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Protocol for Pharmacological Treatment of ADD, ADHD &
ADHD with Tics
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ADHD/ADD/IEP/Conduct Disorder General Principles - November
2003
- Passport Health Plan will approve coverage for psychiatric/neuroleptic
medications that do not follow the Passport Health Plan protocols
if there is documentation that the requested medications are
the discharge medications following a psychiatric hospitalization
within the past three months.
- If the patient was placed on psychiatric/neuroleptic medications
that do not follow the Passport Health Plan protocol by a
psychiatrist, documentation must be submitted that clarifies
the reason why the child was started on a nonformulary/nonpreferred
medication.
- For patients whose psychostimulant medication "wears
off", an afternoon or evening dose of Concerta is first-line,
an afternoon or evening dose of Ritalin is second-line, the
addition of Clonidine/Tenax is third-line, and the use of
Strattera is fourth-line for Passport Health Plan.
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