208.226. Antipsychotic medication, no restrictions on availability in MO HealthNet program — provider updates, content.

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208.226. Antipsychotic medication, no restrictions on availability in MO HealthNet program — provider updates, content. — 1. No restrictions to access shall be imposed that preclude availability of any individual antipsychotic medication.

2. The provisions of this section shall not prohibit the division from utilizing clinical edits to ensure clinical best practices, including, but not limited to:

(1)Drug safety and avoidance of harmful drug interactions;

(2)Compliance with nationally recognized and juried clinical guidelines from national medical associations using medical evidence and emphasizing best practice principles;

(3)Detection of patients receiving prescription drugs from multiple prescribers; and

(4)Detection, prevention, and treatment of substance use disorders.

3. The division shall issue a provider update no less than twice annually to enumerate treatment and utilization principles for MO HealthNet providers, including, but not limited to:

(1)Treatment with antipsychotic drugs, as with any other form of treatment, should be individualized in order to optimize the patient's recovery and stability;

(2)Treatment with antipsychotic drugs should be as effective, safe, and well-tolerated as supported by best medical evidence;

(3)Treatment with antipsychotic drugs should consider the individual patient's needs, preferences, and vulnerabilities;

(4)Treatment with antipsychotic drugs should support an improved quality of life for the patient; and

(5)Treatment choices should be informed by the best current medical evidence and should be updated consistent with evolving nationally recognized best practice guidelines.

4. If the division implements any new policy or clinical edit for an antipsychotic drug, the division shall continue to allow MO HealthNet participants access to any antipsychotic drug that they utilize and on which they are stable or that they have successfully utilized previously. The division may recommend a resource list with no restrictions to access.

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(L. 2021 H.B. 432)