In 2011, the U.S. Government Accountability Office (GAO) reported foster and non-foster children in the MassHealth, Massachusetts Medicaid program, exhibited the highest rate of behavioral health medication (BHM) utilization, with 49.3% of all Medicaid children being prescribed a psychotropic medication, and 39.1% of children in foster care prescribed these medications.
The MassHealth Pharmacy Program, which is managed by UMass Medical School, implemented a PBHMI Workgroup in November 2014 with the collaboration of the Department of Children and Families and the Department of Mental Health.
The workgroup proactively requires prior authorization (PA) for specific medications or combinations of BHMs prescribed to members less than 18 years of age. Interventions include telephonic prescriber outreach by a child/adolescent psychiatrist to discuss opportunities for regimen simplification, drug interactions or toxicity, and to encourage evidence-based practices.
An analysis of the workgroup suggests a peer-to-peer outreach program is associated with increased awareness and implementation of evidence based medicine in a pediatric population treated with behavioral health medications.