MedicaidPrior AuthHigh impact
Pediatric Antipsychotic Utilization Program (New)
Humana·LA · Psychiatry, Pediatrics, Family Medicine +1 more·Medicaid
Effective date
Oct 1, 2025
We identified it
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.
Action Required
Before 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. Providers 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. Update encounter forms and EMR templates to prompt for required documentation. Claims will require prior authorization or face denial.