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HHS Guidelines: Pharmacy Psychotropic Medication

Date: 01/20/20

Superior utilizes Texas Health and Human Services (HHS) guidelines to provide evidence-informed guidance on the use of psychotropic medication for Texas Medicaid (STAR, STAR Health, STAR Kids and STAR+PLUS) and CHIP members. 

In June 2019, HHSC released revised guidelines to broaden the parameters from children in foster care to all children and youth in Texas public behavioral health:

Superior’s Pharmacy Psychotropic Medication Utilization Review (PMUR) team works to ensure that prescribers are acting within an agreed upon standard of care when prescribing.

To assist in this effort:

  • PMUR Service Managers review medication regimens to ensure they are within HHS parameters. Service Managers may contact providers to request medical records, help coordinate care based on PMUR recommendations and provide education.
  • PMUR Service Coordinators review labs to ensure they are ordered for members taking antipsychotic medications. Coordinators may contact providers if records indicate a member in their care has not received the appropriate monitoring.  
    • Pediatric Population Metabolic Monitoring is required at least every 6 months per HHS guidelines:
      • Glucose or Hemoglobin A1c; and
      • Low Density Lipoprotein (LDL) or Total Cholesterol
    • Adult Population Metabolic Monitoring is required at least yearly:
      • Glucose or Hemoglobin A1c

Providers are encouraged to respond to requests for information or records timely, take advantage of education opportunities and collaborate with Superior to coordinate care.

Please utilize the tips below for improving caregiver and member compliance with obtaining lab work for Antipsychotic Glucose and/or Lipid Monitoring:

  1. Order the lab on the same day of antipsychotic initiation, after 3 months, as well as annually.
  2. Discuss the importance of medication monitoring with patients.
  3. Consider and reduce barriers to blood draws by:
    • Suggesting point-of-care monitoring in the office for lipids and glucose or hemoglobin A1c.
    • Providing a list of local in-network laboratories convenient to the patient.

For any questions, please contact the Superior Pharmacy department at 1-800-218-7453, ext. 22080.