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Effective Management Strategies for Alabama Medicaid Pharmacy Prescription Limits

This presentation by Timothy E. Stone, MD, Medical Director of Alabama Department of Mental Health, outlines new Alabama Medicaid pharmacy prescription limits effective October 1, 2013. It addresses potential clinical challenges in managing medication regimens during the implementation of these limits and discusses clinical problems related to medication access issues. The session includes management strategies for providers and prescribers to help ensure consumers maintain access to necessary treatments and avoid disruptions. Key changes include limits on prescriptions and exclusions for certain medication classes.

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Effective Management Strategies for Alabama Medicaid Pharmacy Prescription Limits

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  1. Pharmacy Prescription Limits Management Strategies For Behavioral Health Providers October 2013 Timothy E Stone, MD, Medical Director, Alabama Department of Mental Health

  2. Objectives • Review new rules for Alabama Medicaid Pharmacy prescription limits to be implemented on October 1, 2013 • Discuss potential challenges that may be encountered in clinical management of medication regimens during and after implementation of prescription limits • Review clinical problems that could occur in conjunction with medication access difficulties • Identify and discuss suggested management strategies for providers and prescribers to help consumers avoid treatment disruption during and after implementation of prescription limits Timothy E Stone, MD, Medical Director, Alabama Department of Mental Health

  3. Alabama Medicaid Prescription Limit Implementation – October 1, 2013 • Full summary of changes as well as supporting documents can be found at medicaid.alabama.gov under Programs then Pharmacy Services • OTC (over-the-counter) medications are no longer covered • Five (5) prescription drug limit • Four (4) brand-name prescription drug limit • Children and nursing home residents are excluded • Certain drug classes are excluded, with an absolute limit of ten (10) total prescriptions dispensed per month • Antipsychotic medications • Anti-seizure medications • Anti-Retroviral Medications • 3 month supply of maintenance medications • Each maintenance medication counts against the prescription limit only in the month it is dispensed Timothy E Stone, MD, Medical Director, Alabama Department of Mental Health

  4. Challenges For Behavioral Health Consumers and Providers • Complex medication regimens • Communication of health information between health providers • Medication access decisions • Management of therapeutic boundaries with consumers Timothy E Stone, MD, Medical Director, Alabama Department of Mental Health

  5. Clinical Problems Associated With Medication Access Difficulties • Clinical de-compensation • Drug withdrawal syndromes • Treatment adherence difficulties Timothy E Stone, MD, Medical Director, Alabama Department of Mental Health

  6. Management Strategies • Update • Contact information • Healthcare provider information • Releases of information • Current medication list • Educate • Consumers • Caregivers • Staff • Communicate • Outreach • Be Receptive • Ask For Help • Carter English, Director of Pharmacy Services, ADMH – (334) 242-3216 or carter.english@mh.alabama.gov Timothy E Stone, MD, Medical Director, Alabama Department of Mental Health

  7. Management StrategiesImportant Details • Know and Understand the Medicaid Prescription Limit Rules • Even considering excluded medication classes, no patient can receive more than 10 dispensed medications per month • Option to opt out of 3 month supply in certain circumstances • Sixty (60) day stable therapy requirement • Stay informed about alternative resources for obtaining medications • Confirm pharmacy begins “staggering” maintenance medications on in October 2013, when possible Timothy E Stone, MD, Medical Director, Alabama Department of Mental Health

  8. Prescribing Strategies Be a SMART, SAFE, and THRIFTY prescriber! Timothy E Stone, MD, Medical Director, Alabama Department of Mental Health

  9. Smart • Objective evaluation for response to meds • Treat disorders, not symptoms • Take a good personal and family medication history • Use non-pharmacologic interventions when indicated and available Timothy E Stone, MD, Medical Director, Alabama Department of Mental Health

  10. Safe • Monitor for side effects • Monitor medication levels and other laboratory studies per standard guidelines • Avoid treating medication side effects with additional medications, if possible • Avoid using prn (as needed) hypnotics or anti-anxiety medications for extended periods of time, when non-pharmacologic interventions may prove to be equally effective Timothy E Stone, MD, Medical Director, Alabama Department of Mental Health

  11. Thrifty • “Situational awareness” in the context of treatment • Maintain open, honest communication with consumers about medication compliance • Practice therapeutic flexibility • As far as possible, communicate with patient’s pharmacy to insure that maintenance medications are “staggered” Timothy E Stone, MD, Medical Director, Alabama Department of Mental Health

  12. Thanks For Participating! Timothy E Stone, MD, Medical Director, Alabama Department of Mental Health

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