IMPORTANT NOTICE. Changes to dispensing of some Behavioral Health Medications for DC Healthcare Alliance members

Similar documents
Medications and Children Disorders

Appendix: Psychotropic Medication Reference Tables

Judges Reference Table for the March 2016 Psychotropic Medication Utilization Parameters for Foster Children

Review of Psychotrophic Medications. (An approved North Carolina Division of Health Services Regulation Continuing Education Course)

Guide to Psychiatric Medications for Children and Adolescents

Overview and Update on Current Psychopharmacological Medications, Including New Medications in Clinical Trials

MO Medicaid Foster Care Drugs FY10-FY14

Dealing with a Mental Health Crisis

Supplement: Tables and Figures

A Brief Overview of Psychiatric Pharmacotherapy. Joel V. Oberstar, M.D. Chief Executive Officer

PSYCHIATRY INTAKE FORM

Study Guidelines for Quiz #1

NorthSTAR. Pharmacy Manual

Richard Heidenfelder M.D. Child, Adolescent and Adult Psychiatry 447 9th Ave San Diego, CA

U T I L I Z A T I O N E D I T S

#55 PRESCRIBING AND MONITORING PSYCHI RIC MEDICATIONS

HCA BHS Prescribing Guidelines Committee - Approved Medications 2012

Schedule FDA & literature based indications

May 22, DAL: DAL SUBJECT: Hot Weather Advisory. Dear Administrator/Operator:

Mental Health Intake Form

New Patient Questionnaire

ALAMEDA COUNTY BEHAVIORAL HEALTH CARE SERVICES MEDICATION FORMULARY

Mental Health Medications. National Institute of Mental Health. U.S. Department of HealtH and HUman ServiceS National Institutes of Health

AAA. add dan campbell artwork cats? Report #12 Changes in Medication Use over Time in Adolescents and Adults with Autism Spectrum Disorders

Psychiatric Illness. In the medical arena psychiatry is a fairly recent field A challenging field Numerous diagnosis

Mental Health Intake Form

Medically Accepted Indications for Pediatric Use of Psychotropic Medications by

USF Health Psychiatry Clinic. New Patient Questionnaire Adult

Happy Daisy Ltd. New Client intake Form. What are the issues for which you are seeking care?

Iowa Medicaid Mental Health Advisory Group Meeting February 13, Tentative Agenda

Antidepressant Medication Strategies We ve Come a Long Way or Have We? Who Writes Prescriptions for Psychotropic Medications. Biological Psychiatry

Psychotropic Medications Archana Jhawar, PharmD, BCPP Clinical Faculty of UIC Pharmacy Practice Clinical Psychiatric Pharmacist Jesse Brown VA

CENPATICO INTEGRATED CARE BEHAVIORAL HEALTH DRUG LIST BY DRUG NAME. Use Brand Only

Psychiatric Evaluation Intake Form

Thank you for choosing Pine Rest Christian Mental Health Services. We look forward to providing services to you.

Psychiatric Evaluation Intake Form

COMMONLY PRESCRIBED PSYCHOTROPIC MEDICATIONS NAME Generic (Trade) DOSAGE KEY CLINICAL INFORMATION Antidepressant Medications*

TRANSCRANIAL MAGNETIC STIMULATION & BRAIN MUSIC THERAPY

Patient History Form

Use Brand Only. Preferred Drug Status PRIOR AUTHORIZATION REQUIRED

TDMHMR EXECUTIVE FORMULARY COMMITTEE MINUTES April 16, 2004

Welcome and thank you for choosing University of Florida Physicians!

PHYSICIAN REFERENCE ANTIDEPRESSANT DOSING GUIDELINES

CENPATICO INTEGRATED CARE BEHAVIORAL HEALTH DRUG LIST BY DRUG CLASS

PSYCHIATRIC HISTORY 6. Are you currently seeing a therapist? (Name & contact phone#)

PATIENT FACE SHEET PATIENT NAME: PATIENT DOB: PATIENT PHONE #: INSURANCE: MEMBER ID: GROUP NUMBER: PATIENT ADDRESS

Treat mood, cognition, and behavioral disturbances associated with psychological disorders. Most are not used recreationally or abused

Psychiatric Distress in Chronic & Terminal Illness Barb Henry, ARNP, MSN

New Patient Information - Adolescent

PSYCHIATRIC DRUGS. Mr. D.Raju, M.pharm, Lecturer

Attention: Behavioral Health Providers, Pharmacists and Prescribers N.C. Medicaid and N.C. Health Choice Preferred Drug List Changes - UPDATE

ABILIFY INJ. Products Affected Step 2: ABILIFY MAINTENA PREFILLED SYRINGE 300 MG INTRAMUSCULAR ABILIFY MAINTENA PREFILLED SYRINGE 400 MG INTRAMUSCULAR

OBJECTIVES PSYCHOTROPIC MEDICATIONS WHAT IS PSYCHOTROPIC MEDICATION?

