Letter details pediatric antipsychotic medication problems

Restrictive Medicaid prior authorization policies are leading to substitution of potentially inappropriate, off-label psychotropic medication use and other problems in prescribing antipsychotic medications for children, according to a recent research letter.

BurcuPublished in the March 3 edition of JAMA, the letter was authored by Ian Schmid with FDA's Center for Drug Evaluation and Research; Mehmet Burcu, PhD student with the Department of Pharmaceutical Health Services Research at the University of Maryland – Baltimore; and Julie Zito, PhD, professor at the Department of Pharmaceutical Health Services Research at the University of Maryland.

The researchers reviewed antipsychotic-related Medicaid prior authorization polices for youth under aged 18 years in 50 states and the District of Columbia between June, 2013, and August, 2014. They found that 31 states have implemented prior authorization policies for atypical antipsychotic prescribing to children. Most states apply their polices to children younger than aged 5, 6 or 7 years.

Of the 31 states, 15 have incorporated a peer-review process involving a psychiatrist or other physician specialty. However, the researchers found, a recent study of a mid-Atlantic state found “minimal effect of such a policy in reducing antipsychotic use in children below the age restriction”, they wrote.

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“Potential unintended consequences of these restrictive polices include inadequate treatment, substitution of potentially inappropriate, off-label psychotropic medication classes such as anticonvulsant mood stabilizers and antidepressants and administrative burden on prescribers,” the researchers wrote.

Related: GAO: Antipsychotic overuse "widespread" for dementia

In addition, Medicaid oversight programs should be concerned not only with unnecessary antipsychotic use, but also should ensure adherence to appropriate cariometabolic monitoring practices at baseline and during antipsychotic treatment, the researchers said. The programs should also support access to alternative evidence-based nonpharmacolgical treatments.

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