Abstract
BackgroundAntipsychotic prescribing to Medicaid-enrolled youth has been the target of numerous policy initiatives, including prior authorization and quality monitoring programs, which often target specific populations. Whether these efforts have changed the level or composition of antipsychotic prescribing is unclear.MethodsUsing 2014–2018 administrative claims data for Medicaid enrollees aged 21 years and under in Philadelphia, Pennsylvania,we measured antipsychotic prescription fills overall and for youth without an approved indication (autism, bipolar disorder, or psychosis). We then assessed whether trends differed for populations that have been targeted by policy initiatives, including younger children and foster care-enrolled youth. We also identified the most common approved and unapproved indications and examined whether the treatment duration of antipsychotic prescriptions differed based on whether the youth had an approved or unapproved indication.ResultsOverall, the number of Medicaid youth with an antipsychotic prescription fill halved between 2014 and 2018. Youth aged 17 years and under and foster care-enrolled youth, who were targeted by prior authorization and quality improvement efforts, experienced larger declines. Roughly half of prescriptions were for unapproved indications in both 2014 and 2018; the most common unapproved indication was ADHD, and the treatment duration was shorter for unapproved indications compared to approved indications.ConclusionsAntipsychotic prescribing to Medicaid-enrolled youth is declining, particularly among populations that have been targeted by policy initiatives like prior authorization and quality monitoring programs. Despite the fact that these initiatives often assess diagnostic criteria, half of antipsychotic prescriptions were for unapproved indications in both 2014 and 2018. More research is needed to gauge whether this prescribing is appropriate.
Highlights
Beginning in the 1980s, antipsychotics were increasingly prescribed to children and adolescents in the United States (U.S.) [1, 2]
Using administrative claims data for a large cohort of Medicaid-enrolled youth living in Philadelphia, Pennsylvania between 2014 and 2018, this study provides a relatively up-to-date assessment of antipsychotic prescribing
Study setting and population Our study sample consisted of Medicaid enrollees aged 0 through 21 years in Philadelphia County who filled at least one antipsychotic prescription between January 1, 2014 and December 31, 2018
Summary
Beginning in the 1980s, antipsychotics were increasingly prescribed to children and adolescents in the United States (U.S.) [1, 2]. Off-label prescribing—which encompasses prescribing for unapproved indications, as well as unapproved age categories, dosages, or method of administration—frequently occurs with little to no scientific support, especially in psychiatry [13, 15]. This may increase the risk of adverse drug events and improper medication management [10, 16, 17]. Antipsychotic prescribing to Medicaid-enrolled youth has been the target of numerous policy initiatives, including prior authorization and quality monitoring programs, which often target specific populations. Whether these efforts have changed the level or composition of antipsychotic prescribing is unclear
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