Multidisciplinary workgroup ensures pediatric behavioral health regimens are the right fit

January 10, 2018

A UMass Medical School pharmacy team grew concerned after reviewing the prescriptions of a teen diagnosed with multiple psychiatric disorders, and with a history of bodily harm.

The teen’s complex regimen of several different drugs was flagged as high-risk during the prior authorization process and then sent to a multidisciplinary workgroup for review. That workgroup discussed recommendations for alterations in the teen’s medication regimen. A child psychiatrist from the multidisciplinary workgroup spoke with the teen’s prescriber, and as a result two medications were removed from the regimen.

A team of professionals from UMass Medical School examines cases like these on a daily basis for MassHealth, the Massachusetts Medicaid program, as part of the Pediatric Behavioral Health Medication Initiative (PBHMI). Utilization of behavioral health medications by children and adolescents is monitored, and special attention is paid to regimens including polypharmacy, drug interactions and potential for adverse drug effects.

The initiative is a joint venture between UMass Medical School, which manages the MassHealth Pharmacy Program, and both the Massachusetts Department of Children and Families, and Department of Mental Health.

Since it was launched in 2014, the initiative proactively requires prior authorization when MassHealth members under 18 are prescribed behavioral health medications that are potentially unnecessary or redundant, or combinations of medications, which may cause additional adverse reactions.

“The focus of this initiative is to work with our prescribers by conducting peer outreach on some of the most complex cases thereby allowing us to monitor and adjust as we see the prescribing and care patterns change,” noted Paul Jeffrey, PharmD, director of Pharmacy, UMass Medical School’s Office of Clinical Affairs/MassHealth. 

The impetus for the program stems from a pair of reports in 2011 and 2012 by the U.S. Government Accountability Office that raised safety concerns about the growing number of children across the country being prescribed behavioral health drugs. These drugs include antipsychotics, antidepressants, antianxiety medications, stimulants, and mood stabilizers.

Nationally, children in state Medicaid health programs were twice as likely to be prescribed antipsychotics as those covered by private insurance, the research found. Massachusetts had the highest rate of pediatric behavioral health medication utilization compared to the four other states examined in the study: Florida, Michigan, Oregon and Texas

As a result of the research, UMass Medical School pharmacists and other clinicians collaborated with the Department of Mental Health and the Department of Children and Families to roll out new prescription review guidelines in the form of prior authorization restrictions.

They also formed the Therapeutic Class Management Workshop. Made up of pharmacists, child psychiatrists and a social worker, the group meets weekly to discuss high-risk cases and to formulate follow-up plans as needed.

The workgroup has reviewed a range of cases involving, among other things: behavioral health medications prescribed for children under three; treatment regimens involving five or more drugs; psychiatric hospitalization; children on medication regimens including complex polypharmacy.

“The Pediatric Behavioral Health Medication Initiative is helping to ensure the safe and judicious use of behavioral health medications in children,” Jeffrey said. “It is one piece to a much larger component of care for children in the commonwealth.”

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