Transcript Document
An Overview of State Medicaid Policies for Mental Health Drugs Kyle E. Hultgren, PharmD Candidate Purdue University School of Pharmacy Objective To provide an accurate overview of current state Medicaid policies regarding mental health drugs Methods Identify states with preferred drug lists (PDLs) Isolate and quantify the use of mental health drug policies Form clusters of similar policies Associate each state Medicaid prescription drug benefit structure with a given policy cluster Identify and Quantify PDL Use Percent of PDLs That Control a Given Drug Class 74% (37) have a PDL of some form 100 88 90 84 84 80 80 72 Percent (%) 68% of these 37 states have mental health drug policies in place 70 60 50 52 52 MAO I TCA 44 40 30 20 10 0 T ypic als A typic als N on- S timulant S SR I M is c . A ds A mph. & M phenidate Drug Class Chart displays percentage of policies that address various drug classes Drug and Policy Clusters Drug classes most commonly addressed through policies Antipsychotics Antidepressants ADHD medications Three major arenas of PDL structure and function Brand-Generic Policies Prior Authorization Policies Treatment Algorithm Policies Brand-Generic Policies All generic medications are preferred over brand name (mandatory generic substitution and therapeutic substitution) Brands without generic equivalents may still be preferred Providers may be able to override preferred status Brand manufacturers may pay supplemental rebates to become competitive in the class States: Florida, Alaska, Illinois Florida Preferred SSRIs Citalopram Lexapro Citalopram HBr Paxil CR Fluoxetine Pexeva Fluoxetine HCl Zoloft Table shows mix of both brand name and generic medications Prior Authorization Policies Requires that specific criteria are met before a prescription is dispensed May involve “fail-first” edits or time intervals Method of attempting treatment uniformity for patients with identical diagnoses Moves toward a shared state and provider responsibility for prescribing behaviors States: Maine, Massachusetts, Missouri Prior Authorization Policy Example Condition Attention Def icit Disorder w ithout hyperactivity Attention Def icit Disorder w ith hyperactivity Narcolepsy (stimulants only) Subm itted ICD -9 Diagnose s Infe rred Diagnosis History Date Range 314.00 ------ 730 days 314.01 ------ 730 days 347 Subject to clinical review 730 days Table 3: Missouri Prior Authorization for ADHD stimulant medications38 Under 18 years of age Š appropriate diagnosis 18 Š 23 years of age o Appropriate diagnosis o Goals of therapyŠ Current academic/w orkenrollment Over 23 years of agewith childhood onset and history of treatment o Goals of therapyŠ Current academic/w orkenrollment Approval and therapy may be subject to supervision by mental health specialist Treatment Algorithm Policies The most state-centric set of policies Designed to initiate, change, direct, and terminate patient drug therapy based upon written criteria Designed using most current evidence in tandem with provider consensus lends credibility to the algorithm Series of prior authorizations used as guideposts to ensure appropriate use State: Texas Summary Few states purely use one method for creating mental health drug policies