Insight Matters
Spring 2005

New ODJFS Medicaid Plan Looks Promising

Alice Hale, M.D.

The Ohio Department of Jobs and Family Services (ODJFS) is launching a new program to improve behavioral pharmacy prescribing practices in the Medicaid program next month. The OPA was invited to become members of the advisory group for this project.

On April 21, 2005, Drs. Marilynn Peters and Alice Hale attended the first meeting along with the representatives of 53 organizations. Comprehensive Neuro Science (CNS), Inc., founded in 1999, described their 3 areas of services: 1) expert consensus guideline development, 2) clinical trials, and 3) Behavioral Pharmacy Management (BPM). Financially backed by a grant from Eli Lilly Company, ODJFS will engage the BPM portion of CNS.

The CNS stated its goals as 1) to improve the quality of prescribing based on best practice guidelines; 2) to improve the patient adherence to medication plans, and 3) to reduce the rate of spending. They stressed that this is a voluntary program that succeeds by educating physicians instead of coercing, threatening, or punishing them. They try to identify "outliers" (they are searching for a better word), or those physicians who prescribe more than 2 antipsychotics to the same patient, use too high or too low doses of atypical antipsychotics, prescribe more than 3 behavioral medications concurrently to children/adolescents (or 5 for adults), use 2 or more drugs form the same chemical class, excessively switch antipsychotics, or patients who are receiving prescriptions from multiple providers. CNS tries to engage the physician in a helpful way. They can provide the physician with the records of the all the medications prescribed to the patient, provide educational messages, or provide peer-to-peer consultation using in-state expert physicians. Again, if a physician is identified for "outlier practices", they are not required to engage in the program. It is voluntary and designed to be helpful.

This program was chosen to avoid formulary restrictions. So far, it sounds very promising. Missouri adopted it in 2003 and slowed their rate of behavioral pharmacy spending significantly without restricting the formulary.

Many questions remain with this program. If you have questions, there is a website at www.cnswebsite.com. Drs. Peters and Hale can also be contacted through the OPA.

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