Following a report last summer that large numbers of Pennsylvania children on Medicaid, especially those in foster care, are taking psychiatric medications, state officials Tuesday announced steps to address the problem.
Those include requiring pre-authorization for antipsychotics, developing guidelines for psychiatric medication use, and creating an "electronic dashboard" that will make it easier for the state Department of Human Services (DHS) to monitor what children are taking.
In April, a telephone-based child psychiatric consultation service will begin assisting doctors, physician assistants, and nurse practitioners with medication decisions. In July, the department will begin training caseworkers and caregivers about psychiatric medicines.
Ted Dallas, the DHS secretary, said many children in foster care have already been abused or neglected, then are taken from the only family they have known. Inappropriately prescribing them medications compounds their problems. "That isn't the right thing," he said.
Dallas and several others spoke at Children's Hospital of Philadelphia, home of Policy Lab, the research program that studied psychiatric drug use among children on Medicaid, the federal and state health insurance program for the poor. Policy Lab not only studies problems, but also tries to help solve them.
David Rubin, a pediatrician who directs Policy Lab, said it is not enough to reduce inappropriate medication use. "It's easy to take medications away," he said. Children and their caregivers also need better access to nondrug, trauma-informed treatments, he said. The state needs more services, he said, but an additional problem is that it is difficult for foster families to take children to treatment in the middle of school and work days. "These are not easy services to deliver," he said.
Rubin said Policy Lab was working with the state and local behavioral health providers to improve access to nondrug treatments.
Last June, a Policy Lab report found that more than a fifth of foster children were taking antipsychotic drugs in 2012, the last year the report covered. That compared with 5 percent of all children on Medicaid.
That year, there were 718,500 Pennsylvania children ages 3 to 18 on Medicaid. Of those, 18,400 were in foster care. More than half the children taking antipsychotics were prescribed them off-label, for conditions the drugs were not officially approved to treat. Thirty-six percent had attention deficit hyperactivity disorder, but no record of psychosis.
Dallas said that requiring DHS authorization reduced antipsychotic medication use in children in the Medicaid fee-for-service program 75 percent between 2011 and 2013. The number of children with prescriptions for the drugs dropped from 12,529 to 3,148.
However, fee-for-service accounts for only 2 percent of Medicaid coverage. The department is now working with managed care insurers to require similar procedures.
Rubin said there had been a 10 percent drop in off-label psychiatric prescriptions for children on Medicaid in the last year or two. There was, however, no reduction among foster children.