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

SOURCE: MEDICAID POLICIES ON OUTPATIENT PRESCRIPTION PSYCHIATRIC DRUGS: A SURVEY, BAZELON CENTER FOR MENTAL HEALTH LAW

Managed Care’s Top Ten Articles of 2016

There’s a lot more going on in health care than mergers (Aetna-Humana, Anthem-Cigna) creating huge players. Hundreds of insurers operate in 50 different states. Self-insured employers, ACA public exchanges, Medicare Advantage, and Medicaid managed care plans crowd an increasingly complex market.

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They bring a different mindset. They’re willing to work in teams and focus on the sort of evidence-based medicine that can guide health care’s transformation into a system based on value. One question: How well will this new generation of data-driven MDs deal with patients?

The surge of new MS treatments have been for the relapsing-remitting form of the disease. There’s hope for sufferers of a different form of MS. By homing in on CD20-positive B cells, ocrelizumab is able to knock them out and other aberrant B cells circulating in the bloodstream.

A flood of tests have insurers ramping up prior authorization and utilization review. Information overload is a problem. As doctors struggle to keep up, health plans need to get ahead of the development of the technology in order to successfully manage genetic testing appropriately.

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Shelley Slade
Vogel, Slade & Goldstein

Hub programs have emerged as a profitable new line of business in the sales and distribution side of the pharmaceutical industry that has got more than its fair share of wheeling and dealing. But they spell trouble if they spark collusion, threaten patients, or waste federal dollars.

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