Florida Legislator Questions Antipsychotic Spending
52 CommentsBy Ed Silverman // September 9th, 2008 // 2:17 pm
Earlier this summer, the state’s Agency for Health Care Administration reviewed new guidelines on paying for antipsychotic drugs for children. This came after newspaper stories detailed that the number of kids in the program prescribed the meds had nearly doubled between 2000 and 2006. however, the most common primary diagnosis was ADHD, an ailment not approved for using the meds.
The agency proposed rule changes to permit Medicaid reimbursement under one of two circumstances: if an antipsychotic has an FDA-approved use or is listed in an official compendium or - and this is the new twist - if prior authorization is granted. Both moves would continue to make it possible for very young children to receive antipsychotics. Only Johnson & Johnson’s Risperdal is approved for children as young as 5, and only for treating irritability associated with autism.
Nonetheless, a Florida legislator has since questioned the rationale for permitting Medicaid to pay for antipsychotic prescribing for unapproved uses, even though doctors are allowed to prescribe off-label uses. Twice, Ed Hooper has written AHCA secretary Holly Benson to pursue the state spending, although an AHCA spokeswoman tells us they have not yet provided a response. Here are his letters.
Legislators in other states, such as New Jersey and New Hampshire, have separately made similar inquiries to their own state officials about increased Medicaid spending on antipsychotics, and a group of 15 state Medicaid medical directors is preparing a report for release by January (more on this tomorrow).
Supremacy Claus
This one is easy. Take 10 kids off their neuroleptic tranqulizers. Drop off at legislator’s office. Return to pick up, in three hours, which is half a school day.
Perry
Bravo to the legislators in all these states!
It’s about time this country started to wake up on drugging kids.
Sarah Johnson
Let me get this straight.
The antipsychotic drugs are not approved for kids. Right?
And our state dollars are paying for this?!?!??!
Is that right?
I’ll bet pharma doesn’t want that to get out!
Jack2
So you’d rather the government decide your treatment instead of your doctor?
Careful what you wish for.
Lisa Van S
Jack2
Pretty Sad that government has to protect small children from greedy,self serving psychiatrists.
Marilyn H.
Some of these “doctors” if you want to call them that are out of control. There are no FDA approved indications for most of these antipsychotics in children, nor is there scientific literature supporting such use - yet they are passed out not like candy - like water coming down a slide at the local water amusement park.
These “doctors” need to be reighned in and perhaps the MILLIONS of dollars at stake is the wake up call for legislators.
Lisa Van S
Supremecy,
Antipsychotics can and do cause substance induced mood disorders according to the DSMIV. So if given a choice, Id rather spend the afternoon with children who havent been medicated.
Ken Kramer
What does Florida’s Agency for Health Care Administration say about all this?
Nothing.
You can watch here:
http://www.youtube.com/watch?v=7ibwZJJXAWU
Jim Moore
I am thrilled that we still have legislators that can see through the fraud of drugging little children with these drugs off-label for conditions that the drugs are not approved for. considering the potentially extreme and expensive side effects and physical damage the drugs can do it is refreshing that someone is looking into this for the children and taxpayers sake.
You wonder why there is no long term effects data on Ritalin, which has been around since the 50’s? I say it’s because the manufacturers don’t want anyone to KNOW the real long term effects of that drug or any other drug for that matter.
Supremacy Claus
There are anti-psychotics FDA approved for childhood aggression. Mellaril and Haldol.
This legislator just does not want children on Medicaid to receive brand name,modern neuroleptic tranquilizers. He would not give Mellaril nor Haldol to his dog. He would have dark skinned children get placed on Mellaril or Haldol. This legislator and all others in the cited states are racists.
Lisa, these children will attack you, all the time, everywhere. They are ultra-aggressive and self-injurious. The quality of their lives untreated is grim. There is a marked increase in quality of life on medication. In any case, shouldn’t the parents and teachers, those that know them best, that care about them the most, get to decide? Or, should a vile, racist, government lawyer get to impose his sick, biased ideology on those who will be injured, including the child himself? Beyond ideology is cost. These racist legislators have not a word of protest about rich, white kids getting the same medications. They flip out only when Medicaid recipients get these life saving medications.
truthman30
“There is a marked increase in quality of life on medication”
Wow…
Just… wow..
