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).