Antipsychotics-FAQ-11.4.14.Pdf
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Attention Pharmacists: The Department of Health Care Services (DHCS) recently made changes to utilization controls on antipsychotic medications. Previously, prior authorization through a Treatment Authorization Request (TAR) was required for antipsychotic medications prescribed to children age 0-5. Effective October 1, 2014, a TAR is required for all antipsychotic medications prescribed to Medi-Cal beneficiaries age 0-17. CPhA has been made aware that this policy change may have resulted in some Medi-Cal beneficiaries experiencing a gap in therapy or being unable to receive their prescribed medications. If you are presented a prescription for an antipsychotic medication issued to a Medi-Cal beneficiary aged 0-17,remember that you may provide a 72 hour emergency supply of an antipsychotic for purposes of continuation of therapy while waiting for TAR approval. Please see below for Frequently Asked Questions about this policy. FAQs Q: Which antipsychotic medications does this utilization control apply to? A: The antipsychotic restriction applies to the following drugs: Aripiprazole, Asenapine, Chlorpromazine, Clozapine, Fluphenazine, Haloperidol, Iloperidone, Loxapine HCL, Loxapine succinate, Lurasidone hydrochloride, Molindone hydrochloride, Olanzapine, Perphenazine, Prochlorperazine, Quetiapine fumarate, Risperidone, Thioridazine, Thiothixene, Trifluoperazine, Ziprasidone HCL. For further information on this, see the explanation of Code I Restrictions in the Medi-Cal Pharmacy Manual. Q: I filled a 72 hour emergency medication supply 3 days ago, and the TAR has yet to be submitted. The child is about to run out of medication, what should I do? A: Fill an additional 72 hour supply of medication, and submit a TAR as soon as possible. Notify the prescriber that a TAR is pending submission due to information requested from the prescriber. Q: I received an antipsychotic prescription for a child recently discharged from the hospital. The prescriber included diagnosis information and indicated on the prescription “recent discharge from hospital.” If I am submitting a TAR, is “recent discharge from hospital” a reasonable explanation of medical necessity? A: Yes. Q: I am trying to fill an antipsychotic prescription for a child and submitted to the claim system without a TAR. The Medi-Cal claim system sent a denial back with a stated message “Exceed age limit.” What should I do? A: This reject code is an error and should be disregarded. All that is needed is to have a TAR submitted. Q: I am a pharmacist trying to submit a TAR. I need information regarding diagnosis and medical necessity from the prescribing doctor but am getting no response. What should I do? A: Fill a 72 hour emergency supply. Continue to contact the hospital, clinic, social worker, nurse, to collect the necessary information. Also, inform the parent/guardian of the child about the lack of response from the prescriber as soon as possible so they have an opportunity to intervene. Q: I am a pharmacist trying to submit a TAR. I need information regarding diagnosis and medical necessity from the prescribing doctor. I called the doctor’s office and was told to speak to a psychiatric technician. The psychiatric technician told me they are busy and they have workload issues. I have filled a three day emergency supply and the child is running out of medication. What should I do? A: Fill an additional 72 hour emergency supply. Continue to contact the hospital, clinic, social worker, nurse, to collect the necessary information. Also, inform the parent/guardian of the child about the lack of response from the prescriber as soon as possible so they have an opportunity to intervene. Q: Is there a phone number to call at DHCS to file a complaint about TAR processing? A: The Pharmacy TAR Section can be reached at (800) 572-9315. Ask to speak with a Supervisor. Q: Is it DHCS policy to deny antipsychotics for children? A: No. Maintaining patient continuity of care is of utmost concern to DHCS. Medications are not denied if they are medically necessary. Q: Does the doctor/pharmacist need to resubmit a TAR for each refill? For how many months does DHCS approve TARs? A: A TAR can be authorized for multiple refills based on medical and clinical justification submitted. There are not a fixed number of months for the approved TAR. The maximum approval period for a pharmacy TAR is 1 year. Q: Do we need to put the ICD code or DSM on a TAR, or just simple language of diagnoses? A: An ICD code is required for the primary diagnosis. Any other pertinent clinical information can be typed in the miscellaneous TAR information or medical justification section. Q: When changing the dose on medications tapering up or down, does the TAR office discontinue the previous dose to avoid dispensing mistakes? A: It is not the TAR offices’ practice to discontinue TARs when a new TAR is approved. The dispensing pharmacy is responsible to ensure all drugs are dispensed accurately. Q: What is multiple service line TAR? A: Multiple service line TAR means that there are more than 1 service line (drugs) request on a specific TAR. All TARs have the potential of being a multiple service line TAR..