January 07, 2020 Network in the Know

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.

Adele O'Connell
About the Author

Adele joined CDPHP in 2004 as an internal communications and event specialist. She then spent eight years coordinating the company’s community relations and corporate events program, in which capacity she worked with a host of non-profit organizations and co-chaired the CDPHP annual Charity of Choice campaign. Currently, she is a communications specialist and coordinator of corporate member engagement and serves on the boards of two local charities. Prior to CDPHP, Adele served as a legislative assistant for a trade association and as an acquisitions and developmental editor, specializing in educational and medical publishing. She earned a bachelor’s degree in English from Rosemont College.

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