Research indicates that one in five children and adolescents in the United States has a behavioral or emotional disorder and a substantial number use psychotropic medications. Pediatric primary care providers play an important role in prescribing and managing psychotropic medications. However, they face several challenges with respect to prescribing these medications, including training, confidence, and level of comfort. One way to meet these challenges is through comanagement of behavioral health care, including psychopharmacology, by pediatric primary care providers and child mental health care providers. The authors review literature on patterns of psychotropic medication prescribing for children and adolescents and the role of pediatric primary care providers. They describe two statewide models that were developed to improve pediatric primary care providers' ability to treat patients with behavioral health needs, including prescribing psychotropic medications, by linking them to support from child mental health providers. The authors conclude with recommendations to improve professional training and collaboration.