Behavioral Health Medication Edits

Effective May 1, 2017, new pharmacy point of sale (POS) clinical edits for behavioral health medications will go into effect. These edits are specifically related to dosage and quantity prescribed which exceeds the Food and Drug Administration (FDA) approved maximum dosage and dosage schedule and in class therapeutic duplication. There will be a 60-90 day grace period to allow pharmacists and providers a window of opportunity to identify and address any therapeutic issues that may be impacted by these new POS behavioral health clinical edits. Pharmacists are encouraged to contact prescribers if they identify any recipients that may be affected. The edit list can be found at the links below.

Clinical Utilization Behavioral Health Edits (Adult)-Pending Implementation

Clinical Utilization Behavioral Health Edits (Pediatric)-Pending Implementation