PBHMI Letter to Prescribers
This letter to prescribers describes the PBHMI and goals of the initiative.
Additional Resources
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Open PDF file, 83.26 KB, Pediatric Behavioral Health Medication (PBHMI) Letter_November 2014 (English, PDF 83.26 KB)
PBHMI Clinical Document
This PBHMI clinical document provides a general overview of the initiative and the affected medication classes.
Additional Resources
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Open PDF file, 162.61 KB, PBHMI Clinical Document (English, PDF 162.61 KB)
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Open DOCX file, 55.61 KB, PBHMI Clinical Document (English, DOCX 55.61 KB)
PBHMI Therapeutic Class Table
This therapeutic class table displays the medications affected by the PBHMI and the MassHealth requirements for prior authorization.
Additional Resources
PBHMI Prior Authorization (PA) Form for Pharmacy Services
The PBHMI PA form was created to assist prescribers with requests submitted to the MassHealth Drug Utilization Review (DUR) Program.
There is also a sample Psychotropic Medication Informed Consent Form for your reference.
See "Additional Resources," below.
Additional Resources
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Open PDF file, 653.16 KB, PBHMI Prior Authorization (PA) Form for Pharmacy Services (English, PDF 653.16 KB)
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Open DOCX file, 278.85 KB, PBHMI Prior Authorization (PA) Form for Pharmacy Services (English, DOCX 278.85 KB)
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Open PDF file, 355.45 KB, Sample Psychotropic Medication Informed Consent Form (English, PDF 355.45 KB)
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Open DOCX file, 55.73 KB, Sample Psychotropic Medication Informed Consent Form (English, DOCX 55.73 KB)
PBHMI Q&A
This Q&A answers frequently asked questions regarding the PBHMI.
Additional Resources
Contact Information
For Pharmacists and Prescribers
If you have questions about a specific patient or claim affected by the MassHealth Pediatric Behavioral Health Medication Initiative (PBHMI), please contact the Drug Utilization Review Program at (800) 745-7318.
If you have comments about the PBHMI, contact the Drug Utilization Review Program at (800) 745-7318 or e-mail the MassHealth Pharmacy Program at pbhmifeedback@umassmed.edu. Please include your name, title, phone number, and fax number.
Please note: MassHealth will not answer all emails but will use this feedback for further improvements to the Pediatric Behavioral Health Medication Initiative. This mailbox is dedicated to questions or comments about the MassHealth Pediatric Behavioral Health Medication Initiative only.
For MassHealth Members
If you have questions about the MassHealth Pediatric Behavioral Health Medication Initiative, please call MassHealth Customer Services at (800) 841-2900; TTY: (800) 497-4648.
Date published: | August 1, 2018 |
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Last updated: | April 6, 2023 |