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New Medicaid Atypical Antipsychotic Program

New Medicaid Atypical Antipsychotic Program

BP med HS Dosing Benefit ; Browser has Med Adherence Report

The first phase of the program, began March 20, 2012, includes Medicaid eligible adults (age >=18) on atypical (2nd generation) antipsychotic agents prescribed for an indication or dosage that is not FDAapproved.

http://www.ncdhhs.gov/dma/bulletin/0312bulletin.htm

Non-exempt indications for atypical antipsychotics (e.g., anxiety, insomnia, monotherapy for depression, PTSD), must obtain a prior authorization (PA) by either

  1. filling out the ASAP PA Request Fax Form at http://www.documentforsafety.com or http://www.ncmedicaidpbm.com and faxing it to ACS at 866-246-8507 OR
  2. calling ACS at 866-246-8505 With either method above, provision of the following information will gain prior authorization for 12 months:
  • Drug and total daily dosage
  • Primary psychiatric diagnosis
  • Primary target symptoms
  • Patient has been informed regarding these agents
  • Potential for metabolic & neurologic adverse effects

Patients with any of the following diagnoses are exempt from the requirements of the policy: Schizophrenia, Schizophreniform Disorder, Schizoaffective disorder, Delusional disorder, Brief psychotic disorder, Shared psychotic disorder, Psychotic disorder NOS, Bipolar disorder, MDD with psychosis, Tourette syndrome, Treatment resistant depression (adjunctive treatment), and Other psychosis.

To authorize the exemption for the above indications, the prescriber must write in his or her own handwriting “meets PA criteria” on the face of each new or renewal antipsychotic prescription or in the comment block on e-prescriptions. The authorization is equivalent to the length of the prescription. The ASAP fax form (PA request form described above) should not be used. Note: The exemption applies to all antipsychotic medications prescribed to a given patient for treatment of above indications.