The Wall Street Journal reported the government is probing whether Medicaid programs pay for too many anti-psychotic drugs for children:
Federal health officials have launched a probe into the use of antipsychotic drugs on children in the Medicaid system, amid concern that the medications are being prescribed too often to treat behavioral problems in the very young.....
The effort applies to a newer class of antipsychotic drugs known as "atypicals," which include Abilify, the nation's No. 1 prescription drug by sales. The drugs were originally developed to treat psychoses such as schizophrenia, but some now have Food and Drug Administration approval for treatment of children with conditions such as bipolar disorder and irritability associated with autism.
In 2008, the most recent year for which complete data are available, Medicaid, the government health program for the poor, spent $3.6 billion on antipsychotic medications, up from $1.65 billion in 1999, according to Mathematica Policy Research, a Washington firm that crunches Medicaid data for HHS. The growth came even as pharmacy benefits for millions of Medicaid recipients shifted to Medicare in 2006.
Medicaid spends more on antipsychotics than on any other class of drugs. Abilify, made by Otsuka Pharmaceutical Co., appears on lists of the top 10 drugs paid for by Medicaid in various states.
Mark Duggan, a professor and health-policy expert at the University of Pennsylvania's Wharton School, says his analysis of 2010 data on five leading antipsychotics suggests that more than 70% of the cost of these drugs was paid for by Medicaid and other government programs.
The number of people under age 20 receiving Medicaid-funded prescriptions for antipsychotic drugs tripled between 1999 and 2008, according to an analysis by Mathematica.
Dr. Stephen Cha, a chief medical officer at the Centers for Medicare & Medicaid Services, the HHS agency that foots some of the bill for drugs prescribed to Medicaid recipients, says the government wants to reduce what he termed "the unnecessarily high utilization of antipsychotics." He urges doctors to consider other approaches, including therapy to help children and families cope with psychological trauma that could be at the root of behavior issues.
The drugs in question—in addition to Abilify, the brand names include Risperdal, Seroquel and Zyprexa—were developed to replace medications dating to the 1950s such as Haldol and Thorazine, which produced severe side effects such as uncontrollable muscle twitching. The atypicals, introduced in the 1990s and early 2000s, were hailed as safer and more tolerable, and sales grew rapidly.
The FDA's approval of some of the new drugs to treat certain pediatric conditions, coupled with concern about possible side effects on young people and growing off-label use by doctors to treat various forms of violent or aggressive behavior, has sparked debate about whether they are being dispensed too freely to troubled children.
Spokespeople for the makers of Seroquel, AstraZeneca PLC, and of Abilify said those drugs should be used for FDA approved indications. Janssen Pharmaceuticals Inc., a unit of Johnson & Johnson that makes Risperdal, noted that the drug had been approved for a number of pediatric uses. Eli Lilly & Co., maker of Zyprexa, says the drug's label guides doctors to weigh the risks and consider therapy as part of the treatment. None commented on the government efforts to reduce antipsychotic use by children in the Medicaid system.
Dr. Fernando Siles, a pediatric psychiatrist in the Dallas area who treats many poor foster children, says he sometimes prescribes such medications to treat serious behavior problems. "A child that continues to be aggressive will be kicked out from his foster home," he says. "The antipsychotic is to stabilize the behavior of the child, to keep him from being moved and moved again."
Some doctors say there is too much emphasis on medicating children instead of working with them and their caregivers to understand what is triggering their behavior. Dr. Glenn Saxe, chairman of child and adolescent psychiatry at NYU-Langone Medical Center and a proponent of trauma-focused therapy, says psychiatry has missed "big opportunities to help children. This problem has led to kids being medicated more and more."
Dr. Siles agrees that lots of children could be helped by trauma-centered therapy, "but there is no budget for it."
Children on Medicaid are prescribed antipsychotics at four times the rate of privately insured children, according to a study by Stephen Crystal, a professor of health policy at Rutgers University, that looked at data from 2004 on 6- to 17-year-old children in seven states.
The probe by the inspector general, Daniel Levinson, has been under way for several months and focuses on the five largest Medicaid states: California, Florida, Illinois, New York and Texas. It covers a six-month period from January to June 2011, when 84,654 children age 17 and under in those states received prescriptions for antipsychotics paid for by Medicaid. Pediatric psychiatrists will examine about 700 cases, say people familiar with the effort.
"Through medical-record reviews, we will determine whether these prescriptions were medically indicated, and whether taxpayers were being billed for inappropriate, poor-quality care," says Mr. Levinson.
Government Medicaid data indicate that some of the prescriptions are being written for very young children. An analysis by Mathematica found that in 2008, 19,045 children age 5 and under were prescribed antipsychotics through Medicaid, 3% of recipients under 20, up from 7,759 in 1999, according to James Verdier, a senior fellow at the organization.