1911 Keller Andrews Road Sanford, NC

Briefly state the reason for this evaluation: Patient s Name: Sex: Male/Female (circle one) Date of Birth: Age: Patient s Social Security #

PROBE INITIAL ZERO/ DK: Please include any prescription medicines, even if you took them only once.

LAGUNA BEHAVIORAL Crown Valley Parkway, Suite 140 Phone: (949) Laguna Niguel, CA Fax: (949)

POSITIVE YOUTH CONCEPTS Child and Adolescent Therapy 24 Front Street, Suite 302 Exeter, NH

Mental Illness. Doreen L. Rasp, APN, FNP, PMHNP Advanced Behavioral Counseling

APPENDIX E COMMONLY PRESCRIBED MEDICATIONS BY CATEGORY BY BRAND (GENERIC)

Child & Adolescent Patient History Questionnaire

MORPHINE IR DRUG CLASS Morphine IR, Dilaudid IR (hydromorphone), Opana IR (oxymorphone)

IR PROCEDURE REFERENCE GUIDE

NEW PATIENT INTAKE FORM

HOSPITAL BASED INPATIENT PSYCHIATRIC SERVICES (HBIPS) MEASURE SET

4/2/13 COMMON CLASSES OF MEDICATIONS. Child & Adolescent Behavioral Medicine & Medication Therapies. Behavioral Medicine & Medication Therapies

Pharmacy Benefit Management (PBM) Program FORMULARY/PRODUCT RESTRICTIONS

Adult Initial Assessment / Patient Questionnaire Page 1

Psychopharmacology & Clinical Practice: Helping or Hurting?

Change Your Brain, Change Your Life. The Breakthrough Program for Conquering Anxiety, Depression, Obsessiveness, Anger, and Impulsiveness

Steps for Initiating Electroconvulsive Therapy Treatment

Treatment of Children with Mental Disorders

med ed Copyright All rights reserved. No part of this publication can be reproduced without prior written consent of the authors.

Pre - PA Allowance. Prior-Approval Requirements LEVORPHANOL TARTRATE. None

Welcome and Webinar Logistics

Patient Registration Form. Patient Name: Social Security #: Billing Address: City: State: Zip Code: Home Address. Home Phone#: Cell #: Work #:

Duragesic Patch (fentanyl patch) Prior authorization is not required if prescribed by an oncologist

HYSINGLA ER (hydrocodone bitartrate) Prior authorization is not required if prescribed by an oncologist.

Dual Diagnosis: Substance Abuse and Mental Illness

Texas Prior Authorization Program Clinical Edit Criteria

How did we get here? 1876 Methylene Blue. Insecticide 1935 Du Pont Anthelmintic. Garrett McCann, RPh

The Basics of Psychoactive/Psychotropic Medications Tina Sanchez, RN, SMQT New Mexico Department of Health Division of Health Improvement State

1. Prozac (fluoxetine)-typically activating, available in liquid form. Dosage(child), mg/d.

Psychiatric Medications. Positive and negative effects in the classroom

Medications for Treating Mental Illnesses 3.0 Contact Hours Presented by: CEU Professor

New Jersey Department of Children and Families Office of Child Health Services. Psychotropic Medication Policy

Depression. University of Illinois at Chicago College of Nursing

LifePath Systems Medication and Laboratory Formulary

Anti- Depressants, Mood Stabilizers: What Works Best For Bipolar Disorder? Date: March 30, 2007 Source: NIH/National Institute of.

