OC Medi-Cal Psychiatrists Prescribing Resource Handbook 2011 Page 1. DONALD L. SHARPS, M.D. AMHS / ADAS Associate Medical Director

Transcription

1 OC Medi-Cal Psychiatrists Prescribing Resource Handbook 2011 Page 1 Orange County Medi-Cal PSYCHIATRIST s Prescribing Resource Handbook 2011 DONALD L. SHARPS, M.D. AMHS / ADAS Associate Medical Director

2 OC Medi-Cal Psychiatrists Prescribing Resource Handbook 2011 Page 2 Prescribing Psychotropics for OC Medi-Cal beneficiaries... 3 CalOptima Approved Drug List excerpts as of Benzodiazepines... 4 Antidepressants SSRI & TCA... 5 Antidepressants - other... 6 ADHD / Antabuse / Dementia Medications... 7 Mood Stabilizer - Anticonvulsants... 8 CalOptima limit on psychiatrist s physical health care medications... 9 CalOptima six medication per month limit... 9 CalOptima Prior Authorization of Benefits Medi-Cal Approved Drug List excerpts as of Atypical Antipsychotics aripiprazole, asenapine, iloperidone Atypical Antipsychotics olanzapine, quetiapine, ziprasidone Lithium Medi-Cal s six medication per month limit Medi-Cal TAR... 15

3 OC Medi-Cal Psychiatrists Prescribing Resource Handbook 2011 Page 3 Prescribing Psychotropics for OC Medi-Cal beneficiaries For Medi-Cal patients who are not members of CalOptima: Medi-Cal Fee-For-Service (FFS) is financially responsible for all medications For CalOptima patients there are two formularies: CalOptima, in addition to managing OC Medi-Cal beneficiaries non-psychiatric medical care, they are also financially responsible for: All physical health care medications Psychiatric medications not covered by Medi-Cal FFS CalOptima formulary can be accessed through epocrates Medi-Cal FFS is financially responsible for: Antipsychotics Antipsychotic side-effect medications Lithium preparations MAOI's

4 OC Medi-Cal Psychiatrists Prescribing Resource Handbook 2011 Page 4 CalOptima Approved Drug List excerpts as of 2011 For most up to date information & for the complete formulary the website is: Cal/CalOptimaApprovedDrugList.ashx Benzodiazepines

5 OC Medi-Cal Psychiatrists Prescribing Resource Handbook 2011 Page 5 Antidepressants SSRI & TCA

6 OC Medi-Cal Psychiatrists Prescribing Resource Handbook 2011 Page 6 Antidepressants - other

7 OC Medi-Cal Psychiatrists Prescribing Resource Handbook 2011 Page 7 ADHD / Antabuse / Dementia Medications

8 OC Medi-Cal Psychiatrists Prescribing Resource Handbook 2011 Page 8 Mood Stabilizer - Anticonvulsants

9 OC Medi-Cal Psychiatrists Prescribing Resource Handbook 2011 Page 9 CalOptima limit on psychiatrist s physical health care medications It is anticipated that except on rare occasion, psychiatrists will prescribe only mentalhealth related medications for CalOptima members and will refer members to seek routine medical care from those physicians charged with, and reimbursed for providing this service. An allowance will be made for psychiatrists to write up to 3% of their CalOptimareimbursed prescriptions for medications that are not on the list of mental health medications developed in conjunction with the Orange County Health Care Agency and CalOptima. If a psychiatrist writes a substantial number of prescriptions and exceeds this amount, s/he will be notified in writing of the trend. CalOptima strives to arrange for its members to have an identified medical home, i.e. care managed by contracted primary care physicians (PCPs) contracted with one of the Health Networks. It is the expectation that the PCP will write most prescriptions or coordinate the specialty consults that may result in prescriptions. CalOptima six medication per month limit The prescription limit is part of CalOptima s efforts to reduce the unnecessary and excessive use of prescriptions and over-the-counter medications. When a pharmacy notifies a psychiatrist that a patient s prescription cannot be filled, then the psychiatrist can request an exemption from CalOptima s monthly medication limit by completing the form acy/medi-cal/requestformemberexemptionfromthemonthlymedicationlimit.ashx or by sending a letter to the CalOptima Pharmacy Management Department, Attn: Polypharmacy Program at 1120 West La Veta Avenue, Orange, CA or by fax to (714)

10 OC Medi-Cal Psychiatrists Prescribing Resource Handbook May 2007 Page 10

11 OC Medi-Cal Psychiatrists Prescribing Resource Handbook 2011 Page 11 CalOptima Prior Authorization of Benefits

12 OC Medi-Cal Psychiatrists Prescribing Resource Handbook 2011 Page 12 Medi-Cal Approved Drug List excerpts as of 2011 For most up to date information & for the complete formulary the website is: %23filename+drugscdl%2A%2Edoc+OR+%23filename+drugscdl%2A%2Ezip%29&wFLogo= Contract+Drugs+List&wFLogoH=52&wFLogoW=516&wAlt=Contract+Drugs+List&wPath=N Medi-Cal Approved Antipsychotics Atypical Antipsychotics aripiprazole, asenapine, iloperidone

13 OC Medi-Cal Psychiatrists Prescribing Resource Handbook May 2007 Page 13 Atypical Antipsychotics olanzapine, quetiapine, ziprasidone

14 OC Medi-Cal Psychiatrists Prescribing Resource Handbook May 2007 Page 14 Lithium Medi-Cal s six medication per month limit Because Medi-Cal does not have the responsibility for physical health care medications, it would be very unusual to exceed the six prescription per month limit.

15 OC Medi-Cal Psychiatrists Prescribing Resource Handbook 2011 Page 15 Medi-Cal TAR For antipsychotics and lithium preparations that are not on the Medi-Cal approved drug list, the Medi-Cal TAR will be typically completed at the pharmacy, but the pharmacy will need the diagnosis and medical justification from the psychiatrist.