Calif. Rule Has Curbed Psychiatric Rx Use for Low-Income Children
A rule requiring prior authorization has helped reduce the amount of psychiatric medication prescribed to children covered by Medi-Cal, according to an analysis of prescription data, the Bay Area News Group/Santa Cruz Sentinel reports. Medi-Cal is the state's Medicaid program.
The data were released after the California Alliance of Child and Family Services requested it (de Sá, Bay Area News Service/Santa Cruz Sentinel, 3/11).
Background on Rule
In September 2014, the California Department of Health Care Services developed the rule after a San Jose Mercury News investigation found that children in the California foster care system were prescribed psychiatric drugs at a rate that was three times higher than children nationwide.
Under the rule -- which went into effect Oct. 1, 2014 -- California pharmacists have to show the "medical necessity" for antipsychotic drugs prescribed to children ages 17 and younger who are covered by Medi-Cal.
The rule expanded upon a 2006 requirement that such verification be completed for children ages five and younger (California Healthline, 9/19/14).
Details of Data
According to the data, the rate of prescription request rejections increased from 6% in October 2014 to 18% in January under the new rule.
Meanwhile, the number or antipsychotic drug requests dropped from 16,915 in October 2014 to 6,950 in January. According to the Bay Area News Group/Santa Cruz Sentinel, 4,771 requests during that time were denied on their first submission.
Adriane Fugh-Berman, an associate professor in Georgetown University Medical Center's department of pharmacology and physiology, said the data "really sho[w] the power of prior authorization," adding, "Just indicating that 'we're watching you' makes a difference."
Meanwhile, Lawrence Diller, a behavioral pediatrician, said, "The fact that any are denied is encouraging," noting that "[a]ny second opinion or watchdog oversight is fortunate for these ... kids" (Bay Area News Group/Santa Cruz Sentinel, 3/11).This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.