Letters RESEARCH LETTER
Medicaid Prior Authorization Policies for Pediatric Use of Antipsychotic Medications Over the past 2 decades, antipsychotic prescribing to youth, almost exclusively comprising atypical antipsychotic medications, was estimated to have increased from 0.16% in 19931998 to 1.07% in 2005-2009 in office-based physician visits.1 Antipsychotic use is also 5-fold greater in Medicaid-insured youth than in privately insured youth,2 and occurs mostly for youth with clinician-reported externalizing behavior disorders1,2 rather than indications approved by the US Food and Drug Administration (FDA) and indications that are evidence-supported without FDA-approved labeling (eg, psychotic disorders, bipolar disorder, autism-related irritability, and tic disorders).3 The evidence for atypical antipsychotic use among preschoolers and younger children is particularly limited.3 In light of antipsychotic treatment-emergent cardiometabolic adverse events, 4 several government reports called for efforts to improve pediatric psychotropic medication oversight in state Medicaid agencies. 5 Such efforts include telephone access lines through which prescribers can consult with psychiatrists, letters to prescribers, and, recently, age-restricted prior authorization policies, which require clinicians to obtain preapproval from
Medicaid agencies to prescribe atypical antipsychotics to children younger than a certain age as a condition for coverage. A distinct subset of these age-restricted prior authorization policies, classified as peer review policies, brings clinical expertise into the review process by requiring contracted clinicians (peer reviewers) to adjudicate antipsychotic prescriptions for children. Several studies in adults have shown Medicaid prior authorization policies can reduce antipsychotic use. To facilitate empirical evaluation of these policies in youth, we identified state Medicaid programs with a prior authorization policy in effect for pediatric atypical antipsychotic prescribing and characterized these policies according to agerestriction criteria and whether a peer review process was present. Methods | We reviewed antipsychotic-related Medicaid prior authorization policies for youth (
Medicaid Prior Authorization Policies for Pediatric Use of Antipsychotic Medications Over the past 2 decades, antipsychotic prescribing to youth, almost exclusively comprising atypical antipsychotic medications, was estimated to have increased from 0.16% in 19931998 to 1.07% in 2005-2009 in office-based physician visits.1 Antipsychotic use is also 5-fold greater in Medicaid-insured youth than in privately insured youth,2 and occurs mostly for youth with clinician-reported externalizing behavior disorders1,2 rather than indications approved by the US Food and Drug Administration (FDA) and indications that are evidence-supported without FDA-approved labeling (eg, psychotic disorders, bipolar disorder, autism-related irritability, and tic disorders).3 The evidence for atypical antipsychotic use among preschoolers and younger children is particularly limited.3 In light of antipsychotic treatment-emergent cardiometabolic adverse events, 4 several government reports called for efforts to improve pediatric psychotropic medication oversight in state Medicaid agencies. 5 Such efforts include telephone access lines through which prescribers can consult with psychiatrists, letters to prescribers, and, recently, age-restricted prior authorization policies, which require clinicians to obtain preapproval from
Medicaid agencies to prescribe atypical antipsychotics to children younger than a certain age as a condition for coverage. A distinct subset of these age-restricted prior authorization policies, classified as peer review policies, brings clinical expertise into the review process by requiring contracted clinicians (peer reviewers) to adjudicate antipsychotic prescriptions for children. Several studies in adults have shown Medicaid prior authorization policies can reduce antipsychotic use. To facilitate empirical evaluation of these policies in youth, we identified state Medicaid programs with a prior authorization policy in effect for pediatric atypical antipsychotic prescribing and characterized these policies according to agerestriction criteria and whether a peer review process was present. Methods | We reviewed antipsychotic-related Medicaid prior authorization policies for youth (
