The clinical work group we assembled included leading psychopharmacologists, members of the Massachusetts Psychiatric Society, and representatives of the Department of Mental Health, the Division of Medical Assistance, the State Pharmacy Program, and the Alliance for the Mentally Ill. The group's charge was to evaluate clinical practices in Massachusetts and make recommendations for managing the psychiatric portion of the pharmacy budget. We consulted with the Consumer Advisory Council and the Family Advisory Council of the Massachusetts Behavioral Health Partnership, the Medicaid carve-out vendor during the early stages of the project (4,5). We found that as of January 2002, more than 2,200 adults received more than one atypical antipsychotic at a time for more than 60 days, at a cost of $24 million; that almost 5,000 Medicaid recipients were taking more than one selective serotonin reuptake inhibitor for more than 60 days, at a cost of more than $4.5 million; and that more than 1,100 MassHealth recipients were receiving five or more psychiatric medications in January 2002, often from multiple prescribers. These data were supported by information gathered during case conference presentations throughout the state.