A 2011 Government Accountability Office (GAO) report identified that Massachusetts had the highest rate of psychotropic medication utilization in children compared to the other states examined. Utilization patterns were especially concerning among foster care children: 39.1 percent of foster care children were prescribed behavioral health medications compared to 10.2 percent of those not in foster care. Additionally, antipsychotic utilization in children covered by Medicaid was twice as likely compared to those privately insured, according to a 2012 report.
Clinical Pharmacy Services implemented the Pediatric Behavioral Health Medication Initiative in Massachusetts in collaboration with the state’s Medicaid program (MassHealth), the Department of Mental Health, the Department of Children and Families, psychopharmacology experts, and advocacy groups. This ground-breaking initiative oversees safe and effective utilization of behavioral health medications for pediatric MassHealth members. Our services include:
- Prior authorization review to ensure that the most effective and safest treatment regimens are prescribed
- Prescriber outreach and education to discuss behavioral health medication regimens
- Outcomes analysis and reporting to assess and build upon strategies for medication use
Clinical Pharmacy Services worked with a multidisciplinary team to establish clinically robust prior authorization requirements and age restrictions for specific behavioral medications and polypharmacy combinations. Prescriber and pharmacy outreach efforts prior to implementation included:
- Over 14,000 Massachusetts prescribers receiving mailings
- More than 300 Massachusetts prescribers receiving targeted telephonic outreach
- Over 1,000 community pharmacies receiving information via fax
- Creation of a comprehensive online resources for prescribers and community pharmacies
Utilizing lessons learned from our Opioid Management Program, a multidisciplinary workgroup was created to ensure the highest level of support for the prescribers and pediatric members impacted by this initiative. Participants included pharmacists, child/adolescent psychiatrists, and a social worker. Workgroup activities include:
- Daily case review
- Weekly evaluation of complex cases. This facilitates clinical discussion regarding treatment plans and identifies cases for prescriber outreach. It also initiates referral of select members to a behavioral health program that assists in integrating care and providing psychosocial interventions.