Formulary Principles

The Massachusetts Division of Medical Assistance and the Massachusetts Department of Mental Health accepted principles developed by the Massachusetts Psychiatric Society (MPS) to guide the development of a preferred drug list for Medicaid. The following is the MPS position statement with principles:

The Massachusetts Psychiatric Society endorses the principle that patients shall have wide access to all appropriately prescribed psychiatric medications and that physicians shall have the freedom to prescribe all medications that are deemed clinically necessary for effective, high-quality patient care.

Given the realities of the current budget crisis, MPS strongly endorses the following principles regarding the possible establishment of a formulary:

• The primacy of the psychiatrist-patient relationship must be respected.

• Decisions concerning inclusion of medications on a proposed formulary must be made on the basis of acceptable medical evidence and clinical standards. Psychiatric physicians shall actively participate in all aspects of devising and/or implementing a formulary, and a psychiatric physician shall oversee procedures for authorizing exceptions.

• Patients on established, successful medication regimens shall not be taken off such medications solely on the basis of formulary exclusion.

• In the event that a formulary is adopted, the process for prior approval for nonformulary medications must be rapid and fair, with access to a timely and fair appeal process. All denials of authorization for psychiatric medication must be reviewed by a psychiatric physician. A record of the number and outcome of such appeals shall be made publicly available.

• Ongoing evaluation of the clinical and cost-effectiveness of the formulary and effectiveness and efficiency of the prior authorization process shall be actively maintained.