Florida Medicaid, Antipsychotics And Small Children
33 CommentsBy Ed Silverman // December 17th, 2008 // 12:36 pm
At a time when growing use of atypical antipyschotics in children is under a microscope, Florida’s Medicaid program recently revised rules that makes it possible for doctors to write prescriptions for children of all ages - including those younger than six years old.
Most of these drugs can lead to weight gain and diabetes, and one prominent study found they were no more effective than older meds. Yet the drugs are increasingly prescribed for children, with Medicaid programs in several states reporting rising expenditures for antipsychotics, sometimes to treat ADD or ADHD, which are unapproved uses (look here and here).
In general, the atypical antipsychotics - a newer class that includes AstraZeneca’s Seroquel; Bristol-Myers Squibb’s Abilify; Pfizer’s Geodon; Lilly’s Zyprexa and Johnson & Johnson’s Risperdal - were not approved by the FDA to treat small children, or those younger than 10 years old. Risperdal has been approved for children older than 5 years of age, but only for those with autistic disorder. To be eligible for Medicaid reimbursement, a drug has to be used for a medically accepted indication, which means the drug has to be approved for a specific use or supported by specific compendia (this link indicates the three compendia do not list any use of the atypicals in children younger than 5 years old).
In Florida, meanwhile, the number of children in the state Medicaid program prescribed the drugs nearly doubled between 2000 and 2006 (and the most common diagnosis was ADHD). Such trends recently prompted an FDA advisory panel to chastise the agency for not doing more to discourage such prescribing (back story) and a group of state Medicaid directors to evaluate the use of the drugs in children on state Medicaid rolls to ensure that they are being properly prescribed (look here).
Despite such concerns, the state’s Agency for HealthCare Administration last month made good on earlier promises and modified a rule that now makes it possible for doctors to prescribe the meds to children of any age - if doctors obtain prior authorization. Here is the rule:
“To be reimbursed by Medicaid, a drug must be medically necessary and either (a) prescribed for medically accepted indications and dosages found in the drug labeling or drug compendia in accordance with Section 1927(k)(6) of the Social Security Act, or (b) prior authorized by a qualified clinical specialist approved by the Agency.” [The language about prior authorization is new].
In an e-mail to a source, Mary Elizabeth Jones, a senior pharmacist with the AHCA’s Medicaid Pharmacy Services, wrote this explanation: “Physicians sometimes prescribe medications for special populations that are not included in the official FDA approved indications. This is a decision made between the prescribing physician, the patient and the parent or guardian. AHCA reimburses for medications on the Florida Preferred Drug List (PDL) that are prescribed by qualified, licensed professionals.
“The prior authorization process is activated when a physician prescribes a medication that is not found on the PDL or is prior authorized for a special population. The prior authorization requirement for atypical anti-psychotics in children under the age of 6 years is an example of prior authorization for a special population.
“The AHCA initiated this process to allow review of the request by a qualified clinical specialist prior to approval or denial of medication reimbursement. Clinical review processes help promote safe prescribing practices and help ensure non-medication therapies are applied prior to or along with medication therapies. The reimbursement of antipsychotic medications by Florida Medicaid for children is appropriate and is supported by Medicaid Reimbursement Rules.”
Not every state allows prescribing to small children. In California, for instance, the state Department of Health Care Services’ Medi-Cal has restrictions that prohibit reimbursement for antipsychotics prescribed to children younger than six years old (please see this link and look up the chemical name for each drug; Risperdal, for example, can be seen by searching for Risperidone).
Florida’s AHCA was supposed to hold a meeting on Friday to review its rule change, but that has been cancelled. Anne Wells, the Medicaid Pharmacy Services bureau chief, wrote us this explanation: “It has been determined by the Agency for Health Care Administration that sufficient information has been received to prepare a final report. The previously held public meeting on June 25, 2008 and written comments mailed to the AHCA for a period of one week following the meeting provided opportunity for input from all the stakeholders.
The AHCA has requested a ‘Review of the Topic’ to be prepared by a group of Child and Adolescent psychiatrists who participated in the development of the Florida Best Practice Guidelines for the use of psychotherapeutic medications in children. Some of these group members performed the atypical antipsychotic prior authorization reviews required by the Agency for Health Care Administration for children under the age of 6 years.”
“When this summary report has been completed it will be provided to the Ad Hoc group members for review. The report is expected to be completed before the end of the year.”
UPDATE: At the June meeting of the AHCF panel, Jerome Isaac, an ad-hoc member who also belongs to the Florida Pediatric Society, had this to say: “I think we can all agree that the data on the proper use of these medications in young children is not there. So any recommendations that we make would not be based on any medical science or any facts. We’d all be flying by the seat of our pants.”
You can watch an excerpt of the meeting here…
Dan A.
I understand that the efficacy is the same with atypicals and previous anti-psychotics- yet the adverse events are worse with this newer class, such as obesity, diabetes, and dementia in the elderly, to name a few. And I also heard that of the atypicals, Zyprexia and Clozaril (the first atypical made by Sandoz, which is now Novartis)are the worst regarding adverse events:
http://en.wikipedia.org/wiki/Atypical_antipsychotic
Perry
Disgusting.
