Access and Utilization of New Antidepressant and Antipsychotic Medications. Treatment Guidelines and Preferred Medications


HCFA(now known as CMS) does not instruct States on the choice of appropriate medications for use in specific illnesses. However, HCFA(now known as CMS) did request that States make atypical antipsychotics available for first-line treatment of schizophrenia if requested by physicians.

State Medicaid and State Mental Health programs have not widely adopted treatment guidelines for depression or schizophrenia. This situation has begun to change somewhat with the advent of Medicaid Managed Care.

  • The Texas Medication Algorithm Project algorithms for schizophrenia, depression, and bipolar disorder are the outstanding examples of explicit protocols for the management of the mentally ill within public systems.

There is no consensus on the best first line agents for the treatment of schizophrenia or depression among private payers.

  • Treatment guidelines within private sector payers are only beginning to appear for depression. Schizophrenia is not a primary concern in the private sector.
  • Several PBMs are developing treatment guidelines that recommend the use of new generation agents first-line, together with guidelines for dosing. These guidelines do not endorse one agent over another.
  • Employers do not generally concern themselves with the selection of preferred or covered pharmaceutical agents. Likewise, they do not develop or adopt treatment guidelines or disease algorithms for depression, bipolar disorder or obsessive-compulsive disorder.
  • However, health benefits consultants report that they generally encourage employers to cover the most up-to-date pharmacotherapies for mental illness.
  • Most BHMCOs are not involved in the writing of clinical practice guidelines for the treatment of mental illnesses.