Monitoring Needed for Members Taking Antipsychotics

Date: 08/08/23

Superior HealthPlan's Medical Management department aims to promote high-quality care and judicious use of prescribed medications for Superior members. Members enrolled in Medicaid (STAR, STAR Health, STAR Kids, STAR+PLUS) or CHIP who are prescribed antipsychotic medications are subject to additional screening and monitoring.

For STAR, STAR Health, STAR Kids and CHIP members, Superior follows the Psychotropic Medication Utilization Parameters for Children and Youth in Texas Public Behavioral Health (6th Version) (PDF), developed by The Parameters Workgroup of the Psychiatric Executive Formulary Committee, Health and Specialty Care Division and Texas Health and Human Services (HHS). The parameters require appropriate monitoring of glucose and lipids at least every 6 months for any child or adolescent continuously prescribed an antipsychotic medication.

Superior’s Psychotropic Medication Utilization Management (PMUR) team may contact providers regarding the disposition of members’ labs.

For STAR+PLUS members, Superior reviews medical claims data for members with a diagnosis of bipolar or schizophrenia taking antipsychotic medication(s). Additionally, the PMUR department monitors for annual diabetes screenings according to National Committee for Quality Assurance (NCQA) Diabetes and Cardiovascular Disease Screening and Monitoring for People with Schizophrenia or Bipolar Disorder (SSD, SMD, SMC) guidelines. Appropriate screenings include a glucose and/or HbA1c test.

Providers are encouraged to respond to requests for patient information or records in order to take advantage of education opportunities and to collaborate with Superior to coordinate care.

For any questions or more information, please contact the Superior PMUR Team at 1-800-218-7453.