Lisa Van S
Supremacy,
“He would not give Mellaril nor Haldol to his dog”
Mellaril and Haldol are equally as dangerous as Geodon and other Atypical Antipsychotics. These legislators are concerned for the safety and well being of our most vulnerable population, the children in Foster Care.
“These racist legislators have not a word of protest about rich, white kids getting the same medications”
They Sure do……
Are you a Psychiatrist, or just an evil spirited person.
truthman30
“Are you a Psychiatrist, or just an evil spirited person.
Psychiatrists usually are mean spirited people…
Don’t confuse the poor guy..
;)
Lee
Hats off to Rep. Hooper for asking why these children are getting these drugs. This is a nationwide problem and more representatives in more states need to be asking this same question.
If you beat a child, that’s abuse. If you destroy his or her brain with a chemical kosh, that’s just psychiatry. It’s time for legitimate doctors to distance themselves from specialties and groups that support the senseless drugging of vulnerable children.
L
Jean
Bully for Rep. Hooper! Giving kids powerful mind and mood altering drugs just doesn’t make any sense unless you know that the doctors who started this “trend” are under investigation for conflict of interest by the Senate Finance Committee. Ref: Pharmalot June 27, 2008, “Ties That Bind? Pharma, Money And Doctors” by Ed Silverman: http://www.pharmalot.com/2008/06/ties-that-bind-pharma-money-and-doctors/
Enough said.
Lorraine
Thank you Rep. Hooper! Where are the other legislators that are supposed to protect and work for the people? Our dollars are wasted and children are harmed! What else do they need to get up and demand change?
Supremacy Claus
I invite the left wing deniers here to enroll as respite foster care providers. You get to take of these children for only a weekend, to relieve the biological parent or another foster parent.
I am sure you can get permission from these children’s families and doctors to go medication free, at your house, for a few days.
After your place has been trashed, you have been repeatedly attacked, and had to clean up the blood from these kids’ self-mutilations, after you have managed their mental state with hug therapy, then you may speak.
Santa Claus
When I grew up, grownups used to treat kids with love and tolerance. I think many still do.
Back then kids even let the weird kids play with them. I‘ll bet that is still the case today.
Grown-ups back then were willing to let kids grow up. After all they’d been kids too.
To call children “mentally ill” to generate revenue is unimaginable. A casual observation
tells us at once that lives are being destroyed by these antipsychotic drugs. It takes a criminally insane person to do this for a living. I am happy that Rep. Hopper is at bat.
Linda
Why do we as a nation see the horror of exposing young, developing minds to tobacco and alcohol and illegal drugs, but we continue to think it is ok to swathe developing brains with drugs that blanket the entire brain and nervous system. These drugs do damage!! The damage the brain in a particular way that caretakers and psychiatrists feel is “ok” to subdue behavior. If we could say that these drugs are specifically targeted, that would be one thing….but they are “blanket” drugs — there’s all sorts of other mechanisms in the brain that are affected — including metabolism!! Which is why these kids gain so much weight, endangering them with life-threatening diseases like diabetes that may or may not go away after discontinuing the drug.
ENOUGH!! And then we wonder why they grow up hostile to the system…
Nina
Supremacy -
I see you are of the class of people who think it’s OK to drug children into submission rather than helping them with the real cause for their situation.
The only one in “denial” here is you, for your lack of common sense and research into the actual reality of the harms that these drugs do to developing young bodies and minds.
This legislator has the right idea to be looking into this criminal act that is harming the future of this country - our children!
Sandie
Excuse me! Do I have this right?!?!?!?!
Firstly, We as taxpayers are being bilked out of billions of dollars through what amounts to illegal Medicaid billing.
Secondly, Once this scam was exposed, instead of being outraged, the state of Florida is going to change the rules to make the illegal payments legal????
Huh?
Hmmm……. Perhaps Hooper should be looking into this a little further - perhaps he is….
Follow the money.
Supremacy Claus
Nina: Talk is cheap in the safety of your home.
If a drug has a side effect, shouldn’t the calculation of the cost-benefit ratio best be made by the people who have to endure the condition? The arrogance of the left wing deniers here is that they know what is best for these children, better than their parents or teachers. I invite them to become respite care providers for a taste.
