Antipsychotics Review Programs

Antipsychotics are FDA approved for a variety of diagnoses including but not limited to: Schizophrenia, Schizoaffective Disorder, Bipolar Disorder, Major Depression (as adjunct treatment) and Autistic Disorder (to treat associated irritability). However, there are situations in which a clinician may prescribe an antipsychotic “off-label".​

In the public and health care arena concerns have been raised, not only about the “off-label" prescribing, but also about the lack of side effect (including weight, body mass index and blood glucose and lipid levels) monitoring of antipsychotics.

Federally, a Government Accountability Office (GAO) report has outlined concerns about antipsychotic use in Medicaid recipients in Foster Care.

Published guidelines addressing some of the above issues include, but are not limited to, the American Academy of Child and Adolescent Psychiatry Practice Parameters for Atypical Antipsychotics  and The American Diabetes Association/American Psychiatric Association consensus statement issued in 2004 recommending monitoring body mass index and blood glucose and blood lipid levels on patients taking atypical antipsychotics.

To support providers who prescribe this drug class, the Office of Pharmacy Services (OPS) has established two programs.

  • Peer Review Program (PRP)
  • Tier 2 & Non-Preferred Antipsychotic Review Program


Peer Review Program (PRP)

This program was established to address concerns that an increasing number of children are being prescribed antipsychotics and there is a lack of laboratory monitoring of those children.  The goal of the program is to ensure that children and adolescents receive optimal treatment in conjunction with appropriate non-pharmacologic measures in the safest manner possible. (https://mmcp.dhmh.maryland.gov/pap/docs/Antipsychotic-Peer-review-Project-Narrative.pdf)

This program began in October 2011 and initially addressed the use of antipsychotics in Medicaid patients under five years of age. In July 2012, it expanded to encompass children under 10 years of age. In January 2014, the program expanded to include any Medicaid recipient 17 years or younger who is prescribed any antipsychotic.

The program works in partnership with the Mental Hygiene Administration (MHA) and the University of Maryland (UMD) School of Pharmacy and Division of Child and Adolescent Psychiatry. OPS and MHA hosted a webinar to discuss the PRP and answer questions regarding this program on September 15, 2011.​

For QUESTIONS regarding this program:

Recipients call 1 (800)492-5231   Option 3

Providers call 1 (855)283-0876

 

Transmittals:#196 – PRP admits < 5 year olds​
#197 – PRP expands to include

#198 – PRP expands to include 10 to 17 year olds
Advisories:     #115 – PRP expands to include youth up to age 10 years
#122 – No PA Required for Abilify for ages 10 - 17

#134 – Expansion of Peer Review Program ages 0 to 17

                               ​
Tier 2 & Non-Preferred Antipsychotic Review Program

This program was launched in September 2012. It was designed to address a variety of concerns, including the off-label use of antipsychotics. The goal of the program is to have prescribers, whenever appropriate, prescribe antipsychotics using FDA guidelines for diagnosis, dose and frequency in the most cost-effective manner. 

To meet this goal, the program has established a prior authorization (PA) process. As always, a PREFERRED antipsychotic (see Preferred Drug List) does not require a prior authorization, if prescribed within the FDA Guidelines for the dose and frequency. Clinical criteria have been established which must be met before a Tier 2 & Non-Preferred (Tier 2 & NP) antipsychotic is approved (see Clinical Criteria). When seeking a PA for a Tier 2 or NP antipsychotic, remember that it could take up to 1 business day after all requested information is received before a decision is rendered. 


For QUESTIONS regarding this program:

Recipients call 1(800)492-5231 Option 3

Providers call 1(800)932-3918

 

Advisories:     #117 – PA for Tier 2 & NP Antipsychotic Medications