title: Impact of the Florida Medicaid prior-authorization program on use of antipsychotics by children under age six.
abstract: OBJECTIVE
  This study assessed the impact of a prior-authorization process on the use of antipsychotic medications by children under six years old in Florida's fee-for-service Medicaid program.
  
  
  METHODS
  Child psychiatrists reviewed requests for antipsychotic treatment (N=1,424) using forms and criteria created by a panel of Florida-based experts. Data on the characteristics of the children and clinicians involved were organized into 11 consecutive quarters beginning in July 2008. Multivariate generalized estimating equations were used to examine the association between each study variable and changes in the odds of submission of a new request over time.
  
  
  RESULTS
  Prior-authorization requests declined from 124 in the first quarter to 81 in the last quarter. Compared with applications from child psychiatrists, the odds of applications being submitted by adult psychiatrists, neurologists, and pediatricians increased over time.
  
  
  CONCLUSIONS
  Although applications declined, the diminished role of child psychiatry specialists raises questions about the impact of the program on the quality of care provided.
authors.affiliation: Florida Mental Health Institute, University of South Florida, 13301 Bruce B. Downs Blvd. MHC 2724, Tampa, Florida 33647, USA. rconstantine@fmhi.usf.edu
authors.forename: Robert
authors.initials: R
authors.lastname: Constantine
authors.forename: Michael A
authors.initials: MA
authors.lastname: Bengtson
authors.forename: Tanya
authors.initials: T
authors.lastname: Murphy
authors.forename: Marie
authors.initials: M
authors.lastname: McPherson
authors.forename: Ross
authors.initials: R
authors.lastname: Andel
authors.forename: Mary Elizabeth
authors.initials: ME
authors.lastname: Jones
authors.forename: Christina
authors.initials: C
authors.lastname: Donaldson-Guenther
mesh_terms: D014150:Antipsychotic Agents / Q000627:therapeutic use*; D002648:Child; D002665:Child Psychiatry; D002675:Child, Preschool; D005260:Female; D005431:Florida; D006801:Humans; D007345:Insurance Claim Review; D019458:Insurance Coverage / Q000458:organization & administration*; D008297:Male; D008484:Medicaid; D014481:United States
chemical_list: D014150:Antipsychotic Agents