It is also offensive that that mental illness get dismissed as not worthy of modern technological remedies. The deniers want the approaches of before 1950. Drug free, these children generate massive government employment, by their having to be placed in government institutions. That is the real agenda of the left wing deniers. Rent seeking.
The deniers are racist rent seekers.
Advocate the drug free management of feminist conditions such as breast cancer, or of homosex conditions such as AIDS? For those left wing privileged groups, it is all out with advanced, experimental medications. For dark skinned kids on Medicaid, it’s cheap hug therapy, or generics not fit for animals.
If the extremist left wing bullies want to go drug free, let them. Leave others alone.
Supremacy Claus
Nina: “Deniers” are not “in denial.” They are not fooling themselves. They are “liars.” They are fooling the public with lies.
truthman30
“I invite the left wing deniers here to enroll as respite foster care providers. You get to take of these children for only a weekend, to relieve the biological parent or another foster parent.
I am sure you can get permission from these children’s families and doctors to go medication free, at your house, for a few days.
After your place has been trashed, you have been repeatedly attacked, and had to clean up the blood from these kids’ self-mutilations, after you have managed their mental state with hug therapy, then you may speak”
I have a younger brother who is Dyspraxic and has epilepsy, he has been diagnosed with behavioral disorders by psychologists, i lived with him for 10 years, he is 14 now. I know what it is like to live with kids who exhibit “out of control” behavior. He would throw tantrums for hours, scream down the house, threaten suicide, threaten us, punch his brother, he was an absolute nightmare to live with at times. We have never drugged him though. We deal with him with the biggest weapons of disarming that are known to man. These are called compassion, love, empathy and understanding. He can’t help the way he is , its not his fault. The only meds he was on were for his epilepsy and his behavior is dealt with by a psychologist. He will never be put on psych meds, and if a psychiatrist ever tries to in the future, they will have me to deal with…
truthman30
“left wing deniers” …
If that’s what I am Supremacy Claus , what are you ? .. a gun tootin, drug pushin member of the right wing (supremacy) brigade?….
truthman30
” Nina: Talk is cheap in the safety of your home.”
Tell you what Mr Supremacy …
I’ll send my 14 year old Dyspraxic brother over to your house and see if you can develop the human characteristics of love, compassion, tolerance and understanding…
Much harder to do that isn’t it?..
Much harder to treat difficult kids with respect and love isn’t it?
So much easier to medicate them with dangerous psychiatric meds isn’t it?…
You wouldn’t last 5 seconds with my brother, because you haven’t got a clue …
Mary M.
It’s about time someone looked into this! Bravo to Legislator Hooper!
Supremacy, These children you are talking about are actual, live, human beings in little bodies. None of those children have ever had any kind of medical test that proves they have any kind of mental disease. And most all have NEVER undergone a complete physical to look for the ACTUAL underlying cause for their original behavior and pain - yes pain, so the real reason they are acting out is never addressed! They are being drugged into oblivion.
And yes, I DO know what I’m talking about! Allergies to food, especially in a child, can cause those kinds of problems as well as other causes that can be tested for!
The fact that ANYONE would use these drugs on ANY child -let alone the fact that Medicaid is paying out to use these drugs on children - is an abomination!
Ask ANY parent who has lost a child to these drugs if it was worth it! Look at the scientific studies - Hell, look at the package inserts on these drugs! NOT recommended for children! WHY? Read further on the side-effects! and those are for adults! Who knows what lasting effects they have on little bodies and little minds! We could be creating a whole generation of the next Columbine or Virginia Tech!
Steven J.
Kudos to Mr. Hooper. We need more people like him.
Perhaps it would be good to look into why Florida insists on covering this up rather than making things right?
Supremacy Claus
Truthman: Why is your brother on anti-epilepsy drugs? These are far more dangerous than neuroleptic tranqulizers. Why not treat epilepsy with compassion? It is proven that stress and anger can precipitate seizures in those liable to them. Treat epilepsy with compassion to reduce stress and seizure causing anxiety. Just wait out the end of the seizure, as you wait out the end of the rage attack.
Explain the moral difference between an epileptic attack and a rage attack, both stemming from brain functions.
