Penn Center for Mental Health, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 3535 Market Street, 3rd Floor, Philadelphia, PA, 19104, USA.
Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA.
BMC Psychiatry. 2021 Oct 22;21(1):524. doi: 10.1186/s12888-021-03533-3.
Antipsychotic prescribing to Medicaid-enrolled youth has been the target of numerous policy initiatives, including prior authorization and quality monitoring programs, which often target specific populations. Whether these efforts have changed the level or composition of antipsychotic prescribing is unclear.
Using 2014-2018 administrative claims data for Medicaid enrollees aged 21 years and under in Philadelphia, Pennsylvania, we measured antipsychotic prescription fills overall and for youth without an approved indication (autism, bipolar disorder, or psychosis). We then assessed whether trends differed for populations that have been targeted by policy initiatives, including younger children and foster care-enrolled youth. We also identified the most common approved and unapproved indications and examined whether the treatment duration of antipsychotic prescriptions differed based on whether the youth had an approved or unapproved indication.
Overall, the number of Medicaid youth with an antipsychotic prescription fill halved between 2014 and 2018. Youth aged 17 years and under and foster care-enrolled youth, who were targeted by prior authorization and quality improvement efforts, experienced larger declines. Roughly half of prescriptions were for unapproved indications in both 2014 and 2018; the most common unapproved indication was ADHD, and the treatment duration was shorter for unapproved indications compared to approved indications.
Antipsychotic prescribing to Medicaid-enrolled youth is declining, particularly among populations that have been targeted by policy initiatives like prior authorization and quality monitoring programs. Despite the fact that these initiatives often assess diagnostic criteria, half of antipsychotic prescriptions were for unapproved indications in both 2014 and 2018. More research is needed to gauge whether this prescribing is appropriate.
针对参加医疗补助计划的青年的抗精神病药物处方一直是众多政策举措的目标，包括事先授权和质量监测计划，这些计划通常针对特定人群。这些努力是否改变了抗精神病药物处方的水平或构成尚不清楚。
我们使用宾夕法尼亚州费城参加医疗补助计划的 21 岁及以下的参保人 2014-2018 年的行政索赔数据，测量了整体抗精神病药物处方和无批准适应症（自闭症、双相情感障碍或精神病）的青年的抗精神病药物处方数量。然后，我们评估了政策举措针对的人群（包括年幼的儿童和寄养登记的青年）的趋势是否有所不同。我们还确定了最常见的批准和未批准的适应症，并检查了根据青年是否有批准或未批准的适应症，抗精神病药物处方的治疗持续时间是否有所不同。
总体而言，2014 年至 2018 年间，有抗精神病药物处方的医疗补助计划青年人数减少了一半。年龄在 17 岁及以下和寄养登记的青年，这些人群是事先授权和质量改进措施的目标，经历了更大的下降。大约一半的处方在 2014 年和 2018 年均为未批准的适应症；最常见的未批准适应症是 ADHD，与批准的适应症相比，未批准的适应症的治疗持续时间更短。
针对参加医疗补助计划的青年的抗精神病药物处方正在减少，特别是在那些已经成为事先授权和质量监测计划等政策举措目标的人群中。尽管这些举措通常评估诊断标准，但在 2014 年和 2018 年，仍有一半的抗精神病药物处方为未批准的适应症。需要进行更多的研究来评估这种处方是否合适。
