CHA News Article

DHCS Clarifies new TAR Process for Antipsychotic Medications
Process applies to individuals under age 18

Effective Oct. 1, the Department of Health Care Services (DHCS) now requires physicians to submit a Treatment Authorization Request (TAR) before prescribing antipsychotic medication for children and adolescents under the age of 18 who are covered by Medi-Cal. The new restrictions apply only to antipsychotics, not to other psychotropic medications, including mood stabilizers such as antidepressants and anti-anxiety drugs. The process impacts both fee-for-service Medi-Cal and the Medi-Cal managed care plans — because antipsychotics are carved-out drugs — and changes code 1 restrictions in the section of the provider manual titled “Drugs: Contract Drugs List Introduction.” A state pharmacist now must verify the “medical necessity” of each prescription for antipsychotics before the medications can be given to children who are age 17 and younger and covered by Medi-Cal.

DHCS has provided the attached documents as additional clarity on the new TAR process. The Suggested Language document includes draft instructions for obtaining an emergency 72-hour supply of drugs developed by the DHCS Pharmacy Division and will be formally distributed by DHCS.

The special authorization has been required since 2006 on prescriptions for children five and younger, but will now be expanded to all individuals under the age of 18. The Department’s action comes on the heels of nationwide probes by the federal government and a series of articles investigating the high percentage of foster children and youth receiving psychotropic medication.

In practical terms, the new process extends the time it takes to obtain permission for an individual under age 18 to obtain antipsychotic medication. While this extra step for authorization is intended to decrease the likelihood that children are incorrectly prescribed antipsychotics, it may further delay timely access to needed medication for individuals recently discharged from inpatient services who suffer from psychotic symptoms.

CHA requests that members disseminate the attached documents widely to physicians and alert other staff who may hear about medication access issues post-discharge.

CHA will meet with DHCS on the issue this week.