For Children, Atypical Antipsychotic Rxs Require PA in Most States

Thirty-one states have prior authorization policies in place for atypical antipsychotic prescribing to children, most of which are implemented for children <7 years old, a study published in the Journal of the American Medical Association reports.

Antipsychotic prescribing for youth have increased from 0.16% in 1993–1998 to 1.07% in 2005–2009 in office-based physician visits. Use of antipsychotics is found to be five times greater in Medicaid-insured youth vs. privately insured youth.

A team of researchers reviewed antipsychotic-related Medicaid prior authorization policies for youth (<18 years) in 50 states plus the District of Columbia between June 2013–August 2014. These policies were categorized by age restriction criteria and whether a peer review process was present; a peer review involves contracted clinicians adjudicating antipsychotic prescriptions for children.

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Only seven states (Alabama, Kentucky, Maryland, Nevada, North Carolina, Pennsylvania, Tennessee) apply their prior authorization policies to Medicaid-insured youth up to 18 years of age. Other states such as California, Colorado, Georgia, Mississippi, Nebraska, New York, and Washington implement an age-restriction criteria that vary by each drug. Of the 31 states that have prior authorization policies, 15 have included a peer review process.

The study authors noted that the restrictive policies may possibly result in inadequate treatment, inappropriate substitution with off-label psychotropic drug classes (eg, anticonvulsants, antidepressants), and administrative burden on prescribers. Studying the effect of these policies on atypical antipsychotic use may help clinicians improve clinical appropriateness and avoid consequences.

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