Attention: Pharmacists Reminder: POS Behavioral Health Edits and Override Instructions

On May 1, 2017, new pharmacy point of sale (POS) clinical edits for behavioral health medications became effective for pediatric and adult beneficiaries prescribed such medications. These edits are specifically related to dosage and quantity prescribed which exceeds the Food and Drug Administration (FDA) approved maximum dosage, dosage schedule, and in class therapeutic duplication. The edit descriptions for pediatrics and adults follow:

Note: Concomitant use is 60 or more days of overlapping therapy.

· Quantities more than the dosages recommended by the FDA for the atypical antipsychotics

· Quantities more than the dosages recommended by the FDA for the antidepressants

· Quantities more than the dosages recommended by the FDA for attention deficit/attention deficit hyperactivity disorder (ADD/ADHD) medications

· Concomitant use of three or more atypical antipsychotics

· Concomitant use of two or more antidepressants (Selective serotonin reuptake inhibitor -SSRIs)

· Concomitant use of two or more antidepressants (Serotonin–norepinephrine reuptake inhibitor - SNRIs)

· Concomitant use of two or more anxiolytics

· Quantities more than the dosages recommended by the FDA for the behavioral health medications (does not include antidepressants, atypical antipsychotics, stimulants and ADD/ADHD medications)

Bypassing the edit will require an override that should be used by the pharmacist when the prescriber provides clinical rationale for the therapy issue identified by the edit. The edit override is 10 entered in a submission clarification code field.