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HHS study of second-generation antipsychotic drug use among Medicaid-enrolled children

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HHS's Office of Inspector General investigated the quality of care provided to children receiving second-generation antipsychotics (SGAs) that were paid for by Medicaid.

HHS's Office of Inspector General investigated the quality of care provided to children receiving second-generation antipsychotics (SGAs) that were paid for by Medicaid. The study used a sample of 687 claims for SGAs prescribed to children in five states that represent nearly 40% of total Medicaid payments for SGAs in 2011: California, Florida, Illinois, New York, and Texas. Medical records related to the sampled claims were reviewed using seven quality-of-care criteria. Overall, 8% of SGAs were prescribed for the limited number of medically accepted pediatric indications. The researchers note that it is not uncommon for physicians to prescribe SGAs for children for indications that are not medically accepted. In addition, while three of the SGAs include a boxed warning about the higher risk of suicidal thinking and behavior for pediatric patients, more than one-third of SGAs were prescribed in the presence of conditions described in the boxed warning. Doing so is not prohibited, however, if the prescribing physician believes the potential benefits outweigh the risks. The report makes three recommendations to CMS: that CMS work with state Medicaid programs to perform utilization reviews of SGAs prescribed to children and conduct periodic reviews of medical records associated with claims for SGAs prescribed to children, and that CMS work with states to consider other methods of enhanced oversight of SGAs prescribed to children.

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http://oig.hhs.gov/oei/reports/oei-07-12-00320.asp

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