While other states are suing the antipsychotic makers, over 50% of Florida Medicaid dollars for antipsychotics are prescribed for “ADHD”!
Sickening.
Florida should be ashamed.
Doyle
The pharmaceutical companies have turned our nation’s beautiful children into profit centers, while blunting their future potential. This has to stop - Now!
Moreover, the money spent on these drugs of dubious benefit, high price and high profit is money that cannot be used in other ways to truly benefit these children.
Susie
Florida seems to have a vested interest in the drugging of our children. Otherwise, why would they be doing everything they can to open the floodgates for more drugging, with drugs not approved for children, by the FDA?
Floridians should look for what or who those vested interests may be. At a time when State expenditures should be reduced, wouldn’t you think the first place we could reduce expenses is on the unscientific, harmful and life-threatening practice of drugging innocent children!
Jeffery Mayer
Good for California!
At least one state has its Medicaid head screwed on right.
Salmon
Medicaid also pays based on AWP (average wholesale cost). There really is no longer an average wholesale cost as there are only a few wholesalers left, and AWP is really not much more than a number the drug companies give them.
Even so for some of the pediatric antipsychotic dosage forms (Abilify orally disintegrating tablets) the AWP is in the $400 - $500 per month range per patient. In comparison most drugs are more like $200 per month, and even psych drugs in adult dosage forms (regular tablets) are like $250 - $300 per month. This is one reason these drugs are so profitable especially when prescribed to children.
In fact for BMS (Abilify) most it’s sales growth this decade was due to price increases and then prescribing Abilify for pediatric use.
Salmon
Sandy W.
Mary Elizabeth Jones, senior pharmacist should just be forthright, such as:
AHCA reimburses for practically any drug prescribed, regardless of FDA approval and regardless of science.
Pat Luefan
The druging of children is disgusting and unconscionable. These medications are already wreaking havoc with our society and the pharmacological industry just press on and on.
You know if you are waiting for the sheep to revolt you are going to be waiting a long, long time. How can they when they are already under the thumb of the man.
June
It seems quite obvious that there are several groups (Pharacists, drug companies, doctors - in the mental health field, and perhaps the parents or guardians of these children) that are looking out for how they can benefit from this and not for the well-being of the children.
We all need to do whatever we can do to get the attention of our state (Florida)and national “leaders” to do something about this.
Otherwise those who are responsible for this drugging of our children (most important) and money spent on these programs will continue.
Paul Hoban
Does Florida use the Initiative process, where the citizens can place proposals and new laws on the ballot?
If so, how about a grassroots-generated initiave that would make the improper drugging of children punishable by law, the charge being “battery”? In CA, for instance, there’s a “patient’s bill of rights” wherein a patient can refuse treatment and, if it’s forced upon him/her, he/she can bring charges of battery against the medical people that force it.
Just an idea.
Evelyn Pringle
It just so happens that I a working on an article right now which focuses on the child drugging in the US.
A few days ago I went and gathered pricing data on the various psych drugs from DrugStore.com and below is what I found on atypicals. Because I do not know about doses and the number of pills a person must take a day I used middle doses and the deal they had for roughly 3 a day.
Atypical Antipsychotics
Abilify 15mg 90 tablets $1241.35
Geodon 60mg 100 capsules $725.34
Risperdal 2mg 90 tablets $652.07
Seroquel 100mg 100 tablets $388.38
Zyprexa 10mg 90 tablets $1138.22
Cheers,
Evelyn Pringe
Joanne Cali
What began as an honorable attempt to bring the highly questionable practice of heavily drugging children, especially those on medicaid (hmmm - what a coincidence!!), for such “bad” behaviors as not paying attention in school, or being too active, or not understanding school subjects - has now wound up being “sold” on the whole drug philosophy.
We tell children “say No to drugs” - and then force them down their throats, labelling them crazy to boot. Children are being attacked, plain and simple, by drug companies. WHY? Because they cannot fight back. This is a sure-thing profit market. ESPECIALLY those under foster “care”. I think the more they are drugged, the less care they have or seem to need. What a lazy way to ruin kids - and spend our tax dollars! Why lazy? Because WE are bringing kids up. If they react or act unhappy or agitated or angry - then we should help them by changing our techniques, or changing their diet, or loving them more. Instead, the State is blaming the kids themselves, saying they’re disordered, and useing anti-PSYCHOTICS on them. Since when are anti-psychotics the right fix for wandering attention?? The next time I reach for chocolate (ie wander off my diet), I think I’ll chop off my hand. That would be just the right fix, wouldn’t it?!
Salmon
Evelyn,
Most are either once or twice a day. You can look up the labeling with dosage etc. on Drugs@FDA.gov. It doesn’t always have the latest labeling but if you google the drug names and go to the company’s websites for the drugs you can usually find the labeling under the professional information section. However you really have to look for it usually.
Go into any pharmacy, hospitabl pharmacy, health science library, or hospital pharmacy and ask to take a look at the REDBOOK from Drug Topics. It will give you the AWP. Medicaid pays based on AWP. You should find out the formula from any pharmacy.
