RD410 - Inclusion of Antidepressants and Antianxiety Drugs on Virginia Medicaid’s Preferred Drug List - December 1, 2008


Executive Summary:
Item 306 (R)(7) of the 2008 Appropriations Act requires that the Department of Medical Assistance Services (DMAS) exempt antidepressant and antianxiety medications used for the treatment of mental illness from the Medicaid Preferred Drug List (PDL) program. However, the Appropriations Act states that the Director of DMAS, in cooperation with the Department of Mental Health, Mental Retardation and Substance Abuse Services (DMHMRSAS), shall provide a report to the Chairmen of the House Appropriations and Senate Finance Committees by December 1, 2008, on the impact on patient care and costs of including these medications in the PDL in the future. Attachment A provides a copy of Item 306 (R)(7).

In response, DMAS, in consultation with DMHMRSAS, developed this report. Although the 2008 Appropriations language only mentions antidepressant and antianxiety medications, we also address antipsychotic medications in this report because of their high utilization and the fact that including them on the PDL represents an additional opportunity for cost savings. Furthermore, based on Virginia Medicaid’s experience to date with drugs for general medical treatment, as well as the Pharmacy and Therapeutics (P&T) Committee’s unanimous consent (previously) regarding the inclusion of antidepressant and antianxiety medications on the PDL, DMAS and DMHMRSAS do not believe the inclusion of these drugs on the PDL will adversely impact patient outcomes.

Specifically, this report describes: (1) the antidepressant, antianxiety, and antipsychotic drug classes; (2) Virginia’s PDL and the role of the P&T Committee; (3) the PDL performance; (4) Virginia Medicaid’s mental health drug utilization data; (5) the history of efforts to place mental health drugs on Virginia Medicaid’s PDL; (6) policies regarding mental health medications; (7) DMHMRSAS Community Pharmacy Services; (8) estimated savings of including antidepressant, antianxiety, and antipsychotic drugs on the Virginia Medicaid PDL; and, (9) the patient impact associated with including antidepressants, antianxiety, and antipsychotic drugs on the PDL.