Riddle me this: Why would children covered by Medicaid get antipsychotic drugs four times more often than children covered by private insurance? And why would the Medicaid kids often get those drugs for less severe conditions than their middle-class counterparts did? The New York Times poses these questions today after federally funded research discovered the imbalance.
Here are the figures: More than 4 percent of patients ages 6 to 17 on Medicaid got antipsychotic meds, compared with 1 percent of privately insured kids. More of the Medicaid-covered children got antipsychotics for off-label uses like ADHD, while privately insured kids were more likely to get them for FDA-approved uses like bipolar treatment.
One difference is that poor kids are more likely to be treated with drugs rather than with family therapy or individual counseling, at least in part because Medicaid's reimbursement for those services is often much lower than reimbursements from private insurance. Fewer providers may take Medicaid patients, making it harder to find those services, especially in locations and at hours that are convenient for the families. Fewer psychiatrists take Medicaid as well, leaving family doctors and pediatricians to treat many children on Medicaid for mental and emotional disorders.
Whatever the reason, some Medicaid administrators are trying to change the prescription patterns. Medical directors in 16 states have been working on ways to cut back on antipsychotic scrips for Medicaid children, the Times reports. Antipsychotic drugs tend to be expensive, so Medicaid programs have a cost incentive to curtail use. They also carry risks of serious side effects.
- see the NYT story