HJAR Jan/Feb 2020

HEALTHCARE JOURNAL OF ARKANSAS I  JAN / FEB 2020 45 including a long-acting stimulant per day, as well as several short-acting doses. With respect to antipsychotics a great deal of off-label (non-FDA approved indications) use was seen, exposing children to adverse side effects like the metabolic syndrome of hyperglycemia and hyperlipidemia, as well as significant weight gain. Prescribing excessive doses of psychotropic medications can also result in an exponential cost burden. To address these issues, the Pharmacy Unit began to develop edits and guidelines to ensure safe prescribing. Three changes have been made dating back to 2003 for C-II Stimulants: • October 2003: Implemented manual review PA process for C-II stimulants requested for children under the age of five. • November 2006: Implemented Therapeutic Duplication (TD) edits that limited C-II stimulant use to only allow one short-acting and one-long acting C-II stimulant with overlapping days’ supply; Implemented quantity edits and dose-optimization edits in all C-II stimulants. • January 2011: Implemented a PA Laurence Miller, MD Senior Psychiatrist Medicaid requirement for adults 18 years old and older. In addition, multiple requirements have been changed or added for Antipsychotic Agents: • July 2009: Added a requirement that agents prescribed for all children under the age of five should be manually reviewed by DHS child psychiatrist; Therapeutic Duplication (TD) edits were rejected 2nd agent at point-of- sale and manually reviewed by a DHS child psychiatrist for ages 5-12; Quantity edits and dose-optimization edits “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.”