Restrictions on antidepressant medications for children: a review of Medicaid policy.
OBJECTIVE
This study evaluated Medicaid's prior-authorization policies restricting the prescribing of antidepressant medications for children.


METHODS
Medicaid program prior-authorization policies for antidepressant medications were obtained for all available states. All criteria needed for authorization were recorded, with a focus on policies that applied specifically to children.


RESULTS
Data from 49 states and the District of Columbia revealed that 30 states (60%) required prior authorization for antidepressants, of which eight (27%) made specific provisions for children. These provisions varied across states. In most states fluoxetine could be prescribed for children with minimal restrictions, and two states had prior-authorization policies that strongly encouraged pediatric patients to use fluoxetine. State policies regarding other selective serotonin reuptake inhibitors varied widely.


CONCLUSIONS
Although relatively few states included provisions for children in prior-authorization requirements for antidepressants, in states that did, the policies implemented varied widely. These findings raise important questions about the rational development of prescription drug reimbursement policy.
Fischer
Michael A
MA
Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital, 1620 Tremont St., Suite 3030, Boston, MA 02120, USA. mfischer@partners.org
Servi
Amber D
AD
Polinski
Jennifer M
JM
Wang
Philip S
PS
D000928:Antidepressive Agents / Q000627:therapeutic use*; D002648:Child; D003866:Depressive Disorder / Q000188:drug therapy*; D006291:Health Policy; D006801:Humans; D008484:Medicaid / Q000331:legislation & jurisprudence*; D008605:Mental Health Services / Q000331:legislation & jurisprudence*; D017367:Selective Serotonin Reuptake Inhibitors / Q000627:therapeutic use*; D014481:United States
D000928:Antidepressive Agents; D017367:Selective Serotonin Reuptake Inhibitors