives to ensure that the most appropriate diagnosis- related, evidence- based treatment is provided. The Medicaid Pharmacy Unit has developed several initiatives to achieve this goal, underscoring the philosophy that the prescribing of psychotropic medications is only a portion of any treatment plan, and may not be appropriate in all cases.