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Final Psych Consult Dose Thresholds
M.S. 245.4862 and 256B.0625
Effective June 1, 2014, psychiatric consultations will no longer be required for high-dose ADHD and SGA drugs prescribed for children over age 3. Instead, pharmacies will receive an informational point-of-service (POS) message when they bill for prescriptions which exceed the dose/age threshold for recipients under age 18.
Also, as of June 1, 2014, a child must be at least three years old for all ADHD and SGA prescriptions. Prior authorization (PA) overrides will not be available for children younger than age 3. Some drugs will continue to be subject to higher age requirements. PA requirements for prescription drugs, including age requirements for prescription drugs, are available on the PA Criteria and Regimen Review Sheets.
Psychiatric Consultation Process - Phase One
To initiate or continue psychotropic drug therapy in children at dosages exceeding the thresholds listed in Tables 1 and 2, providers must complete a Collaborative Psychiatric Consultation with the Minnesota Collaborative Psychiatric Consultation Service as part of the prior authorization process. The consultations are provided by board certified child and adolescent psychiatrists.
This program will be implemented in phases, and all medications listed in Tables 1 and 2 will eventually be affected. The implementation dates and consultation requirements are listed below:
Two exceptions to an immediate, mandatory consultation are allowed:
In the above situations, a prior authorization may be granted for up to 90 days, allowing time for the consultation to be completed.
Beginning September 17, 2012
Claims for SGA medications for children age five and younger will reject at the point of sale if a consultation has not been completed prior to claim submission. The rejection displayed will be reason code 340: “recipient’s age less than minimum specified on drug record.”
Table 1. Second Generation Antipsychotics Max Allowed Thresholds (Excludes Injectable Formulations)
Table 2. ADHD Drugs Max Allowed Thresholds
Psychiatric Consultation Request Form (DHS-6176): for prescribers to transmit to the Psychiatric Consultation Service
Additional information: www.dhs.state.mn.us/psychconsult
Legal reference: legislation
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