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Pediatric Antipsychotic Utilization Program (New)
Effective date
Oct 1, 2025
Identified
Jun 24, 2026
Summary
Humana Medicaid Louisiana has implemented a new Pediatric Antipsychotic Utilization Program requiring prior authorization for all antipsychotic medications in pediatric and adolescent patients. The policy restricts use in children under 6 years unless compendia-supported diagnosis exists, and prohibits multiple concurrent antipsychotics without compendia support for patients 6 years and older.
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What to do
Action · 4 steps
01Before October 1, 2025: Billing team must update prior authorization system to require approval for all antipsychotic medications listed in the policy for pediatric and adolescent Medicaid patients.
02Providers must document age criteria (≥6 years OR <6 years with compendia-supported diagnosis) and ensure no concurrent antipsychotic use without compendia support for patients ≥6 years.
03Update encounter forms and EMR templates to prompt for required documentation.
04Claims will require prior authorization or face denial.
Original notice
Pediatric Antipsychotic Utilization Program (New)
mcp.humana.com · Always check the source before changing claims.