1. An Overview of State Medicaid Policies for Mental Health Drugs Kyle E. Hultgren, PharmD Candidate Purdue University School of Pharmacy

2. Objective To provide an accurate overview of current state Medicaid policies regarding mental health drugs

3. Methods Identify states with preferred drug lists (PDLs) Isolate and quantify the use of mental health drug policies Form clusters of similar policies Associate each state Medicaid prescription drug benefit structure with a given policy cluster

4. Identify and Quantify PDL Use 74% (37) have a PDL of some form 68% of these 37 states have mental health drug policies in place Chart displays percentage of policies that address various drug classes

5. Drug and Policy Clusters Drug classes most commonly addressed through policies Antipsychotics Antidepressants ADHD medications Three major arenas of PDL structure and function Brand-Generic Policies Prior Authorization Policies Treatment Algorithm Policies

6. Brand-Generic Policies All generic medications are preferred over brand name (mandatory generic substitution and therapeutic substitution) Brands without generic equivalents may still be preferred Providers may be able to override preferred status Brand manufacturers may pay supplemental rebates to become competitive in the class States: Florida, Alaska, Illinois

7. Florida Preferred SSRIs CitalopramLexapro Citalopram HBrPaxil CR FluoxetinePexeva Fluoxetine HClZoloft Table shows mix of both brand name and generic medications

8. Prior Authorization Policies Requires that specific criteria are met before a prescription is dispensed May involve “fail-first” edits or time intervals Method of attempting treatment uniformity for patients with identical diagnoses Moves toward a shared state and provider responsibility for prescribing behaviors States: Maine, Massachusetts, Missouri

9. Prior Authorization Policy Example

10. Treatment Algorithm Policies The most state-centric set of policies Designed to initiate, change, direct, and terminate patient drug therapy based upon written criteria Designed using most current evidence in tandem with provider consensus lends credibility to the algorithm Series of prior authorizations used as guideposts to ensure appropriate use State: Texas

12. Summary Few states purely use one method for creating mental health drug policies