TennCare has announced changes in criteria for coverage of drugs in the following Preferred Drug List (PDL) classes for individuals with an intellectual and/or developmental disability (I/DD): Atypical Antipsychotics, Typical Antipsychotics, Antidepressants, Antianxiolytics, and Sedative Hypnotics. Drugs that fall within these classes will now be subject to prior authorization in enrollees with a history of I/DD if there is no co-occurring mental health diagnosis on file.
Prior authorization requires (but is not limited to) the prescriber’s completion of a training module, OR evaluation of underlying conditions and differential diagnosis, OR short-term approval until training and complete physical work-up can be completed.
TennCare has developed a training opportunity that can help providers (especially prescribers) provide better care for patients with I/DD. The training program, titled APPROPRIATE USE OF PSYCHOTROPIC MEDICATIONS FOR PEOPLE WITH I/DD: HELPING INDIVIDUALS GET THE BEST BEHAVIORAL HEALTH CARE, can be accessed and completed online HERE at no charge. The training is available to pharmacists. Unfortunately, Pharmacy CE credits were not approved for this training, but ACPE advised that, if taken, pharmacists can submit the training to the Board of Pharmacy for credit evaluation. This letter to physician providers offers more information about the training modules.
The training program is the result of a partnership between TennCare, the Tennessee Department of Intellectual and Developmental Disabilities, and the Vanderbilt Kennedy Center, a University Center for Excellence in Developmental Disabilities. In addition, TennCare has provided a toolkit to assist providers, which is available at www.iddtoolkit.org or vkc.mc.vanderbilt.edu/etoolkit/.
This change follows the recommendation of the TennCare Pharmacy Advisory Committee and is part of a larger initiative that involves free provider and caretaker training, an increase in access to mental health providers, and extensive preventative measures for treatment of patients with a history of I/DD.