Among the graphs that grace these pages, this one remains the most shocking – that the most prescribed drug class by cost to Medicaid is the [Atypical] Antipsychotics. I still find it hard to wrap my mind around this story. In 2008, they list over 600,000 kids on Antipsychotics at a cost of $3.6 B!
Federal health officials are reviewing antipsychotic drug use on children in the Medicaid systemWall Street JournalBy LUCETTE LAGNADOAugust 11, 2013Federal health officials have launched a probe into the use of antipsychotic drugs on children in the Medicaid system, amid concern that the medications are being prescribed too often to treat behavioral problems in the very young. The inspector general’s office at Department of Health and Human Services says it recently began a review of antipsychotic-drug use by Medicaid recipients age 17 and under. And various agencies within HHS are requiring officials in all 50 states to tighten oversight of prescriptions for such drugs to Medicaid-eligible young people.
The effort applies to a newer class of antipsychotic drugs known as "atypicals," which include Abilify, the nation’s No. 1 prescription drug by sales. The drugs were originally developed to treat psychoses such as schizophrenia, but some now have Food and Drug Administration approval for treatment of children with conditions such as bipolar disorder and irritability associated with autism.
In 2008, the most recent year for which complete data are available, Medicaid, the government health program for the poor, spent $3.6 billion on antipsychotic medications, up from $1.65 billion in 1999, according to Mathematica Policy Research, a Washington firm that crunches Medicaid data for HHS. The growth came even as pharmacy benefits for millions of Medicaid recipients shifted to Medicare in 2006.
Medicaid spends more on antipsychotics than on any other class of drugs. Abilify, made by Otsuka Pharmaceutical Co., appears on lists of the top 10 drugs paid for by Medicaid in various states. Mark Duggan, a professor and health-policy expert at the University of Pennsylvania’s Wharton School, says his analysis of 2010 data on five leading antipsychotics suggests that more than 70% of the cost of these drugs was paid for by Medicaid and other government programs.
The number of people under age 20 receiving Medicaid-funded prescriptions for antipsychotic drugs tripled between 1999 and 2008, according to an analysis by Mathematica. Dr. Stephen Cha, a chief medical officer at the Centers for Medicare & Medicaid Services, the HHS agency that foots some of the bill for drugs prescribed to Medicaid recipients, says the government wants to reduce what he termed "the unnecessarily high utilization of antipsychotics." He urges doctors to consider other approaches, including therapy to help children and families cope with psychological trauma that could be at the root of behavior issues…
hat tip to Pharmagossip
The probe by the inspector general, Daniel Levinson, has been under way for several months and focuses on the five largest Medicaid states: California, Florida, Illinois, New York and Texas. It covers a six-month period from January to June 2011, when 84,654 children age 17 and under in those states received prescriptions for antipsychotics paid for by Medicaid. Pediatric psychiatrists will examine about 700 cases, say people familiar with the effort."Through medical-record reviews, we will determine whether these prescriptions were medically indicated, and whether taxpayers were being billed for inappropriate, poor-quality care," says Mr. Levinson. Government Medicaid data indicate that some of the prescriptions are being written for very young children. An analysis by Mathematica found that in 2008, 19,045 children age 5 and under were prescribed antipsychotics through Medicaid, 3% of recipients under 20, up from 7,759 in 1999, according to James Verdier, a senior fellow at the organization.
Data from the inspector general’s five-state probe indicate that 482 children 3 and under were prescribed antipsychotics during the period in question, including 107 children 2 and under. Six were under a year old, including one listed as a month old. The records don’t indicate the diagnoses involved. All five states said they have guidelines to prevent the improper use of the drugs on children in Medicaid…
Ah. Biederman and the bipolar infant— it’s important to give the devil his due.
Programs to send nurses to visit poor families to educate them on child development and give them useful tips appear to have good outcomes. A family doesn’t have to be poor for a parent(s) to have no understanding of child development and no knowledge about how to care for a baby, so I think it would be great if some personable experts visited mothers and fathers in the maternity ward and educated them. As a public health issue it would save a lot of money and heartache in the long run.
Those first three years are so precious and we don’t remember them— if there were a catalog of problem traits, behaviors, and perspectives that were created during infancy I bet it would be a much more weighty tome than the catalog for the next 15.
A few years ago PBS did a show The Medicated Child. This frightened me and I do not have children. One of the major points was that once in that system children would, or could not, get out. What they did receive was ever increasing doses of ever more potent drugs.
A moment that brought me to a complete stop was when a little girl, little girl, with this thin frame and big glasses stated she needed drugs to make her “normal.” She then went on to state she expected to be on medications the rest of her life.
Pharma 1, Kids 0.
Steve Lucas
Yes the Medicated Child. If I remember correctly one poor boy was on ritalin for ADHD, anti-psychotics to stop the mania caused, anti-depressants and other drugs to stop the twitching caused by this cocktail. This is child abuse pure and simple. And the perpetrators of this abuse are criminals.
I am not a medical professional. I do have a master’s degree, however, and my family would be considered by most to be “privileged.” And Abilify was prescribed to my 14 year old daughter by a board certified psychiatrist in 2005 as a “first line” medication. I remember how my jaw dropped when I learned the cost, which we paid out of pocket because we were worried at the time about our daughter entering the medical record information base. So maybe someone can comment on how that same med was prescribed for a non-Medicaid recipient child??? It took the intervention seven months later by a psychologist to ask the question (again) WHY???? And to take her off of it and everything else. Our “system” is a joke. A complete and utter joke. And I am a mad mother. A very mad mother.
So Peggi, I take it you’re not a member of NAMI? If you don’t mind my asking— just say so if you do mind— were you referred to NAMI by a mental health professional?
Searches for MEDICAID fraud and the names of psychiatric drugs gets a lot of hits. Some members of Congress, and the Obama Administration are cracking down on MEDICAID fraud. Mental health professionals and other officials are finally challenging the indiscriminate use of atypicals, the prescribing of drugs that are unnecessary and/or contraindicated, prescribing of drugs still under patent when generics will do as well or better, prescribing drugs in lieu of behavioral approaches, prescribing drugs for social control (foster children and adults in foster care andelderly care), and good old fashioned fake patient scams to milk the taxpayers. By comparison, the small percentage of persons who commit fraud to get on disability and use MEDICAID is a drop in the bucket.
Have you considered getting copies of the records and challenging them or making a complaint in writing?
Let us apply Occam”s Razor to the ballooning use of “antipsychotics” to large groups of people who are unable to say “no”: children in foster care and residents of nursing homes.
The simple explanation that suggests itself is that the “antipsychotics” are the current manifestation of a practice that has a long history. If a person is annoying you, put him or her in restraints. In the 19th Century, physical restraints began to be phased out in favor of chemical restraints: first opium, then chloral hydrate, followed by bromides, barbiturates, the first generation “antipsycholtics,” and now the “second generation antipsychotics.”
Chemical restraints work. Institutions needs fewer personnel when their inmates are somnolent. Foster parents collect their subsidies and have less childcare to do when the children are turned into couch potatoes.
Is not this what it’s all about?