Data from the inspector general's five-state probe indicate that 482 children 3 and under were prescribed antipsychotics during the period in question, including 107 children 2 and under. Six were under a year old, including one listed as a month old. The records don't indicate the diagnoses involved.
All five states said they have guidelines to prevent the improper use of the drugs on children in Medicaid.
In New York, a spokesman for the state health department said some children between ages 1 and 2 received antipsychotics for conditions such as autistic disorder and attention deficit disorder with hyperactivity.
Texas said about five children under the age of 1 had been prescribed antipsychotics during the time period of the probe, including two who were five months old.
"No child is getting these drugs unless they're under a doctor's care, and the doctor has to be able to defend the use of the drug," said a spokeswoman for the Texas Health and Human Services Commission. "For infants, the drugs aren't being used for behavior. The infants most often have seizures or complex health issues like heart and respiratory problems, and these drugs can be prescribed to help with discomfort."
Of particular concern is use of the drugs on foster children in the Medicaid system. One study, based on 2007 Medicaid data in 13 states, found that 12.4% of children in foster care received antipsychotics, compared with 1.4% of Medicaid eligible children in general, according to Mr. Crystal, co-author of the study.
Bryan Samuels, head of the Administration on Children, Youth and Families, the agency within HHS that helps oversee the nation's foster children, is pushing states to adopt tougher rules on prescribing antipsychotics.
"The medications tend to be the stopgap measure," Mr. Samuels says. "We are making significant investments in medication that have limited evidence of effectiveness and rarely address the issues of trauma." Rest of article
Monday, September 2, 2013
Overmedicating the poor?
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25 comments:
I have observed for years that entirely too many (especially elderly) people are on entirely too many different medications. There are a great many doctors, especially in small rural towns that will have their elderly patients on a number of different types of medications. I have also observed that too many times, one or more of these types of medications will cause severe reactions when taken together. There should certainly be more oversight into what drugs are being prescribed for these patients.
There is a direct correlation to disability checks in the black community. Get them diagnosed and get on the gravy train. Doctor gets paid, drug company gets paid and caretaker (guardian ) gets big bucks. Look into SS payments to grandparents adopting children. huge scam
Doctors don't get paid for putting patients on medications. Physicians would make more money using non-pharmaceutical intervention. Get your facts straight.
1:59 am - your point may or may not be true, but it has nothing to do with this WSJ article. This is about children and poverty (Read: Medicaid) not the elderly (Read: Medicare).
12:33 - They do however, get kickbacks from the drug companies! Get your facts straight!!!
3:26 - It is only a difference in generations and it is still Medicaid and in some instances Medicare. I know the difference. It's time for your to READ!
3:46, i do have my facts straights. I am a physician married to another physician. Drug companies are not even allowed to give doctors pens with their drug names on them anymore. Its illegal to give doctors "kickbacks.". Its pretty cynical to think that MDs give children atypical antipsychotics to line their pockets in some nefarious get rich scheme.
4:45 - thanks for your help, but I can take care of myself (3:36 here, by coincidence also a physician married to a physician).
I stand by my original comment at 3:26 completely, because it is accurate.
3:46 is delusional if he/she thinks drug companies are giving anything away to physicians; the history of billion-dollar fines from the FDA has killed so much as even (as you pointed out) a pen with a drug's name on it.
3:49 apparently knows nothing about how either Medicaid or Medicare are funded. For instance, how much of the State of Missisippi budget goes to Medicare today? How much of the state budget goes to Medicaid? Hmmm?
The WSJ article focused solely on children, Medicaid, and what seems to be a tremendous overuse of atypical antipsychotics in children on Medicaid. I welcome the audits described in the article.
In an ideal world those with reading comprehension programs would not litter these boards with ignorant, uninformed comments. The best we can do is ignore them when they rant.
So; All those catered meals hauled into clinics on the credit cards of drug reps every day of the week, every week of the month, every month of the year are simply my imagination? I see.
Sample drugs are dispensed purely as a means of satisfying return customers. Return customers represent income. And where do you think all these closets full of samples come from?
You know what 7:21--you have finally figured it all out. I change my prescription writing habits for a platter of sandwiched from mcallisters that are largely eaten by receptionists and nurses!!! What an expose on the medical community.
Dirty little "secret" of medicine: being low in IQ isn't the only effect of a badly wired brain. Dumb people are more likely to have severe mental illnesses, problems with impulse control, and behavioral issues. And most dumb people are the children of dumb people, and most dumb adults are poor. It is no surprise that antipsychotic prescriptions are more common in Medicaid children than in those with private insurance. Any other result would be a surprise, actually.
