Antidepressant Medication Management Tip Sheet

Incentives will be paid on an annual basis, following the end of Quarter 4. For additional information refer to the 2021 CBI Technical Specifications.

Members are excluded if they received antidepressant medication within 105 days before a new prescription.

Data for this measure will be collected using claims.

Diagnosis Codes of Major Depression:

F32.0, F32.1, F32.2, F32.3, F32.4, F32.9, F33.0, F33.1, F33.2, F33.3, F33.41, F33.9.

Telehealth visits are now accepted when a member is diagnosed with major depression.

Find a full list of antidepressant medication codes and encounter codes in the CBI Technical Specifications.

• Screening for depression should be completed annually in addition to clinical judgment and/or member life events (i.e. prenatal and postpartum care visit). Postpartum depression screening can also be screened at the infant’s 1, 2, 4 and 6 month well-child visits (this is a covered benefit).
• PHQ-9 instructions and proposed treatment options based on score.
• Complete an initial assessment such as:
  • History of present illness and symptoms.
  • Psychiatric and general medical history.
  • Medications.
  • Mental status exam and physical exam.
• Refer to psychiatric or psychological services (internal services or Carelon Behavioral Health) if concerns arise from the assessment.
• American Psychiatric Association's Treating Major Depressive Disorder: A Quick Reference Guide.
• Complete diagnostic tests to rule out general medical causes of depressive symptom (e.g. medication known to cause depression, physical pain).
• Consult with a Carelon psychiatrist prior to prescribing antidepressant medications. This process is not immediate and requires the PCP to complete a PCP Referral Form.
  • Alliance behavioral health services (Carelon Behavioral Health).
• Make it a multidisciplinary collaboration with the provider, patient, and therapist or psychiatrist.

New Start of Antidepressants

• Carefully monitor patients to assess patient safety and response to pharmacotherapy.
• The frequency of patient monitoring should be based upon:
  • The patient’s symptoms severity.
  • Co-occurring disorders.
  • Cooperation with treatment and severity of side effects.
  • Availability of social support.
  • Frequency and severity of side effects. If there are side effects, the initial strategy is to lower the dose of the antidepressant or change antidepressants.

Recommendations for Medication Adherence

• Explain when and how often to take the medicine.
• Suggest reminder systems like pill boxes, alarms, etc.
• Discuss the need to take medication for at least 2-4 weeks before beneficial effects may be noticed.
• Emphasize the need to take medication even after feeling better.
• Review the need to consult with the psychiatrist before discontinuing medication.
• Give the patient an opportunity to express their understanding of the medication, hear their concerns, and correct misconceptions.
• Explain what to do if problems or questions arise.
• Talk with the patient and family about potential barriers to treatment such as:
  • Side effects of treatment.
  • Problems in the therapeutic relationship.
  • Logistical, economic and cultural barriers to treatment.
• Discuss the importance of tapering rather than discontinuing antidepressants in order to minimize risk of withdrawal symptoms.
• Implement a call back program for reaching out to patients to keep them engaged and ensure medications are being taken appropriately.