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Antipsychotic Medication Use In Medicaid-Insured Children Decreased Substantially Between 2008 And 2016

Greta Bushnell1, James Lloyd2, Mark Olfson3

  • 1Greta Bushnell (greta.bushnell@rutgers.edu), Rutgers University, New Brunswick, New Jersey.

Health Affairs (Project Hope)
|July 5, 2023
PubMed

Insights

Pediatric antipsychotic prescribing significantly declined between 2008 and 2016, with usage decreasing across all demographic groups. This trend suggests a move toward more appropriate medication use in children covered by Medicaid.

Area of Science:

  • Pediatric psychopharmacology
  • Health services research
  • Public health policy

Background:

  • Concerns over the rapid increase in pediatric antipsychotic prescribing, particularly among Medicaid beneficiaries, prompted safety and appropriateness reviews.
  • State-level policy and educational initiatives were implemented to encourage safer and more judicious antipsychotic use in children.
  • Previous trends showed antipsychotic use leveling off, but recent national data on pediatric Medicaid populations were lacking, especially regarding racial and ethnic variations.

Purpose of the Study:

  • To estimate national trends in antipsychotic use among children (ages 2-17) enrolled in Medicaid from 2008 to 2016.
  • To examine variations in antipsychotic prescribing trends by demographic factors, including race and ethnicity.
  • To assess changes in the proportion of children receiving antipsychotics for FDA-approved pediatric indications.

Main Methods:

  • Analysis of a national Medicaid prescription claims database.
  • Longitudinal study design examining trends from 2008 to 2016.
  • Stratification of data by age, sex, race, ethnicity, and foster care status.

Main Results:

  • A significant decline in antipsychotic use was observed among children aged 2-17 in the Medicaid population between 2008 and 2016.
  • Declines in antipsychotic prescribing were consistent across various demographic subgroups, including race and ethnicity.
  • The percentage of children with an antipsychotic prescription who had a diagnosis for an FDA-approved pediatric indication increased from 38% in 2008 to 45% in 2016.

Conclusions:

  • Antipsychotic prescribing among children in the Medicaid population has substantially decreased over the study period.
  • This decline, coupled with an increase in use for approved indications, suggests a positive shift towards more judicious prescribing practices.
  • Further research may explore the long-term impact of these trends on child mental health outcomes.

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