Insurance Coverage Tips for VMAT2 Inhibitors as Tardive Dyskinisia Treatment

(Part 1 of 2)

Carmen Kosicek, MSN, APNP, PMHNP-BC discusses insurance coverage of VMAT2 therapies for tardive dyskinesia and the usefulness of documenting an abnormal involuntary movement scale (AIMS) score.

Dr Kosicek answers questions from the audience in a recent Psych Congress Regionals virtual Q&A session moderated by Rakesh Jain, MD, MPH, following her session titled “TD360 2021: Tardive Dyskinesia Across the Complexity Spectrum – From Quality of Life Improvement to Novel Treatments” that she co-presented with Rajeev Kumar, MD.

In part 2, Dr Kosicek answers the questions: "What changes do I need to make with the antipsychotic therapy in order to start VMAT2 therapy?", "What is the evidence base for the long-term use of the VMAT2 inhibitors?", and "Why are you so concerned about the use of [anticholinergics] in tardive dyskinesia?".

Listen to the Q&A session from June's Psych Congress Regionals.

Part 2: Tardive Dyskinesia Treatment With VMAT2 Inhibitors Doesn't Need to Impact Antipsychotic Therapy

Read the transcript:

Dr Rakesh Jain: Now, let's turn our attention to questions directly from our audience.

Welcome back, everyone. Dr. Kumar's Internet line is giving some trouble, but Carmen is here to help us out. Thank you, Carmen. Wonderful presentations, by the way. Thank you.

The first question I have is, what pearls can you share with our colleagues about getting insurance coverage to cover the VMAT2 therapies?

Dr Carmen Kosicek:  Great question. Please understand that when new medications come out, there are absolutely ways to overcome the fiscal challenges. There is fiscal obtainability for new meds.

Many times, yes, you will have to do a prior authorization, so please be ready. Obviously, be mindful that there are only two VMAT2 inhibitors in the class. These are the medications that are approved for treatment of TD. You will not have to do the hoops and hurdles of medications that are not approved for TD and showcasing those.

You may have to document an AIMS score. Some insurance companies are requiring that now. Some are not. Please be mindful to have your documentation ready.

The global impression is additionally something to make sure that you markdown. It doesn't really matter if the score of AIMS is 2, 6, 12—if it's impairing that person's function, that's the key thing.

Always be mindful to reach out to your representatives or someone within the company if you need help. That is their job, to help you to be able to get the medications.

Lastly, sometimes it does matter the pharmacy that you send that prescription to. Not all of them are able to work with you as readily as others. I have found more successes in smaller pharmacies versus big chains.

Jain:  Great advice. Great practical tips. Thank you very much.