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More than half of US enforces prior authorizations for pediatric antipsychotic prescriptions

More than half of the United States has implemented prior authorization policies for pediatric atypical antipsychotic use, according to a JAMA Psychiatry research letter.

“Over the past 2 decades, antipsychotic prescribing to youth, almost exclusively comprising atypical antipsychotic medications, was estimated to have increased from 0.16% in 1993-1998 to 1.07% in 2005-2009 in office-based physician visits,” the researchers wrote.

They added that antipsychotic use is fivefold greater in Medicaid-insured youth compared with privately-insured youth.

Researchers reviewed the prescribing policies for youth aged younger than 18 years in 50 states, in addition to the District of Columbia from June 2013 through August 2014.

Data indicate 31 states have implemented prior authorization policies (mostly within the last 5 years) for the prescribing practices of atypical antipsychotics in pediatric patients.

While most states apply the policies to children aged younger than 5, 6, or 7 years, seven states apply theirs to Medicaid-insured youth up to 18 years.

An additional seven states have age-restricted criteria based on medication type. Of those, Colorada, Georgia and Mississippi have separate age restrictions for antipsychotic entities on the basis of current FDA recommendations, according to data.

“Our study does not provide additional details within specific programs (eg, criteria for antipsychotic dosage, concomitant pharmacotherapy, or the extent of clinical information required for adjudication), but does provide an impetus to learn if peer review, a novel approach, advances the quality of care,” the researchers concluded. – by Samantha Costa

Disclosure: Schmid reports support from a fellowship administered by the Oak Ridge Institute for Science and Education and funding by the FDA. The study was supported by the FDA. Please see the full study for a list of all other authors’ relevant financial disclosures.