To4:45 and 5:40 - There is an old adage that goes like this: The cat with his tail caught under the rocking chair is the one who squalls the loudest! Am I to believe that the two of you are the cats with your tails caught under the rocking chair????
Its seems to me like you "squawk" the worst, 12:03. I am just setting the record straight. So why don't you put your tin foil hat back on and move on to your next conspiracy theory.
I have to get back to writing dangerous and unnecessary prescriptions so that I can get a free Chick-fil-A sandwich. It will keep me from having to take the elevator downstairs where I can eat a free lunch provided by the hospital in the doctor's lounge.
7:37 - I did not accuse you (personally) of writing dangerous and unnecessary prescriptions. Also, I am not the poster who accused doctors of getting free lunches from drug reps. However, there are rotten apples in every barrel and the medical community is no exception!
I know this is anecdotal; it is not a scientific survey. I am a retired public school teacher who had several students describe to me how their parents coached them as to behavior during testing in order to qualify for the "crazy check". This is not because of their poverty level, but because of a greed level.
12:03 - 5:40 here. I notice you didn't/couldn't address or refute a single point I made.
If I didn't have any evidence to support an argument I'd resort to ad hominem character attacks too. Next time try banging your show on the table - ot worled so well for Kruschev.
I have worked as an MD in a mental hospital, including one treating children. There are so many stories of abuse and social trauma for most of these kids. A lot of them come from developmentally delayed parents and drug and alcohol abusers. There are not resources to treat them non-medically. When they are trying to place them in psychiatric facilities or foster homes, they are trying to get them stable as soon as possible. Some of these kids assault other children or try to set the family dog on fire. It's a no-win situation, but most of these kids have Medicaid and it doesn't provide for much. 3 Circle at UMC and Whitfield are full of these children.
And, for 2:48, there are bad apples in every field. However, most of them aren't working for peanuts treating disadvantaged children with psychiatric problems. I also have never heard of a kickback from a drug company. In fact, many physicians are irritated by having to slow down to deal with salespeople. Many do so to make sure patients that can't pay for their medication get into the drug company's assistance programs.
I wish the clowns who spew hatred at MDs would volunteer to spend some time on 3 South at UMMC. It's hard to think of a sadder place on earth.
11:23, it's much easier to be an armchair quarterback.
I think people in general are over medicated. But instead of getting to the root of the problem, people want a quick fix of medication. Therapy and diet can help most people.
But, like someone mentioned before- go work where these doctors work and see what they see on a regular basis and then comment about them.
I, for one, could not begin to comprehend working with those children. I do not see how doctors do it on a daily basis and not let it effect them in some way. It takes a very strong person to do what they do. Most of the doctors make a VERY lucrative income but they also do not have an easy job by any means! They give up their lives to work with people. They sacrifice time with their families to help us. Are there shady doctors? Well if course!! There are shady people everywhere and that's life. But for the honest and hard working ones, they deal with alot.
Go visit the Batson Children's Emergency room in the middle if the night like we had to do once. It was a terrible night and ill never forget it. I hope we never have to go back. Children cannot help theirselves. If they have no parents or their parents are worthless then who else is going to care for them?? It isn't the child's fault. It is the responsibility of the damn people who brought them into this world. But don't knock the medical field for doing what they can to help these children. Blame their parents.
Rebekah, thank you for being sensitive about the situation. It is very frustrating as an MD to be "damned if you do and damned if you don't." I don't know a colleague that doesn't stay concerned about these issues, and it is very frustrating to be accused of greediness and lack of humanity. We would all like to live in a utopia where there aren't screwed-up nine year olds. We have to work with what we have, and it sucks to be attacked by know-nothing's with nothing but snide commentary. All points bulletin: when there is a solution to being the child of a crack addicted prostitute that has anti-social tendencies before the age of 8, please let the rest of us know.
Couldn't agree more. Are there times kids are o ey medicated? Yes. Sometimes it is a quick fix to a problem that only lacks knowledge and research by the parents. But that's the PARENT's fault- not the doctors.
It is easy to judge people when you are sitting behind a computer. But it takes a special mind and complete selflessness to do what you and other doctors do on a daily basis.
Over medicated I mean. Damn auto correct
The point made that we don't have the resources to actually treat children and so medicating them has become a necessity is well taken.
It grieves me to see both adults and children, some of whom are having normal reactions to traumatic experiences medicated rather than resolving the problems life has thrown at them.
I am particularly upset that those with anxiety disorders, which is very curable with therapy after several months and is rather common, are medicated. The anxiety doesn't go away, just the symptoms.
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