High-Expenditure Pharmaceutical Use Among Children in Medicaid

Area of Science:

• Pediatric Health Economics
• Pharmacoeconomics
• Health Services Research

Background:

• Medication use is a key area for quality improvement and cost containment in healthcare.
• Understanding pediatric medication spending patterns is crucial for resource allocation and policy development.

Purpose of the Study:

• To identify medication classes with the highest expenditures among children enrolled in Medicaid.
• To characterize the demographics, clinical profiles, and healthcare utilization of children prescribed these high-cost medications.

Main Methods:

• Retrospective, cross-sectional study of over 3.2 million Medicaid-enrolled children.
• Analysis of outpatient medication spending for 2013, focusing on the 10 most expensive of 261 medication classes.
• Data sourced from transaction prices paid by Medicaid agencies and managed care plans.

Main Results:

• The top 10 medication classes comprised 63.9% of total medication expenditures.
• Stimulants (amphetamine-type) represented the highest expenditure (20.6%) and medication use days (14.0%).
• Children using high-expenditure medications were more likely to have chronic, mental health, or complex chronic conditions; psychotropic medications dominated spending.

Conclusions:

• Pediatric Medicaid medication spending is concentrated in a few classes, predominantly for children with chronic conditions.
• Interventions targeting medication safety, effectiveness, and cost containment should focus on these high-expenditure classes.
• Further research into appropriate prescribing practices for these medications is warranted.