Psychotropic Medication Management

Psychotropic medications—drugs that affect psychic function, behavior or experience—are part of the medical benefit and are generally administered by companies contracting with health plans called pharmacy benefit managers (PBMs). Psychotropic medications account for a significant part of the overall cost of health care because of the chronic nature of many mental illnesses, but a fractionalized system currently exists that prevents optimum management of these medications. Although behavioral specialists contracting with MBHOs routinely prescribe psychotropic medication to their patients, approximately 70 to 80 percent of psychotropic medications (primarily antidepressants) are prescribed by family physicians, internists, and pediatricians, who have little training in mental health issues. Because MBHOs do not manage the prescription drug benefit but bear theresponsibility for managing the behavioral care for their members, they are often unaware if psychotropic medications prescribed to their members are of the appropriate types and dosages, or if there are appropriate interventions during treatment to ensure their members are medication-compliant. Even if the "silos"—MBHOs, health plans, PBMs, primary care physicians, and behavioral specialists—are bridged through coordination-of-care protocols, the situation is further complicated by the Health Insurance Portability and Accountability Act (HIPAA) privacy legislation, which adds another layer of difficulty in sharing prescription information.