Growing Use of Antipsychotic Drugs Prescribed to Children and Paid for by Medicaid Under Investigation

Within nearly a decade, the number of people under 20 years old taking antipsychotic drugs funded through Medicaid tripled, leading the government to launch an investigation of minors with behavioral problems being prescribed the drugs intended for disorders like schizophrenia.

From 1999 to 2008 the number of children on antipsychotic drugs funded through Medicaid tripled, according to Mathematica. (Photo: Shutterstock.com)

The Wall Street Journal reported that the Department of Health and Human Services inspector general's office is reviewing the use of antipsychotic drugs prescribed through Medicaid for those 17 and younger and is also requiring more oversight for such prescriptions.

The specific class of drugs under investigation are known as atypicals, which includes Abilify, the nation's number one selling prescription drug, according to WSJ:

In 2008, the most recent year for which complete data are available, Medicaid, the government health program for the poor, spent $3.6 billion on antipsychotic medications, up from $1.65 billion in 1999, according to Mathematica Policy Research, a Washington firm that crunches Medicaid data for HHS. The growth came even as pharmacy benefits for millions of Medicaid recipients shifted to Medicare in 2006.

Medicaid spends more on antipsychotics than on any other class of drugs. Abilify, made by Otsuka Pharmaceutical Co., appears on lists of the top 10 drugs paid for by Medicaid in various states.

Mark Duggan, a professor and health-policy expert at the University of Pennsylvania's Wharton School, says his analysis of 2010 data on five leading antipsychotics suggests that more than 70% of the cost of these drugs was paid for by Medicaid and other government programs.

Stephen Cha, a chief medical officer at the Centers for Medicare & Medicaid Services, told WSJ that the government is hoping to reduce the "the unnecessarily high utilization of antipsychotics," encouraging doctors to take other approaches with some children.

In a separate article, WSJ reported about the situation of a foster parent with five children, four of whom are currently on or have been on antipsychotic medication.

"They are not manageable. They are angry at everybody," Rebecca Green of Lancaster, Texas, told WSJ, noting that she's tried other therapies that don't involve drugs. "The drugs seem to calm them down somewhat."

"I am the first one to say, I don't want a child zombied out," Green continued. "But you have kids who are 4 and they are throwing chairs and attacking the foster parents, and some at 3 are doing that. They kick you in the shins. They are very strong."

Dallas-based pediatrician Fernando Siles, who treats Green's foster children, explained to WSJ that aggressive kids get bounced around the system, but such drugs can help "stabilize the behavior of the child, to keep him from being moved and moved again."

It's not just children and teens in the U.S. that have been increasingly prescribed the drugs either. Earlier this year, Canadian researchers saw an "exponential" rise in the number of young patients on such medication. Canada's Post Media News reported:

The phenomenon “is of great concern” given emerging evidence showing that the drugs can cause rapid weight gain, high blood pressure, diabetes and other serious side effects that make children vulnerable to an increased risk of heart attack and stroke when they’re older, the research team reports in the June edition of the Canadian Journal of Psychiatry.

The study is based on data from the B.C. health ministry. Researchers looked at rates of prescribing of both older, “first generation” antipsychotics, and the newer SGAs.

Overall, the total number of children under 18 who received an antipsychotic prescription increased to 5,791 in 2011 from 1,583 in 1996 — a nearly four-fold jump.

The review of Medicaid-financed antipsychotic drugs for those 17 and under is being conducted by inspector general Daniel Levinson, who told WSJ it will involve a review of medical records in various states to see if "taxpayers were being billed for inappropriate, poor-quality care" or if the prescriptions were legitimately needed.

Featured image via Shutterstock.com.

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