Medicaid Behavioral Health Medication Guidelines in Massachusetts


From 1997 to 2002 the number of children ages 18 years and younger receiving antipsychotic treatment increased from 201,000 to 1,244,000. This sharp rise has been accompanied by an alarming increase in antipsychotic drug prescribing around the country. Many of these drugs are not FDA approved for children and have been showed to be unsafe and ineffective in treating children with behavioral health illnesses.

Safe and responsible presciring is an important part of effecive pediatric behavioral health care

Safe and responsible prescribing is an important part of effective pediatric behavioral health care

These concerning trends along with the pressure to reduce healthcare spend has invoked the need to develop an effective model for supervising behavioral health medication prescribing. In November, 2014, the Massachusetts department of health and human services started a program to regulate the prescription of behavioral health medications to children under the age of 18. The the Pediatric Behavioral Health Medication Initiative (PBHMI) outlines nine new situations in which the prescribing doctor must get authorization before their patients can receive the medication. The new policies outlined in the initiative primarily target polypharmacy, and aims to increase and ensure safe prescribing practices for specific drugs outlined by MassHealth.

This initiative includes important and educated information on how to successfully implement such a policy; including:

  • Notifying providers and giving them ample time to adjust to new practices
  • Allowing existing prescriptions to complete refills without preauthorization
  • Providing 30-day emergency medication supplies without authorization

The PBHMI currently only impacts MassHealth, but it should be expanded to include all Managed Care Organizations (MCOs) that cover Medicaid in Massachusetts. This would have two important impacts on behavioral health medication practices. One, MCOs would be required to monitor prescribing trends for potentially harmful, and wasteful situations. Two, it would prevent unnecessary preauthorizations that cause provider abrasion, and could prevent  life-threatening situations where members cannot receive the medications they rely upon.


2 Responses to “Medicaid Behavioral Health Medication Guidelines in Massachusetts”

  1. adiehl9 Says:

    I’m so glad you wrote about this. So many kids are being prescribed psychotropic medications inappropriately. With such a low supply of child psychiatrists in the US, primary care providers are now the largest prescribers of psychotropic medications to children, and many do not have the same prescribing expertise, nor the capacity to properly monitor their patients as child psychiatrists. This is not to say that pediatricians shouldn’t be prescribing medications to children- it is completely within their scope of practice and also the only accessible method for many children to get mental health treatment. I think having this pre-authorizing process is a good idea, just as a simple failsafe to make sure kids aren’t receiving inappropriate medications. I agree that this program should be expanded beyond kids on Medicaid, but I also think this is a particularly crucial place to start. Kids in foster care are at a three to four fold increased risk of being subject to inappropriate psychotropic prescribing, compared to children who are not in foster care, and adding this rule to Medicaid will hopefully address some of the most egregious overprescribing as a first step.

  2. sterlingharing Says:

    I have mixed feelings about this policy. On the one hand, polypharmacy is a problem among all age groups, and should be addressed (especially in children, who are at risk of losing long-term quality of life). On the other, many low-income families lack access to care, and attempts to increase physician oversight of prescriptions can sometimes have the unintended consequence of requiring more face-to-face interactions with patients. If a child lives in a single-parent home, with a working parent, he or she may go without medications for months before the parent has the opportunity to take him or her to the doctor’s office in order to get a refill; these visits may be expensive, and may not be a priority for the parent.

    I agree with attempts to address this problem overall, and agree with supporting access-friendly requirements that cut down on pediatric polypharmacy!

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