Mary: You are a left wing ideologue seeking to generate jobs for government workers. These children would end up in large state hospitals as they did in 1950. That is the wage of your ilk of left wing denier racist rent seeking.
Supremacy Claus
Mary M: The Columbine and V Tech shooters were not on neuroleptic tranquilizers. Had they been, their mass murders would have been prevented.
Such people murder 1000 people a year. Why because the lawyer has prevented their being forced into treatment.
The racist, rent seeking left wing denier does not care about murder victims. It only cares about government make work.
truthman30
Truthman: Why is your brother on anti-epilepsy drugs? These are far more dangerous than neuroleptic tranqulizers. Why not treat epilepsy with compassion? It is proven that stress and anger can precipitate seizures in those liable to them. Treat epilepsy with compassion to reduce stress and seizure causing anxiety. Just wait out the end of the seizure, as you wait out the end of the rage attack.
Explain the moral difference between an epileptic attack and a rage attack, both stemming from brain functions.
Mary: You are a left wing ideologue seeking to generate jobs for government workers. These children would end up in large state hospitals as they did in 1950. That is the wage of your ilk of left wing denier racist rent seeking.
Supremacy Idiot ….
He is on epilepsy drugs to treat epilepsy, seizures, fits… ever heard of them?…
Epilepsy is a real illness Supremacy asshole…
Kids being subdued because of their behavior is not the same thing you moronic , arrogant smart ass …
truthman30
” Mary M: The Columbine and V Tech shooters were not on neuroleptic tranquilizers. Had they been, their mass murders would have been prevented.
Such people murder 1000 people a year. Why because the lawyer has prevented their being forced into treatment. ”
Almost all the school shooters were involved with psych medications or withdrawing from them… even the mainstream media has picked up on this…
You don’t have any experience or knowledge of the topics which you choose to spew your hate speech at Mr Supremacy…
Supremacy Claus
Truthman: Did you consider your brother’s mental state normal, perhaps a variant of normal? Or did whatever damaged his brain to lower his seizure threshold not damage his brain to lower his rage threshold? Do you think he had two separate conditions, or one? What are the chances of having 2 conditions that affect 1 in 100 people? They are 1 in 10,000. Why do you deny that the unknown cause of his epilepsy is the same cause of his rage attacks? If it is, both disorders are symptoms of the same original causation, possibly genetic. Why would you discriminate against one manifestation of the one causation and not against the other? If you have a cold caused by a virus, why treat the headache, but adamantly refuse to treat the runny nose? Explain the reason for the discrimination.
If he were to come to my house for respite weekend, the first thing to do would be to call child welfare authorities. Child welfare authorities would remove him from custody for child medical neglect. He would be placed on medication, improve, and get adopted away to a less oddball family.
Do his rage attacks stem from brain function, or perhaps from evil spirits of the past, from his upbringing? I thought you said, he had a compassionate upbringing. Explain why you discriminate between a rage attack that seems very uncomfotable and painful brain function problem, and an epileptic attack during which he is unconscious and suffers no discomfort. What if his blood pressure and pulse rise so high, he has a stroke or sudden cardiac death during an untreated rage attack?
I do not find you more persuasive when you call me bad names. These distract from potentially valid and informative arguments.
Dale Evans
As Roy said earlier, time to saddle up and hit the trail, folks. As we say here on the ranch, “You can’t nail quicksand to a tree.”
Supremacy Claus
I know of no mass murderer who had recently ingested anti-psychotic medications. Most had gone off them, for months. Their mass murders were caused by their untreated mental illnesses.
Supremacy Claus
Dale: You keep saying that. When are you actually going to leave?
Lisa Van S
Supremacy
Eric Harris was taking 200mg of Luvox at the time of the Columbine Massacre
Cho of VTech had a history of being prescribed Paxil. Some of his medical records are missing and the Government has sealed his toxicology report.
truthman30
“Truthman: Did you consider your brother’s mental state normal, perhaps a variant of normal? Or did whatever damaged his brain to lower his seizure threshold not damage his brain to lower his rage threshold? Do you think he had two separate conditions, or one? What are the chances of having 2 conditions that affect 1 in 100 people? They are 1 in 10,000. Why do you deny that the unknown cause of his epilepsy is the same cause of his rage attacks? If it is, both disorders are symptoms of the same original causation, possibly genetic. Why would you discriminate against one manifestation of the one causation and not against the other? If you have a cold caused by a virus, why treat the headache, but adamantly refuse to treat the runny nose? Explain the reason for the discrimination.
