PMH65 - Patterns of use of atypical antipsychotics in children and young adults

Abstract

Use of atypical antipsychotics for conditions such as conduct disorder, depression, ADHD, and Tourette’s syndrome in children is highly prevalent; however, efficacy has not been proven in clinical trials. A DHHS letter to state Medicaid directors expressed concern over the use of antipsychotics in children and initiated steps to increase its safe, effective and appropriate use. This study examined the level of evidence available in claims to support atypical antipsychotic use in Mississippi Medicaid children and young adults. A retrospective analysis was conducted using the Mississippi Medicaid claims data from 2008-2011. Pharmacy and medical claims files were linked using beneficiary ID. Prescriptions, included only if the beneficiary was below 21 years of age on the day of the claim, were classified as to whether a diagnosis to support the use of the drug appeared in medical claims within one year of the prescriptions and whether diagnoses that were in the claims were supported by evidence ratings provided in Micromedex. The 7,487 beneficiaries eligible for the study accounted for a total of 107,544 prescriptions for antipsychotics. 75.6% of these prescriptions could not be associated with an identifiable mental illness diagnosis from the medical claims. Of the 26,164 prescriptions that were associated with a diagnosis, about 53% of the prescriptions were supported by evidence. Among the other 47%, which were not supported by evidence, depression, bipolar disorder and mental retardation were the most common diagnoses. It appears that some antipsychotic use in this population may not be supported by evidence and/or prescribers are reluctant to record mental health diagnoses. Since most of these prescriptions required prior authorization, diagnoses were provided but do not appear in the medical claims. The lack of supporting diagnoses in medical claims is a significant limitation when examining the use of antipsychotics among children.