Prior Authorization Guidelines
Concomitant Antipsychotic Treatment
Approved Indications:
Treatment Refractory
1. Schizophrenia spectrum disorders or
2. Bipolar disorder, with psychosis and/or severe symptoms
Special Considerations:
Cross tapers will automatically be approved for 60 days. Providers must submit a prior authorization request for continued utilization of concomitant use of any 2 antipsychotics beyond the 60 days allowed for cross tapering.
Guidelines for Approval for refractory schizophrenia spectrum disorder:
1. Evidence of adequate trials of at least three (3) individual formulary antipsychotics, one of which is clozapine, 4-6 weeks of maximum tolerated doses, and failure due to:
a. Inadequate response to maximum tolerated dose b. Adverse reaction(s),
c. Break through symptoms
Guidelines for Approval for refractory bipolar disorder with psychosis and/or severe symptoms:
1. Evidence of adequate trials of at least four (4) evidence based treatment options dependent upon the episode type. Trials may include lithium, divalproex, atypical antipsychotic monotherapy,
carbamazepine, haloperidol, lamotrigine, lithium + an anticonvulsant, lithium + an antipsychotic, or an anticonvulsant + an antipsychotic. Trials should be 4-6 weeks of maximum tolerated
doses, with failure due to:
a. Inadequate response to maximum tolerated dose b. Adverse reaction(s),
c. Break through symptoms
Additional Requirements:
· Provider must provide supporting documentation that adherence to the treatment regimen has not been a contributing factor to the lack of response in the medication trials.
Coverage is Not Authorized for:
1. Members with known hypersensitivity to requested medication(s).
2. Prior Authorization Requests not meeting the above stated criteria.
References:
1. ADHS/DBHS: Provider Manual Section 3.15: Psychotropic Medication: Prescribing and Monitoring
2. Correll CU, Rummel-Kluge C, Corves C, et al. Antipsychotic combinations vs monotherapy in schizophrenia: A meta-analysis of randomized controlled trials. Schizophrenia Bulletin, 2009;35:443-457.
3. Essock SM, Schooler NR, Stroup TS, et al. Effectiveness of switching from antipsychotic polypharmacy to
monotherapy. Am. J. Psychiatry, 2011;168:702-708.
4. Tandon R, Belmaker RH, Gattaz WF, et al. World Psychiatric Association Pharmacopsychiatry Section statement on comparative effectiveness of antipsychotics in the treatment of schizophrenia. Schizophrenia Research, 2008;100:20-38.
5. Tsutsumi C, Uchida H, Suzuki T, et al. The evolution of antipsychotic switch and polypharmacy in natural practice- A longitudinal perspective. Schizophr. Res. 2011;130:40-46.
6. Zink M., Englisch S, Meyer-Lindberg A. Polypharmacy in schizophrenia. Curr. Opin. Psychiatry, 2010;23:103-
111.s
7. Yatham LN, Kennedy SH, Schaffer A, et al, Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) collaborative update of CANMAT guidelines for the management of patients with bipolar disorder: update 2009. Bipolar Disorder. 2009 May;11(3):225-55.
8. Hirschfeld R., Bowden C., Gitlin M, et al. Practice Guideline for the Treatment for Patients With Bipolar
Disorder (Revision). Am J Psychiatry. 2003: 1(1) 64-110.
9. Crimson, L., Argo T., Bendele S., Suppes T., Texas Medication Algorithm Project Procedural Manual- Bipolar
Disorder Algorithms. Texas Department of State Health Services. Web address:
http://www.pbhcare.org/pubdocs/upload/documents/TIMABDman2007.pdf Accessed July 15, 2013.