HJAR Jan/Feb 2020

46 JAN / FEB 2020 I  HEALTHCARE JOURNAL OF ARKANSAS ME D I CA I D • January 2017: Medicaid currently requires a manual review PA for any antipsychotic agent prescribed for children under 10 years old for all new starts on an antipsychotic agent, including a change in the chemical entity for children currently on an antipsychotic agent. • October 2019 : Point-of-sale edits were implemented, including age edits for 18 years and older; Therapeutics Duplication (TD) edits and maximum therapeutic dose edits were implemented, and doses above the maximum therapeutic dose now require a manual review prior authorization. Before switching agents or adding an additional agent to current therapy, the recommendation must maximize the dose on the current medication unless contraindicated; oral antipsychotics were added to the preferred drug list (PDL). At least two preferred oral antipsychotics agents should be attempted and failed before considering a change to a non- preferred oral antipsychotic agent. To further address the issues of inappro- priate prescribing, an educational interven- tion letter has been developed with the Ret- rospective Drug Utilization Review (RDUR) for prescribing providers regarding children who are receiving a C-II simulant without a corresponding ADD/ADHD diagnosis code in medical history, or who may have other mental health diagnosis without an ADD/ ADHD diagnosis where a C-II stimulant is were implemented for all oral second- generation antipsychotic agents for children under 5 years, ages 5-12, and ages 13-17 years. Later these categories were further divided for children under 5 years, and ages 6-9, 10-12, and 13-17. • November 2011: Implemented additional PA requirements to address the potential for onset of the “metabolic syndrome;” a signed informed consent form and metabolic labs for lipids and glucose began as a requirement prior to all new starts; the manual review age requirement for PAs was increased to children under 6 years. • June 2012: Implemented a metabolic lab test requirement for lipids and glucose for every six months for all children under 18 years old receiving antipsychotic agent before the claim for the first- or second-generation antipsychotic agent would pay at point-of-sale. • July 2013: Implemented manual review PA requirement on all long- acting injectable antipsychotic agents for children under 18 years old; made age-related dose edits and dose- optimization quantity limit proposals for oral first-generation antipsychotic agents for children under 18 years in addition to the second-generation antipsychotic agents. • December 2016: Added a requirement for a manual PA review of any antipsy- chotic agent prescribed for children un- der 7 years old. not warranted. A second educational intervention letter was developed regarding children who are receiving an antipsychotic agent and have a trauma diagnosis in medical history with no other mental health diagnosis to support its use. The Medicaid Pharmacy Unit continues to monitor and address prescribing trends and revise our policies accordingly to ensure that Arkansas Medicaid provides the most appropriate treatment. n Dr.Laurence H.Miller serves as senior psychiatrist for the Department of Human Services (DHS) Division of Medical Services (Medicaid), and as a clinical profes- sor of psychiatry at UAMS. He is a board certified psychiatrist who completed his psychiatric residency at Boston University School of Medicine, where he worked for 23 years in various capacities, including director of the Division of Psy- chiatry at Boston City Hospital, and medical director of addiction services for the City of Boston. Hemoved toArkansas in 1994 to assume the position of medical director of Arkansas State Hospital, a role he held until 2005. During that time, he also served as medical director of the DHS Division of Behavior- al Health Services, and as director of the Arkansas Mental Health Research and Training Institute from 1998–2012. He began a fulltime position at Arkansas Medicaid in January 2013, after having served as a consultant from 2000–2012. Locally,he is the immediate past president of Recovery Centers ofArkansas,and serves as senior consultant to the Arkansas Psychiatric Society. Nationally, he serves the American Psychiatric As- sociation as chair of the Committee on Reimburse- ment of Psychiatric Services,and the National Quality Forumas amember of its Behavioral Health Standing Committee.