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Pediatric Stimulants Among Highest Medicaid Prescription Expenditures


August 30, 2017

A recent report in Pediatrics revealed that amphetamine-type stimulants are the highest costing pediatric drugs purchased by Medicaid managed care.

Eyal Cohen, MD, MSc, of the Hospital for Sick Children in Toronto, Canada, and colleagues explained that medication spending is the central issue for payers, with prescriptions accounting for $457 bill in expenses in the United States in 2015—almost 17% of all health care spending. In order to understand trends in Medicaid prescription spending among children in managed care plans, the researchers sought to determine which prescriptions had the highest utilization and cost for these patients.

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“For adults, concern about rising drug spending has been raised, particularly regarding expensive, new drugs for the treatment of conditions such as hepatitis C and cancer,” Dr Cohen and colleagues wrote. “However, less is known regarding potential contributors to pharmaceutical expenditure in pediatric populations. Given the substantial contribution of medications to overall expenditures, a better understanding of medication spending may provide another target for comparative effectiveness research, quality improvement, and appropriate cost-containment strategies.”

The researchers conducted a retrospective review of medications speeding among 3,271,081 Medicaid-enrolled children. In order to determine the 10 most expensive drugs, the researcher used the transaction prices paid by Medicaid for 261 medication classes in 2013.

Study results showed that outpatient medication use among pediatric patients accounted for 16.6% of Medicaid expenditures—with the 10 most expensive drugs accounting for 63.p% of all medication spending.

Dr Cohen and colleagues found that amphetamine-type stimulants, often prescribed for attention-deficit/hyperactivity disorder, were the most expensive, accounting for 20.6% of Medicaid medication spending and 14% of days of medication use. Additionally, the four most costly medications were all psychotropic medications, including methylphenidate, lisdexamfetamine, amphetamine, and aripiprazole.

“Growth in the use of psychotropic medications, particularly in young children, has received substantial media attention; it is not known how much of this reflects physicians electing to prescribe pharmacotherapies (often multiple psychotropic medications in those receiving antipsychotics) when access to psychological or other supportive services is limited or lacking,” Dr Cohen and colleagues wrote. “Interventions implemented by states to strengthen oversight and limit prescribing of antipsychotics, such as instituting previous authorization processes‍ or telephone access for primary care providers to consult child psychiatrists, may be contributing to recent reports of decreased rates of prescribing of antipsychotics in pediatric Medicaid enrollees.‍”

David Costill

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