Pediatric Use of Antipsychotic Medications Before and After Medicaid Peer Review Implementation | Pediatrics | JAMA Psychiatry | JAMA Network
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Research Letter
January 2018

Pediatric Use of Antipsychotic Medications Before and After Medicaid Peer Review Implementation

Author Affiliations
  • 1Department of Pharmaceutical Health Services Research, University of Maryland, Baltimore
  • 2Department of Psychiatry, University of Maryland, Baltimore
  • 3Now with Merck & Co Inc
  • 4Acumen, LLC, Burlingame, California
  • 5Centers for Medicare & Medicaid Services, Washington, DC
JAMA Psychiatry. 2018;75(1):100-103. doi:10.1001/jamapsychiatry.2017.3493

In response to the growing cardiometabolic safety concerns about the use of atypical antipsychotic (AAP) medications in children,1,2 several state Medicaid agencies have adopted a novel, more clinically nuanced and individualized approach to reviewing the appropriateness of AAP use, namely, peer review prior authorization (PA) policies.3 Physicians must receive preapproval through contracted clinicians (peer reviewers) to prescribe AAPs to certain-aged children. We assessed the effect of peer review PA policies on AAP use among Medicaid-insured youth according to age restriction criteria.

We used Medicaid administrative claims data from 4 geographically diverse states wherein AAP-related peer review PA policies were implemented between April 2008 and August 2009. Data analysis was conducted from November 4, 2014, to June 12, 2017. Peer review policies were implemented for children younger than 8 years in state A, younger than 6 years in states B and C, and younger than 5 years in state D. We used an interrupted time-series design to assess monthly and quarterly use of AAPs across 36 months, including 12-month prepolicy, 12-month transition, and 12-month postpolicy analysis.4 The unit of analysis was child with any AAP dispensing. The 12-month transition period represented 6 months before and after the policy implementation date in each state. The study was an extension of an interagency agreement between the Centers for Medicare & Medicaid and the US Food and Drug Administration’s Safe Use Initiative. The US Food and Drug Administration Research in Human Subjects Committee determined that the study does not qualify as human research (records review with no identifiers). In multivariable logistic regression models with generalized estimating equations, we added interaction terms for time period and age group to assess whether changes in AAP use differed by age group in the postpolicy vs prepolicy periods.