Managed Care


States exempt psychiatric drugs in some Medicaid programs

MANAGED CARE November 2003. © MediMedia USA
The Formulary Files

States exempt psychiatric drugs in some Medicaid programs

MANAGED CARE November 2003. ©MediMedia USA

While states are implementing broad policies to control Medicaid costs, outpatient prescription psychiatric drugs are falling into newly created exemptions, according to a recent survey conducted by the Bazelon Center for Mental Health Law.

For example, 30 states exclude some or all psychiatric medications from prior authorization policies, and 15 states with preferred drug lists exclude some or all psychiatric medications from that restriction. Six states with mandatory generic substitutions and one third of the states with prescription limits exclude some psychiatric medications. On the other hand, 18 states have developed policies that target psychiatric medications by requiring that individuals first fail on one medication before another can be used. In a few states, pharmacy issues have been addressed through initiatives to improve prescribing practices and quality of care, instead of through arbitrary restrictions on access.

In most states, some psychiatric medications are protected from some restrictions, but are included in others. For example, several states exclude SSRIs from their preferred drug list while, at the same time, they have a policy mandating the use of generic medications, such as fluoxetine. When states make these exemptions in most of their restrictive pharmacy policies, it not only makes the medications more readily available, it also makes prescribing rules simpler for providers.

Number of states excluding specific drug groups



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