BACKGROUND: In response to concerns surrounding pediatric behavioral health medication prescribing, the Massachusetts Medicaid Pharmacy Program implemented a Pediatric Behavioral Health Medication Initiative (PBHMI), proactively requiring prior authorization for specific behavioral health medications and combination regimens. A multidisciplinary therapeutic class management (TCM) workgroup retrospectively reviews complex cases and conducts prescriber outreach to encourage evidence-based practices in Massachusetts. OBJECTIVE: To evaluate recommendation outcomes of telephonic peer-to-peer consultations conducted by the PBHMI TCM workgroup by assessing the percentage of accepted, modified accepted, or rejected recommendations, as well as prescriber satisfaction with consultation. METHODS: This retrospective evaluation reviewed PBHMI TCM workgroup cases with completed peer-to-peer consultations from September 1, 2015, to August 28, 2016. The proportion of medication interventions (e.g., medication changes, dose reductions, and elimination of polypharmacy within or across behavioral health medication classes) accepted, modified accepted, or rejected were assessed based on pharmacy claims data and prior authorization resubmission, following a peer-to-peer consultation. The medication class and prescriber type were categorized in relation to the acceptance, modified acceptance, or rejection outcomes. Satisfaction with the TCM workgroup process was evaluated with an anonymous survey offered to prescribers who participated in prescriber outreach. RESULTS: A total of 70 cases requiring a peer-to-peer consultation by a TCM workgroup child/adolescent psychiatrist had a completed outreach attempt during the evaluation period. Peer-to-peer consultations resulted in a recommendation acceptance rate of 31.4% (22/70), modified acceptance rate of 44.3% (31/70), and a rejection rate of 24.3% (17/70). Recommendations made during a peer-to-peer consultation were rejected by 30% (12/40) of child/adolescent psychiatrists compared with 16.7% (5/30) of nonchild/adolescent psychiatrists with completed peer-to-peer consultations (P = 0.43). Antipsychotics were most frequently recommended for regimen changes. All recommendations pertaining to a benzodiazepine were accepted by the prescriber. Results of an anonymous prescriber survey assessing satisfaction with the peer-to-peer consultation process exhibited variable responses among individual prescribers. CONCLUSIONS: The small sample size in this observational evaluation and lack of a defined control group prevented direct associations between the endpoints and outcomes. Further research is required to determine if prescriber specialty and medication class may be influencing factors on recommendation acceptance. DISCLOSURES: No outside funding supported this study. The authors have nothing to disclose. A poster of this project was presented at the AMCP Managed Care & Specialty Pharmacy Annual Meeting 2017; March 27-30, 2017; in Denver, CO.

This poster evaluates the financial impact of high-cost infused medications across three site of care programs. Site of care programs help payers save money on specialty drug spend by shifting utilization on high costs infused medications to less costly sites of administration. The objective of this project was to evaluate the costs associated with the administration of select high-cost infused medications in site of care programs in Massachusetts Medicaid populations. Research was done through retrospective analysis that included pharmacy and medical claims data for select high cost infused medications between April 1, 2017 - September 20, 2017. This presentation was given at the 2018 Managed Care & Specialty Pharmacy Annual Meeting and received the AMCP Foundation Best Poster Award in the Resident and Fellows category.

In 2011, the U.S. Government Accountability Office (GAO) reported foster and non-foster children in the MassHealth, Massachusetts Medicaid program, exhibited the highest rate of behavioral health medication (BHM) utilization, with 49.3% of all Medicaid children being prescribed a psychotropic medication, and 39.1% of children in foster care prescribed these medications. The MassHealth Pharmacy Program, which is managed by UMass Medical School, implemented a PBHMI Workgroup in November 2014 with the collaboration of the Department of Children and Families and the Department of Mental Health. The workgroup proactively requires prior authorization (PA) for specific medications or combinations of BHMs prescribed to members less than 18 years of age. Interventions include telephonic prescriber outreach by a child/adolescent psychiatrist to discuss opportunities for regimen simplification, drug interactions or toxicity, and to encourage evidence-based practices. An analysis of the workgroup suggests a peer-to-peer outreach program is associated with increased awareness and implementation of evidence based medicine in a pediatric population treated with behavioral health medications.