CHILD/ADOLESCENT INTAKE FORM

AHCCCS BEHAVIORAL HEALTH DRUG LIST EFFECTIVE OCTOBER 1, 2016

Creating Partnerships. Laine Young-Walker, MD

Moderator: Michele Y. Splinter, Pharm.D., BCPS Clinical Associate Professor, University of Oklahoma College of Pharmacy, Oklahoma City, Oklahoma

Major Depressive Disorder

PROBLEM: PSYCHOSIS GOALS APPROACHES

Psychiatric Medication Guide

AD/HD is a mental disorder, and it often lasts from

Transcription:

IMPORTANT NOTICE Changes to dispensing of some Behavioral Health Medications for DC Healthcare Alliance members These changes apply only to members covered under the DC Healthcare Alliance program Alliance members who need to fill the behavioral medications noted on the attached list will be required to fill them at the Core Service Agency (CSA) /Department of Behavioral Health (DBH) Pharmacy located at 35 K Street NE, Washington, DC. The pharmacy is open Monday through Friday from 8:30 am to 5 pm. Prescriptions received before 4:15 pm will be filled the same day. Should assistance be required, call (202) 442-4954. This change applies only to the medications and the dosages and dosage forms indicated on the list. For example, prescriptions for fluoxetine 10 mg and 20 mg capsules should be filled at the CSA/DBH pharmacy, but 40 mg capsules and all tablet doses should be filled at MFC network retail pharmacies. Additional behavioral health medications on the MedStar Family Choice formulary remain available to Alliance members. The standard MFC request procedures for prior authorization, step therapy and non-formulary requests will apply. Emergency 3-Day supplies will be available at MFC network pharmacies for fills when the CSA/DBH pharmacy is closed. Page 1

CSA FORMULARY of Medications available through the Department of Behavioral Health Pharmacy at 35 K street NE, Washington, DC Applies to: DC Healthcare Alliance Members Only Generic Name (Brand Name) Forms of Drugs Available Description Alprazolam (Xanax) Tablets 0.25mg, 0.5mg, Anxiety agent 1mg and 2mg Amitripryline (Elavil) Tablets 10mg, 25mg, 50mg, 75mg, and 100mg Antidepressant Amoxapine (Asendin) Tablets 25mg, 50mg, 100mg, Antidepressant/Tranquilizer and 150mg Amphetamine Sulfate/Asparate Tablets 5mg, 10mg, 20mg, 30mg Dextroamphetamine sac/dex Sul Tablets-XR 5mg, 10mg, 20mg, Used to treat narcolepsy and attention deficit hyperactivity (Adderall) and 30mg disorder Ariprazole (Abilify) Tablets 10mg, 15mg, 20mg, Atypical antipsychotic and 30mg Atomoxetine (Strattera) Capsules 10mg, 18mg, 25mg Used to treat Attention- 40mg, 60mg Deficit/Hyperactivity Disorder (ADHD) Bupropion (Wellbutrin) Tablets 75mg, 100mg Antidepressant Tablets-SR (q12h) 100mg, 150mg Tablets-XL (q24h) 150mg, 300mg Buspirone (Buspar) Tablets 5mg, 10mg, and 15mg Antianxiety agent Suspension 100mg.5ml Page 2

Chlordiazepoxide (Librium) Capsule 5mg, 10mg, 25mg Used to relieve nervousness, tension, or treat alcohol withdrawal Chlorpromazine (Thorazine) Tablets 25mg, 50mg, 100mg, Antipsychotic and 200mg. Citalopram (Celexa) Tablets 10mg, 20mg and 40mg Antidepressant (SSRI) Clomipramine (Anafranil) Capsules 25mg, 50mg, and Antidepressant 75mg Clozaril (Clozapine) Tablets 25mg and 100mg Atypical antipsychotic Desipramine (Norpramin) Tablets 10mg, 25mg, 50mg, Antidepressant 75mg, and 100mg Dextroamphetamine Sulfate Tablets 5mg Stimulant used to treat (Dexedrine) Spansules 5mg, 10mg & 15mg narcolepsy and attention deficit disorder Diazepam (Valium) Tablets 2mg, 5mg, 10mg Antianxiety agent Depakote-ER Depakote-DR 250mg & 500mg ER 250mg& 500mg Doxepin (Sinequan) Capsules 10mg, 25mg, 50mg, Antidepressant and 75mg Duloxetine HCL (Cymbalta) Capsules 20mg, 30mg & 60mg Antidepressant (SSNRI) Droperidol (Inapsine) Injection 5mg/2ml Used to treat psychosis Page 3

