Antipsychotic medication prior authorization for children under 6 years
Prior authorization form and review criteria for antipsychotic medications prescribed to children under 6 years of age for Medicaid recipients; defines required documentation, monitoring, and approval duration (180 days). Governs new and continuation requests, metabolic and movement-disorder monitoring, and required attachments.
No material clinical or coverage changes — brief indicates has_material_change=false and provides standard review and monitoring requirements.
Coverage Summary
This policy covers prior authorization for antipsychotic medications prescribed to Medicaid recipients under 6 years of age. It is covered with criteria and governs both new and continuation requests, specifying required documentation, monitoring, and an approval time limit. Relevant required materials and actions include submission of the completed antipsychotic prior authorization form, attachment of medical records and recent labs, and documentation of movement-disorder screening where applicable. The policy notes a maximum approval duration of 180 days.
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