Systems of Care Yakima: Off Label: Neuroleptic prescriptions are fraudulently billed to Medicaid

via Health Services Research:
Best of the 2012 Academy Health Research Meeting
The Relationship between Mental Health Diagnosis and Treatment with Second-Generation Antipsychotics over Time: A National Study of U.S. Medicaid-Enrolled Children

In 2002 7,990 3-5 year old children on Medicaid were given 3 or more psychiatric diagnoses and 1804 of them were prescribed neuroleptic drugs off label in the U.S. In 2007, 13,934 were given 3 or more psychiatric diagnoses, and 3,341 of these pre-school aged children were prescribed neuro-toxic neuroleptic drugs whose adverse effects include cognitive and neurological impairments that can be disabling, and even fatal...

Appendix table 3A Frequency and Rates of Diagnosis and SGA Antipsychotic Treatment
Among US Medicaid Enrolled children 3-5 years old from Best of the 2012 Academy Health Research Meeting "The Relationship between Mental Health Diagnosis and Treatment with Second-Generation Antipsychotics over Time: A National Study of U.S. Medicaid-Enrolled Children"

click to enlarge

As horrifying as the above information is, it is the the data on young children with a diagnosis of schizophrenia and the data on who is being prescribed neuroleptics that is inexplicable. Schizophrenia is the one diagnosis that both the APA and the AACAP practice parameters authoritatively state neuroleptics, or antipsychotics are to be used as a "first-line treatment." Some psychiatrists go so far as to say that it would be "unethical" to not treat symptoms of schizophrenia with this class of teratogenic drugs, a questionable claim, all things considered. In this study, 78 preschoolers were diagnosed with schizophrenia in 2002; of these 78 children given a diagnosis of schizophrenia, only 6 were prescribed neuroleptics. In 2007, there were 92 children labeled with schizophrenia that were 3-5 years old; not a single one of them was prescribed a neuroleptic drug according to the above reference chart.

6-11 year old children on Medicaid pdf download

#on %on %Total #on %on %Total

total# dx% SGA SGA SGA total# dx% SGA SGA SGA

Schizophrenia 278 0.01% 82 29.50% 0.10% 311 0.01% 66 21.22% 0.05%

12-18 year olds on Medicaid pdf download

#on %on %Total #on %on %Total

total# dx% SGA SGA SGA total# dx% SGA SGA SGA

Schizophrenia 1,571 0.03% 965 61.43% 0.74% 1,537 0.03% 871 56.67% 0.40%

The prescription rate for neuroleptics to treat schizophrenia went down, while the rate of off label prescriptions for non FDA-approved conditions have risen dramatically. An alarming trend that is bound to get worse when the DSM5 is released; some children are drugged absent any psychiatric diagnosis whatsoever. Many children who are drugged are given 2, 3, or more psychiatric diagnoses; and the children are then prescribed multiple drugs concomitantly, all off label, and without any definitive data it is safe or effective to prescribe the drugs in the manner they are most often being used.

The study was paid for by the Agency for Healthcare Research and Quality, a federal program whose budget is derived from federal tax dollars, and it is copyrighted by the Health Research and Educational Trust. This begs the question, why is it not easily accessible to the American people who paid for it? It is on the Wiley Online Library behind a pay wall requiring that you buy the PDF or pay for 24 hour access to it online, unless you're a health professional affiliated with an institution that is a Wiley Library subscriber.

Best of the 2012 Academy Health Research Meeting

The Relationship between Mental Health Diagnosis and Treatment with Second-Generation Antipsychotics over Time: A National Study of U.S. Medicaid-Enrolled Children

Meredith Matone M.H.S.1,
Russell Localio Ph.D.2,
Yuan-Shung Huang M.S.3,
Susan dosReis Ph.D.4,
Chris Feudtner M.D., Ph.D., M.P.H.1,3,5,
David Rubin M.D., M.S.C.E.1,3,5,*

Article first published online: 4 SEP 2012

DOI: 10.1111/j.1475-6773.2012.01461.x

© Health Research and Educational Trust

Issue

Health Services Research

Volume 47, Issue 5, pages 1836–1860, October 2012

Funded by
Agency for Healthcare Research and Quality

Keywords:

Antipsychotics;
mental health;
pediatrics;
Medicaid

Objective
To describe the relationship between mental health diagnosis and treatment with antipsychotics among U.S. Medicaid-enrolled children over time.

Data Sources/Study Setting
Medicaid Analytic Extract (MAX) files for 50 states and the District of Columbia from 2002 to 2007.

Study Design
Repeated cross-sectional design. Using logistic regression, outcomes of mental health diagnosis and filled prescriptions for antipsychotics were standardized across demographic and service use characteristics and reported as probabilities across age groups over time.

Data Collection
Center for Medicaid Services data extracted by means of age, ICD-9 codes, service use intensity, and National Drug Classification codes.

Principal Findings
Antipsychotic use increased by 62 percent, reaching 354,000 youth by 2007 (2.4 percent). Although youth with bipolar disorder, schizophrenia, and autism proportionally were more likely to receive antipsychotics, youth with attention deficit hyperactivity disorder (ADHD) and those with three or more mental health diagnoses were the largest consumers of antipsychotics over time; by 2007, youth with ADHD accounted for 50 percent of total antipsychotic use; 1 in 7 antipsychotic users were youth with ADHD as their only diagnosis.

Conclusions
In the context of safety concerns, disproportionate antipsychotic use among youth with non-approved indications illustrates the need for more generalized efficacy data in pediatric populations.