If he were to come to my house for respite weekend, the first thing to do would be to call child welfare authorities. Child welfare authorities would remove him from custody for child medical neglect. He would be placed on medication, improve, and get adopted away to a less oddball family.
Do his rage attacks stem from brain function, or perhaps from evil spirits of the past, from his upbringing? I thought you said, he had a compassionate upbringing. Explain why you discriminate between a rage attack that seems very uncomfotable and painful brain function problem, and an epileptic attack during which he is unconscious and suffers no discomfort. What if his blood pressure and pulse rise so high, he has a stroke or sudden cardiac death during an untreated rage attack?
I do not find you more persuasive when you call me bad names. These distract from potentially valid and informative arguments.”
First of all..
If you were to come anywhere near my house or my 14 year old brother, I would kick you in the nuts…
His rage comes from his dyspraxia , and there are also side effects from the epilepsy drugs too which can make him moody..
It is the Dyspraxia which is the root of his behavior , dyspraxia also comes with learning disabilities …
Check it out .. you might learn a thing or two ..
http://en.wikipedia.org/wiki/Developmental_dyspraxia
I am ceasing to discuss this any further with you, because I would not do a disservice to my brother by discussing his condition with an ignorant, arrogant, misinformed and hate filled individual such as yourself.
Dale and Roy
“hate filled individual”
bingo
Supremacy Claus
Truthman: Is this your offer? “I’ll send my 14 year old Dyspraxic brother over to your house and see if you can develop the human characteristics of love, compassion, tolerance and understanding…”
I would not be so cruel as to let him suffer these rage attacks repeatedly, while failing to treat them.
I read your reference and find it offensive. The article implies he is a “spaz.” You are called your brother a bad name, as you called me bad names. I suggest you keep your offensive characterizations of your brother to yourself, to avoid setting him off.
That offensive characterization of your own poor brother also contradicts your claim that his rage is not a brain disorder. If he has dev dyspraxia, does he not deserve a shot at a highly effective, widely used, standard of care treatment with anti-psychotics? Or is he just expressing a free choice to have frequent rage attacks. Is dev dyspraxia a real brain disorder? If it is, does it not treatment with modern medications as much as epilepsy does?
Discuss why and why not.
Supremacy Claus
Lisa: Luvox is an anti-depressant. It just did not work on this child with conduct disorder (the child equivalent of antisocial personality disorder). He would have done better on anti-psychotics. Forcing Harris to take anti-psychotics would have prevented the Columbine mass murder.
Supremacy Claus
Dale: You are still here.
truthman30
I read your reference and find it offensive. The article implies he is a “spaz.”
Supremacy Claus..
You are a hate filled scumbag..
Why don’t you go and slither back to the nest of vipers which you crawled out of..
Supremacy Claus
Truthman: You are the one that used that offensive characterization.
If developmental dyspraxia exists as a brain disorder, and it is the cause of rage attacks, why do you treat one brain disorder with anti-epileptics, and another valid brain based disorder with neglectful compassion, standing by as your brother suffers repeated, uncomfortable rage attacks for hours at a time?
If you were to refuse to provide his epilepsy medication, would you agree, that is reportable medical neglect? Explain why refusing to treat brain based, developmental dyspraxia caused rage attacks should not be reported as medical neglect?
I do not see much difference between the two brain function disorders. Explain the difference.
#30 Sub Cole Slaw
Good drug? Bad drug? Chemical straight jacket? Suicide Inducing? Strokes? Subdue? Restrain? Profits? Whatever. This is not a debate on the risks or imagined benefits of atypical antipsychotics.
Obviously, this is a simple legal matter - Medicaid rules and federal statutes with multi-millions at stake.
I hope Florida Rep. Hooper gets his simple questions answered. It’s rude that he hasn’t yet.
Thanks for your pharma news blog Mr. Silverman! I see your honest reporting attracts those who want to confuse this matter.
