title: The effects of prior authorization policies on medicaid-enrolled children's use of antipsychotic medications: evidence from two mid-Atlantic states.
abstract: OBJECTIVE
  The purpose of this study was to examine the impact of prior authorization policies on the receipt of antipsychotic medication for Medicaid-enrolled children.
  
  
  METHODS
  Using de-identified administrative Medicaid data from two large, neighboring, mid-Atlantic states from November 2007 through June 2011, we identified subjects <18 years of age using antipsychotics, from the broader group of children and adolescents receiving behavioral health services or any psychotropic medication. Prior authorization for antipsychotics was required for children in State A <6 years of age from September 2008, and for children <13 years of age from August 2009. No such prior authorizations existed in State B during that period. Filled prescriptions were identified in the data using national drug codes. Using a triple-difference strategy (using differences among the states, time periods, and differences in antidepressant prescribing rates among states over the same time periods), we examined the effect of the prior authorization policy on the rate at which antipsychotic prescriptions were filled for Medicaid-enrolled children and adolescents.
  
  
  RESULTS
  The impact of prior authorization policies on antipsychotic medication use varied by age: Among 6-12 year old children, the impact of the prior authorization policy on antipsychotic medication prescribing was a modest but statistically significant decrease of 0.47% after adjusting for other factors; there was no effect of the prior authorization among children 0-5 years.
  
  
  CONCLUSIONS
  Prior authorization policies had a modest but statistically significant effect on antipsychotic use in 6-12 year old children, but had no impact in younger children. Future research is needed to understand the utilization and clinical effects of prior authorization and other policies and interventions designed to influence antipsychotic use in children.
authors.affiliation: 1 RAND Corporation , Pittsburgh, Pennsylvania.
authors.forename: Bradley D
authors.initials: BD
authors.lastname: Stein
authors.forename: Emily
authors.initials: E
authors.lastname: Leckman-Westin
authors.forename: Edward
authors.initials: E
authors.lastname: Okeke
authors.forename: Deborah M
authors.initials: DM
authors.lastname: Scharf
authors.forename: Mark
authors.initials: M
authors.lastname: Sorbero
authors.forename: Qingxian
authors.initials: Q
authors.lastname: Chen
authors.forename: Ka Ho Brian
authors.initials: KH
authors.lastname: Chor
authors.forename: Molly
authors.initials: M
authors.lastname: Finnerty
authors.forename: Jennifer P
authors.initials: JP
authors.lastname: Wisdom
mesh_terms: D000293:Adolescent; D000367:Age Factors; D000928:Antidepressive Agents / Q000627:therapeutic use; D014150:Antipsychotic Agents / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007356:Insurance, Pharmaceutical Services / Q000639:trends*; D008297:Male; D008484:Medicaid; D008873:Mid-Atlantic Region; D057766:Policy; D014481:United States
chemical_list: D000928:Antidepressive Agents; D014150:Antipsychotic Agents