Escitalopram Oxalage (Lexapro) Tablets 10mg & 20mg Antidepressant (SSRI) Fluoxetine (Prozac) Capsules 10mg, 20mg Antidepressant Fluphenazine (Prolixin, Permitil) Tablets 1mg, 2.5mg, 5mg, 10mg Typical antipsychotic Injection 2.5mg/ml 10ml vial Deconoate 25mg/ml 5ml vial Concentrate 5mg/ml 120mg Fluvoxamine (Luvox) Tablets 50mg, 100mg Antidepressant 400mg, 600mg, & 800mg treat Bipolar Disorder Haloperidol (Haldol) Tablets 0.5mg, 1mg, 2mg, Typical Antipsychotic 5mg, 10mg & 20mg. Solution 2mg/ml 120ml Injection 5mg/ml Deconoate 50mg/ml 5ml vial 100mg/ml 5ml vial Imipramine (Tofranil) Tablets 10mg, 25mg, 50mg Antidepressant Lithium Carbonate (Eskalith, Tablets 300mg, Used to treat bipolar disorder Lithobid) 450mg (controlled released) Capsules 150mg, 300mg Lithium Citrate Syrup 8meq lithium (as citrate Used to treat bipolar disorder equivalent to 300mg lithium carbonate) 5cc 480ml Lorazepam (Ativan) Tablets 0.5mg, 1mg, 2mg Antianxiety, hypnotic Page 4

Injection 2mg/ml Loxapine (Loxitane) Capsules 5mg, 10mg, 25mg, Typical antipsychotic 50mg Methylphenidate (Concerta) Tablets 18mg, 36mg, 54mg Used to treat attention deficit hyperactivity disorder & narcolepsy Methylphenidate (metadate) Tablets ER 10mg Used to treat attention deficit hyperactivity disorder and narcolepsy Methylphenidate (Ritalin Tablets 5mg, 10mg, 20mg Used to treat attention deficit SR 20mg hyperactivity disorder and narcolepsy Mirtazapine (Remeron) Tablets 15mg, 30mg, 45mg Antidepressant Nortriptyline (Pamelor) Capsules 10mg, 25mg, 50mg, Antidepressant 75mg Olanzapine (Zyprexa) Tablets 2.5mg, 5mg, 10mg, Atypical antipsychotic 15mg, 20mg Injection 10mg vials **FOR STABLIZATION ONLY-- NO MORE THAT 5 DAY SUPPLY** Zydis-oral disintegrating tablets 5mg, 10mg, 20mg Paroxetine HCL (Paxil Tablets 10mg, 20mg, 30mg, Antidepressant 40mg Perphenazine (Trilafon) Tablets 2mg, 4mg, 8mg Typical Antipsychotic Page 5

Perphenazine/Amitriptyline Tablets 2/10, 2/25, 4/10, 4/25, Used to treat nervous, mental (Triavil, Etrafon) and emotional conditions Phenobarbital Tablets 15mg, 30mg, 60mg Used to relieve anxiety or tension or to help control seizures Quitiapine (Seroquel) Tablets 25mg, 100mg, 200mg Atypical antipsychotic Resperidone (Risperdal) Tablets 0.25mg, 0.5mg, 1mg, Atypical antipsychotic 2mg, 3mg, 4mg, Solution 1mg/ml 30mg **for stabilization only-no more M-Tabs (oral disintegrating) than a 5 day supply** 0.5mg, 1mg, 2mg Sertraline (Zoloft) Tablets 25mg, 50mg, 100mg Antidepressant Thioridazine (Mellaril) Tablets 10mg, 15mg, 25mg, Typical antipsychotic 100mg, 150mg, 200mg Thiothixene (Navane) Capsules 1mg, 2mg, 5mg, Typical antipsychotic 10mg, 20mg Concentrate 5mg/ml 120mg Trazodone (Desyrel) Tablets 50mg, 100mg, 150mg Antidepressant Trifluoperazine (Stelazine) Tablets 1mg, 2mg, 5mg, 10mg Typical antipsychotic Venlafaxine (Effexor) Tablets 25mg, 37.5mg, 50mg Antidepressant Capsules-XR 37.5mg, 75mg, 150mg Ziprasidone (Geodon) Capsules 20mg, 40mg, 60mg, 80mg Atypical antipsychotic Injection 20mg/ml Page 6

Page 7

2024 © healthdocbox.com Privacy Policy | Terms of Service | Feedback