Upcoming Changes to Prior Authorization for Antipsychotic Medications

Effective September 1, 2018, the prior authorization for antipsychotic medications will change. At the May 15th Texas Association of Community Health Plans P&T Committee meeting, the Texas Managed Care Organizations, supported by Navitus, voted by majority to modify the Antipsychotic Clinical Prior Authorization Edit in compliance with the guidelines set forth by the Health and Human Services Commission Vendor Drug Program. The health plans opted to remove the requirements for diagnoses, while maintaining criteria for age and duplicate therapy in order to maintain safety standards for members. The question about insomnia will also be removed as this appeared to cause difficulty for some appropriate authorizations. This change will not impact currently approved prior authorizations. All existing prior authorizations must be honored until the prior authorizations are up for renewal. Details of these changes will be forthcoming to Texas Children’s Health Plan providers and members.