Ed Silverman
Folks,
I would appreciate it if the remarks stick to the topic at hand and avoid unnecessary personal comments directed at others.
Thanks,
ed
truthman30
My apologies Ed..
I shouldn’t have resorted to Mr Supremacy’s inane level ..
Sam
See http://www.psychdrugdangers.com/US/MedicaidPsychDrugPayments.html which lists the 2000-2007 Medicaid Payments for drugs that are not FDA-approved for pediatric use or have limited approval (and includes other tables that list the Medicaid payments that have been made for all psychiatric drugs for all patient ages).
These tables list Medicaid payments for all age groups as no patient age is included in the Center for Medicare & Medicaid Services reports, but the pediatric portion has been estimated at 12% of the total based on other limited State reports where patient age was disclosed.
Also see http://www.psychdrugdangers.com/NotApprovedForPediatricUse.html which gives a complete list of not FDA-approved or limited approval psychiatric drugs that are being given to pediatric patients for which we have been paying with our State and Federal tax dollars where the pediatric patient was under Medicaid or (since 2006) Medicare Part D - $6.9 BILLION dollars during 2000-2007 with but a small portion of that for approved indications.
And while I am not a medical doctor, I’m a database programmer, this is my money they’re spending and I do not accept “off-label” prescribing as a justification where the drug is “not approved for pediatric use” by the FDA - period. Go ahead and experiment if they must, just don’t then ask me to pay for it when the FDA - who usually bends over backwards to please the drug companies - says it’s not approved.
Supremacy Claus
Sam: Experimentation benefits others, by definition.
A treatment that benefits the patient is clinical care. That the use of anti-psychotics is growing is prima facie evidence of their great benefit. That is the ultimate validation, acceptance by patients and by clinicians, and spreading use. That 10’s of 1000’s of doctors, millions of families maintain these prescriptions is proof of an established standard of care, of its effectiveness, and of its growing necessity. Doctors not prescribing them appear to be getting ever farther from the standard of due care.
This is not discretionary. It is the law of the land. In a half dozen decisions, the U.S. Supreme Court has held for the presumptive validity of clinical decision making. The most famous was Roe v Wade, where a state law negating the clinical decision of a patient and her doctor was repealed, as unconstitutional.
As a private party, keep your opinion. As public officials, the witch hunts and the attacks are unlawful. If I were a psychiatrist with grants, or an academic center under scrutiny by that vile Blue Cross running dog, Grassley, or a drug company, I would be in federal court seeking to enjoin these left wing ideologue public officials. If I were a dark skinned Medicaid patient, I might join the legal action against these racist public officials.
Salmon
Boy with all the time Supremacy Claus has to write I wonder who’s paying his salary.
As to increased use being prima fascia evidence that they work. I disagree it’s prima fascia evidence that advertising and bribes/kickbacks work (average ~ $50,000 / yr / psychiatrist). I’m not saying they don’t work at all but they’re incredibly overused and they are an incredible cash cow for pharma.
(Average Wholesale Price for Abilify for disintegrating tablet that kids were taking off label was almost $500/month.)
Plus when you look at the actual numbers use of these drugs in kids is what’s driving nearly all the growth in Pharma income.
Supremacy clause misleads just like Pharma does. Even if we assume his arguments that Mellaril (no longer available?) and Haldol are useful for “irritability” in Autism, the numbers of patients from potentially valid indications doesn’t come close to the numbers they’re actually being used in.
So please spare me. For the vast majority of kids it’s is nothing more than fraud and corruption, and all risk with no benefit to the kids.
truthman30
“So please spare me. For the vast majority of kids it’s is nothing more than fraud and corruption, and all risk with no benefit to the kids.”
Well said Salmon …
Tony Miller
Thank you, Ed Hooper. More inquiries into the irresponsible prescribing practices of psychiatry (and other doctors influenced by them) are sorely needed. Their willingness to put millions of children on extremely dangerous drugs against FDA recommendations is reprehensible. The wild abandon in which they operate make me wonder what financial arrangement could buy such confidence in the face of the preponderance of scientific evidence against them.
A thorough explaining in court will do our society a world of good.
A pit-bull with or without lipstick should do the trick!