Medicaid Prior Authorization Policies for Medication Treatment of Attention-Deficit/Hyperactivity Disorder in Young Children, United States, 2015
GroupCenter for Public Health Law Research (Temple University Beasley School of Law)
Permanent link to this recordhttp://hdl.handle.net/20.500.12613/7417
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AbstractObjectives: In 2011, the American Academy of Pediatrics updated its guidelines for the diagnosis and treatment of children with attention-deficit/hyperactivity disorder (ADHD) to recommend that clinicians refer parents of preschoolers (aged 4-5) for training in behavior therapy and subsequently treat with medication if behavior therapy fails to sufficiently improve functioning. Data available from just before the release of the guidelines suggest that fewer than half of preschoolers with ADHD received behavior therapy and about half received medication. About half of those who received medication also received behavior therapy. Prior authorization policies for ADHD medication may guide physicians toward recommended behavior therapy. Characterizing existing prior authorization policies is an important step toward evaluating the impact of these policies on treatment patterns. We inventoried existing prior authorization policies and characterized policy components to inform future evaluation efforts. Methods: A 50-state legal assessment characterized ADHD prior authorization policies in state Medicaid programs. We designed a database to capture data on policy characteristics and authorization criteria, including data on age restrictions and fail-first behavior therapy requirements. Results: In 2015, 27 states had Medicaid policies that prevented approval of pediatric ADHD medication payment without additional provider involvement. Seven states required that prescribers indicate whether nonmedication treatments were considered before Medicaid payment for ADHD medication could be approved. Conclusion: Medicaid policies on ADHD medication treatment are diverse; some policies are tied to the diagnosis and treatment guidelines of the American Academy of Pediatrics. Evaluations are needed to determine if certain policy interventions guide families toward the use of behavior therapy as the first-line ADHD treatment for young children.
DescriptionIn 2011, the American Academy of Pediatrics updated its guidelines for diagnosing and treating children with attention deficit/hyperactivity disorder, which is also known as ADHD. That same year, around 6.4 million US children ages 4-17 had been diagnosed with ADHD. The new guidelines recommend that clinicians refer parents for training in behavior therapy first, and then treat with medication if that therapy fails to improve the child’s functioning. Data from the before the release of those guidelines showed that fewer than half of preschoolers with ADHD received behavior therapy. Prior authorization policies for ADHD medication could guide physicians toward recommending behavior therapy. This study, by researchers from CDC and the Center for Public Health Law Research, used policy surveillance to inventory state Medicaid prior authorization policies for ADHD medication. Explore the policy surveillance data on ADHD medication prior authorization policies at LawAtlas.org. As of 2015, 27 states had Medicaid policies that prevented approval of pediatric ADHD medication payment without additional provider involvement. Seven states required prescribers to indicate whether non-medication treatments were considered BEFORE Medicaid payment for ADHD medication could be approved. The study finds a diverse landscape of Medicaid policies – some tied to diagnosis, others tied to AAP guidelines. The authors suggest that this study is a first step to understanding how policy interventions may guide families toward the use of behavior therapy as a first-line in ADHD treatment for young children.
CitationRachel L. Hulkower et al., Medicaid Prior Authorization Policies For Medication Treatment of Attention-Deficit/ Hyperactivity Disorder in Young Children, United States, 2015, 132 Pub. Health Reports 654 (2017).
Citation to related workSAGE Publications
Copyright © 2017 Association of Schools and Programs of Public Health. DOI: 10.1177/0033354917735548.
Has partPublic Health Reports, Vol. 132, Iss. 6
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