Prior Authorization Requirements for Psychotropic Medications in Children and Adolescents

New York state requires CDPHP, as a Medicaid Managed Care plan, to implement a Children’s Behavioral Health Pharmacy Program that includes the monitoring and oversight of key medications for children. Effective February 1, 2020, prior authorization will be required for:

• All antipsychotics, benzodiazepines, hypnotics, anxiolytics, and lithium prescribed for members younger than 18 years of age.
• Formulary stimulant and non-stimulant medications prescribed to treat attention deficit hyperactivity disorder (ADHD) in members younger than six years of age.
• Antidepressants prescribed for members younger than the FDA-approved age.

When receiving prior authorization requests for these medications, CDPHP will be looking for documentation of any non-pharmacologic interventions that have been tried, as well as evidence of ongoing medication monitoring. Additionally, we encourage providers to use age-appropriate, FDA-approved medications whenever clinically appropriate.

Patients who are stabilized on their current medication regimen will be grandfathered to prevent any disruption in treatment. As always, the CDPHP behavioral health team is available by phone (518-641-3600) to answer any questions about these requirements or behavioral health services in general.