Increasing antipsychotic prescribing in visits in which no diagnosis with an FDA approval for antipsychotic treatment is present may raise concerns over the quality of care. Although off-label prescribing is highly prevalent, there is substantial variation in evidence supporting these practices. Across drug classes, antipsychotic medications rank near the top in off-label use with drug safety concerns and inadequate supporting evidence (37). However, in the absence of information on antipsychotic dosing and duration, a risk analysis cannot presently be determined. Off-label prescribing of antipsychotics for treating anxiety disorders raises difficult challenges for payers, who must balance the needs for treatment access, clinical flexibility, and prescriber autonomy with concerns over safety, costs, and quality of care.