New Toolkit for Providers: Antidepressant Medication Management Recommendations for Adults

Date: October 1, 2024
Attention: Behavioral Health Providers

Call to Action

Texas Children Health Plan (TCHP) encourages providers to continue to take measures to ensure your patients, our members, receive excellent care. TCHP is committed to optimizing the quality of care provided to our members with behavioral health condition(s). TCHP would like to share information on antidepressant medication management recommendations for adults with major depression.

Why it Matters

Major depression can lead to serious impairment in daily functioning, including change in sleep patterns, appetite, concentration, energy and self-esteem, and can lead to suicide, the 10th leading cause of death in the United States each year. Clinical guidelines for depression emphasize the importance of effective clinical management in increasing patients’ medication compliance, monitoring treatment effectiveness and identifying and managing side effects. Effective medication treatment of major depression can improve a person’s daily functioning and well-being and can reduce the risk of suicide. With proper management of depression, the overall economic burden on society can be alleviated, as well.¹

Consider the following when prescribing antidepressant medications for patients with major depression:

Effective Acute Phase Treatment - The percentage of members who remained on an antidepressant medication for at least 84 days (12 weeks).

Effective Continuation Phase Treatment - The percentage of members who remained on an antidepressant medication for at least 180 days (6 months).

• Provide written and verbal education to members on:
  • Taking medication as prescribed for at least six months.
  • Continuing their medication even if they feel better.
  • Possible side effects
  • Expected length of time for the medication to have the desired effect.
  • Coming in for an appointment with the prescribing provider prior to stopping their medication.
  • The value of psychotherapy, counseling, stress management, sleep, social support, diet, and exercise to enhance medication effectiveness.
  • Automatic refills, medication delivery, and other tools to avoid delay in receiving medication refills.
• Schedule a follow up to assess for side effects and response to treatment within 30 days.
• When appropriate, consider 90-day supplies of medication to prevent gaps in adherence.
• Monitor for response to treatment with a standardized tool such as the Patient Healthcare Questionnaire (PHQ-9).
• Consider non-adherence or inadequate dosing as contributing factors if there is limited or no response to treatment.
• Be aware that medication samples, discount programs, or Veterans Affairs (VA) benefits are not captured through pharmacy claims and therefore will not close gaps.
• If your patient experiences a hospitalization for mental illness, please note that you will also need to adhere to the Follow-Up After Hospitalization for Mental Illness (FUH) HEDIS measure requirements. This requirement identifies the need for both a 7 day and 30 day follow-up after discharge to ensure patient safety, medication adherence, and prevention of readmission.

Antidepressant Medications

Next step for Providers: Providers are encouraged to share this communication with their staff. 

Resources:

• HEDIS toolkit on Antidepressant Medication Management (AMM)
• HEDIS toolkit on Follow-Up After Hospitalization for Mental Illness (FUH)
• Patient Healthcare Questionnaire (PHQ-9).
• National Institute of Health (NIH) Digital Shareables on Depression
• Texas Health & Human Services Commission (HHSC)

References:

1 “Antidepressant Medication Management (AMM).” NCQA, 1 Jan. 2024, www.ncqa.org/hedis/measures/antidepressant-medicationmanagement/

If you have any questions, please email Provider Relations at: providerrelations@texaschildrens.org. 

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