Hulkower Rachel L, Kelley Meghan, Cloud Lindsay K, Visser Susanna N
1 Cherokee Nation Assurance, Public Health Law Program, Office for State, Tribal, Local and Territorial Support, Centers for Disease Control and Prevention, Atlanta, GA, USA.
2 Policy Surveillance Program, Center for Public Health Law Research, Temple University, Philadelphia, PA, USA.
Public Health Rep. 2017 Nov/Dec;132(6):654-659. doi: 10.1177/0033354917735548. Epub 2017 Oct 26.
In 2011, the American Academy of Pediatrics updated its guidelines for the diagnosis and treatment of children with attention-deficit/hyperactivity disorder (ADHD) to recommend that clinicians refer parents of preschoolers (aged 4-5) for training in behavior therapy and subsequently treat with medication if behavior therapy fails to sufficiently improve functioning. Data available from just before the release of the guidelines suggest that fewer than half of preschoolers with ADHD received behavior therapy and about half received medication. About half of those who received medication also received behavior therapy. Prior authorization policies for ADHD medication may guide physicians toward recommended behavior therapy. Characterizing existing prior authorization policies is an important step toward evaluating the impact of these policies on treatment patterns. We inventoried existing prior authorization policies and characterized policy components to inform future evaluation efforts.
A 50-state legal assessment characterized ADHD prior authorization policies in state Medicaid programs. We designed a database to capture data on policy characteristics and authorization criteria, including data on age restrictions and fail-first behavior therapy requirements.
In 2015, 27 states had Medicaid policies that prevented approval of pediatric ADHD medication payment without additional provider involvement. Seven states required that prescribers indicate whether nonmedication treatments were considered before Medicaid payment for ADHD medication could be approved.
Medicaid policies on ADHD medication treatment are diverse; some policies are tied to the diagnosis and treatment guidelines of the American Academy of Pediatrics. Evaluations are needed to determine if certain policy interventions guide families toward the use of behavior therapy as the first-line ADHD treatment for young children.
2011年，美国儿科学会更新了注意力缺陷/多动障碍（ADHD）儿童的诊断和治疗指南，建议临床医生将学龄前儿童（4至5岁）的家长转介接受行为治疗培训，若行为治疗未能充分改善功能，则随后进行药物治疗。指南发布前可得的数据表明，患有ADHD的学龄前儿童中，接受行为治疗的不到一半，约一半接受了药物治疗。接受药物治疗的儿童中约有一半也接受了行为治疗。ADHD药物的事先授权政策可能会引导医生采用推荐的行为治疗。明确现有的事先授权政策是评估这些政策对治疗模式影响的重要一步。我们梳理了现有的事先授权政策，并描述了政策组成部分，以为未来的评估工作提供信息。
一项涵盖50个州的法律评估描述了各州医疗补助计划中的ADHD事先授权政策。我们设计了一个数据库来收集有关政策特征和授权标准的数据，包括年龄限制和先试行行为治疗要求的数据。
2015年，27个州的医疗补助政策规定，若无额外的医疗服务提供者参与，不得批准支付儿科ADHD药物费用。七个州要求开处方者在医疗补助批准支付ADHD药物之前，指明是否考虑过非药物治疗。
医疗补助计划中关于ADHD药物治疗的政策各不相同；一些政策与美国儿科学会的诊断和治疗指南相关。需要进行评估，以确定某些政策干预措施是否能引导家庭将行为治疗作为幼儿ADHD的一线治疗方法。
