TCHP Psychotropic Medication Utilization Review (PMUR

Date: March 14, 2023

Attention: Pediatricians, Psychiatrists

Call to action: Texas Children’s Health Plan (TCHP) utilizes a PMUR program to promote safe prescribing of behavioral health medications to children and adolescents. TCHP identifies potential “prescribing outliers” using parameters established by the Texas Health and Human Services (HHSC). This does not mean the prescribing is wrong or harmful to the child, but requires additional review due to potential for adverse reactions, polyprescribing, and other implications.

Who is identified for review?

Members under the age of 18 years of age taking:

1. Two (2) or more stimulants (i.e. ADD/ADHD medications) concomitantly
2. Three (3) or more antipsychotic medications concomitantly
3. Antipsychotic medication(s) prescribed without appropriate monitoring of glucose and/or lipids at baseline and/or continuously at least every 12 calendar month
4. Members under a certain age taking a psychotropic/behavioral health medication:
   • a. Under the age of 5 and taking an antipsychotic
   • b. Under the age of 3 and taking a stimulant (ADD/ADHD drug)

Why is this important?

TCHP recognizes we serve vulnerable members in our membership. We also recognize members may see multiple providers or pharmacies to fill medications. We want to bring additional visibility to providers so they can discuss potential gaps and risks with their members.

Did you know?

• Children enrolled in the Medicaid program are disproportionately prescribed behavioral health medications compared to other children.
• • Children who begin using antipsychotics have a 50% increased risk of developing type 2 diabetes compared to similar children without treatment.
• • More than 90% of members taking four or more psychotropic medications, and over 30% receiving multiple stimulants, potentially received medications from more than one prescriber.1
• • By the mid-2000s, half of all children prescribed antipsychotics had a diagnosis of attention deficit hyperactivity and 14% had ADHD as their only mental health diagnosis.

What actions will TCHP take?

TCHP will send letters to providers with a member meeting one (1) or more parameter. TCHP will also offer prescriber detailing and peer to peer (P2P) opportunities. Additional interventions may target members receiving duplicative medications from multiple prescribers or pharmacies.

Next steps for providers: Providers should conduct a medication and prescriber reconciliation during every visit. Providers should also continue to follow American Academy of Child and Adolescent Psychiatry (AACAP) guidelines when prescribing, while following new formulary guidelines for impacted members.

References:

Edelsohn GA, Karpov I, Parthasarathy M, et al. Trends in Antipsychotic Prescribing in Medicaid-Eligible Youth. J Am Acad Child Adolesc Psychiatry. 2017 Jan;56(1):59-66. doi:10.1016/j.jaac.2016.10.005

Sultan RS, Wang S, Crystal S, Olfson M. Antipsychotic Treatment Among Youths With Attention-Deficit/Hyperactivity Disorder. JAMA Netw Open. 2019;2(7):e197850. doi:10.1001/jamanetworkopen.2019.7850

If you have any questions, please email TCHP Pharmacy at: tchppharmacy@texaschildrens.org.

For access to all provider alerts, log into: www.thecheckup.org or www.texaschildrenshealthplan.org/for-providers.