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Protocol for Pharmacological Treatment of ADD, ADHD & ADHD with Tics

ADHD/ADD/IEP/Conduct Disorder General Principles - November 2003

  1. 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.
  2. 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.
  3. 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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