Daily Archives: September 9, 2008

Florida Legislator Questions Antipsychotic Spending

Pharmalot
By Ed Silverman

Earlier this summer, the state’s Agency for Health Care Administration reviewed new guidelines on paying for antipsychotic drugs for children. This came after newspaper stories detailed that the number of kids in the program prescribed the meds had nearly doubled between 2000 and 2006. however, the most common primary diagnosis was ADHD, an ailment not approved for using the meds.

The agency proposed rule changes to permit Medicaid reimbursement under one of two circumstances: if an antipsychotic has an FDA-approved use or is listed in an official compendium or – and this is the new twist – if prior authorization is granted. Both moves would continue to make it possible for very young children to receive antipsychotics. Only Johnson & Johnson’s Risperdal is approved for children as young as 5, and only for treating irritability associated with autism.

Nonetheless, a Florida legislator has since questioned the rationale for permitting Medicaid to pay for antipsychotic prescribing for unapproved uses, even though doctors are allowed to prescribe off-label uses. Twice, Ed Hooper has written AHCA secretary Holly Benson to pursue the state spending, although an AHCA spokeswoman tells us they have not yet provided a response. Here are his letters: http://tinyurl.com/5ck7lx

Legislators in other states, such as New Jersey and New Hampshire, have separately made similar inquiries to their own state officials about increased Medicaid spending on antipsychotics, and a group of 15 state Medicaid medical directors is preparing a report for release by January (more on this tomorrow).

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Half of nursing home residents wrongly drugged

The Daily Telegraph
London, England
By Kate Devlin – Medical Correspondent

Experts who looked at 22 nursing homes found 51 per cent of residents were being inappropriately given drugs, including anti-psychotics, antidepressants and painkillers.

More than 420,000 people live in care and nursing homes in Britain, of which around 405,000 are elderly.

Previous estimates have suggested that 100,000 residents, suffering from dementia, were being drugged unnecessarily every year.

However, if the results of this study are replicated across the country, it suggests that around 200,000 patients are being given inappropriate medication in homes.

Paul Burstow, the Liberal Democrat MP, said: “This adds to the growing evidence that inappropriate medicating in care homes is much more routine in practice than we would like to believe.

“And when it comes to the prescribing of anti-psychotics, these drugs are actually killing people. The Government must come up with concrete proposals to crack down on this problem.” Mr Burstow has previously called for GPs who overprescribe to patients in homes to face prosecution.

The use of anti-psychotics has become increasingly controversial in recent years after they were linked to strokes. A report released last year suggested that the drugs could be responsible for more than 23,000 deaths in care homes every year.

Lizzie McLennan, from Help the Aged, said that “too many” elderly people were being drugged in care homes.

She called for GPs to be forced to make regular visits to care homes for which they prescribe and for routine reviews of residents’ medication.

The nursing homes study shows that when pharmacists reviewed the medication residents had been prescribed 171 out of 334 were receiving drugs that they did not need.

The findings, by researchers at Queen’s University in Belfast and Brown University in Rhode Island, were presented at the British Pharmaceutical Conference in Manchester.

Another study also presented at the conference shows that staff at nursing homes believed that the culture in a home could lead to over prescribing and patients receiving powerful drugs they did not need “to make life easier”.

The Government has ordered a review into inappropriate prescribing in care homes, which is due to report later in the autumn.

Critics say that problems can arise because some GPs visit care homes only rarely and rely on issuing repeat prescriptions from one year to the next, and because of the commercial relationship that can exist between GPs and homes.

Anti-psychotic drugs are not licensed to treat dementia but are commonly prescribed to control agitation, sleep disturbance and aggression in sufferers in care homes, previous studies have shown.

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