This article is more than 5 years old. Information may no longer be current.

Antipsychotic use in young children declines following peer review policy

Following implementation of the peer review prior authorization policy, atypical antipsychotic use significantly decreased among children aged younger than 5 to 8 years in Medicaid programs.

“In response to the growing cardiometabolic safety concerns about the use of atypical antipsychotic medications in children, several state Medicaid agencies have adopted a novel, more clinically nuanced and individualized approach to reviewing the appropriateness of [atypical antipsychotic] use, namely, peer review prior authorization policies,” Julie M. Zito, PhD, of University of Maryland, Baltimore, and colleagues wrote. “Physicians must receive preapproval through contracted clinicians (peer reviewers) to prescribe [atypical antipsychotics] to certain-aged children.”

To assess the impact of peer review prior authorization policies on atypical antipsychotic use among Medicaid-insured youth, researchers analyzed Medicaid administrative claims data from four geographically diverse states where atypical antipsychotic peer review prior authorization policies were implemented in 2008 to 2009. Interrupted time-series design was used to assess monthly and quarterly use of atypical antipsychotics across 36 months, including 12 months prepolicy, 12 months during transition and 12 months postpolicy.

Peer review policies were implemented for children aged younger than 8 years in state A, younger than 6 years in states B and C, and younger than 5 years in state D.

After policy implementation, atypical antipsychotic prevalence significantly decreased from 0.25% to 0.17% (OR = 0.68; 95% CI, 0.64-0.72) among children aged younger than 8 years in state A; from 0.09% to 0.05% (OR = 0.57; 0.5-0.66) among children aged younger than 6 years in state B; from 0.09% to 0.07% (OR = 0.76; 95% CI, 0.69-0.84) among children aged younger than 6 years in state C; and from 0.03% to 0.02% (OR = 0.64; 95% CI, 0.46-0.88) among children younger than 5 years in state D.

Among older youth, atypical antipsychotic use significantly increased in states A, B and C.

In state D, atypical antipsychotic use decreased in both older (age 5 to 17 years) and younger (age younger than 5 years) groups; however, the decrease was significantly greater among children aged younger than 5 years.

“These findings are consistent with recent national estimates suggesting that the rapid increase in [atypical antipsychotic] use among publicly insured young children had stabilized since 2008,” the researchers wrote. “However, challenges exist, such as growing use of complex [atypical antipsychotic] regimens and low uptake of recommended cardiometabolic monitoring. Educationally oriented peer review, as demonstrated in state D, may account for spillover effects among older youth who were not similarly monitored. – by Amanda Oldt

Disclosures: The authors report no relevant financial disclosures.