Behavioral Health, Mental Health, Substance Abuse
Effect of Prior Authorization On Utilization Of Antipsychotics Among Maryland Foster Care Youth, 2010-2014
(School of Pharmacy (UMB) Pharmaceutical Health Services Research Other)
Background: Federal policies mandate oversight of psychotropic use among youth in foster care. Prior authorization (PA) for antipsychotics prescribed to Maryland Medicaid-insured youth was implemented in October 2011 for children under 5 years old, and incrementally covered all children 18 or younger by January 2014. The effect of PA on antipsychotic use among youth in foster care has not been assessed. Objective: To estimate the change from 2010-2014 in antipsychotic prevalence among youth in foster care following implementation of the Maryland PA program. Methods: Youth <21 years old involved in foster care at any time from 2010 through 2013 were identified. Demographics and foster care placement data were obtained from the child welfare administrative database, linked to Medicaid pharmacy claims of dispensed medications. Quarterly period antipsychotic prevalence rates per 100 children were estimated pre-post PA implementation by age group: <5, <10 and ≥10 years old. Log-linear regression estimated the average quarterly percent change in antipsychotic prevalence pre-post PA for each age group. Results: Of the 18,040 youth in foster care during the study period, 3,134 (17.4%) received an antipsychotic, and most were male (n=1,735; 55%) and Black (n=1,941; 62%). The average age of antipsychotic use for each age-strata was 4.1 [SD 0.8] years (0-4 years), 8.0 [SD 1.3] years (<10 years), and 15.4 [SD 2.6] years (≥10 years). The overall quarterly antipsychotic prevalence change was 17.2% (quarter 1 2010) to 14.2% (quarter 1 2014). The quarterly average percent change was -66.5% (0-4 years), -12.9% (<10 years) and -5.5% (≥10 years). Conclusions: The PA policy had the largest reduction in antipsychotic use among preschool age youth in foster care. The short and long-term impact on outcomes and on the use of other psychotropic medications remains to be explored.