For the amount of US sales you can also google Drug Topic’ss top 200 retail and hospital drugs by sales and by year.
Salmon
Sam
Evelyn,
See http://www.psychdrugdangers.com/US/MedicaidPayments.html which lists the total Medicaid Payments for psychiatric drugs that are (currently) not approved (or have very limited approval) for pediatric use (children under 18) by the FDA. The source is the Center for Medicare & Medicaid Services. They do not give a breakdown by patient age, just totals by drug, by State, by year. I have detailed pediatric Medicaid payment tables for a couple States and from those I came up with a ballpark 12% average pediatric portion of the total Medicaid payouts.
All of this is funded by our tax dollars. Even if you are living in California, you’re paying for 1/2 of Florida’s Medicaid expenditures.
Sam
Janet Stein
Drugging children is not the answer. It makes them lifelong “clients” of the pharmaceutical industry and psychiatry. Some of these children will die, and others be permanently disabled, by having these drugs pushed on them as a solution.
Sandy W.
This article says that Anne Wells, the Medicaid Pharmacy Services bureau chief, wrote: “It has been determined by the Agency for Health Care Administration that sufficient information has been received to prepare a final report.”
“Sufficient information” means AHCA has already decided what they are going to do and and to hell with science!
This is what one of the panel members said at the meeting held on June 25:
Dr. Jerome Isaac: “I think we can all agree that the data on the proper use of these medications in young children is not there. So any recommendations that we make would not be based on any medical science or any facts. We’d all be flying by the seat of our pants.”
You can hear him at the end of this video:
http://www.youtube.com/watch?v=-HxQujRftGo
Ann Wells is on the left. Mary Elizabeth Jones is on the right. Both are mentioned in this article.
Dr. Gail Allen
I can’t believe that there are people out there who are chemically decerebrating the only future that really matters, our children. The psychs have no idea what the repercussions of these medications are. I am old enough to remember what a,” miracle drug”, the medical community thought Thalidemide was. I don’t have any further faith in the Food and Drug Administration. I am heart-broken that the children are being given these poisonous and character-changing pills. For all I am able to see, any company can put cyanide on the market. The Food and Drug Administration hierarchy should have to take these medications before they poison the public.
anon
Here’s an idea- stop brain damaging the kids with vaccines and they won’t need the drugs.
Santa Claus
This goes beyond the almighty dollar and evidences pure evil. You don’t destroy a civilization by accident. It takes hard work. It requires the best marketing and a mission run and executed by the criminally insane. Ref: “A synthesis of the Russian textbook on Psychopolitics”
Pyrrho
CATIE reviewed newer and older drugs for Schizophrenia only, in adults. It was a flawed study and is impossible to extrapolate for kids.
I agree that atypicals are overprescribed for children but don’t wish typical antipsychotics on them.
Jim Moore
This has probably been mentioned already but these drugs suppress symptoms at best. that’s where the usefulness ends. After that the list of side effects that prove the toxicity of the drugs is literally overwhelming.
The atypicals were the new replacement for the old typical antipsychotics. As usual the truth is far from the hype. Lots of money has been made and yet the harm is just as bad though different.
How about lets figure out a non-drug solution? How about not harming someone and calling it help. Why not do nothing if you really don’t know what to do and at least not make it worse. Wait, there’s no money in it. Nevermind.
Rena Goodrich
Stop poisoning our children in the name of helping them!
Rena
Marc F
This is sick and it’s criminal. These drugs are NOT a solution to anything but making money for the schools, the drug makers, the psychiatrists. Stop drugging our future leaders.
LIsa
I heard that if a parent on FL Medicaid has an ADHD child , the parent gets a bigger check.
So the parent puts all their kids on drugs (or just fill the presciptions).
Can someone me if this true?
Wow
Wow, I went away for a couple months. Thought I would try it again and see if it has gotten any better. I was afraid I would have to search far and wide for an article regarding kids and psych drugs. Lucky for me they are still in abundance!!
Yeah, f’ the vaccines too. And physicals.
It's not ADHD
The problem is the Doctors not the drug companies…First and foremost no drug company has the ability to RX a drug of any kind…the MDs/NPs/PAs are the ones RXing the meds….Second Doctors tend to use what works…the atypicals work much better than the typicals and have FAR less side effects…and last the kids do not have ADHD, they are Bipolar…the Doctor list ADHD as the reason for the drug because 1) it tends to fit the symptoms 2) pts ‘understand’ ADHD 3) Pts and MDs are scared of a BP label 4) Most MDs that are treating kids have ZERO training in mental health and could not make a clinical differentiation between BP and ADHD even if they had a gun to there head.
And for those of you that don’t understand the science or reasons why the MDs use atypicals….would you rather have your child on Amphetamines (think Meth)???
Bottom Line. Forget the label (ADHD, BP), does the drug help the child function better??
Parents
Wow..tons of comments and not one has blamed the parents….come on isn’t this the parents fault…they dump there kids off at day care at 6am and pick them up at 6pm, grab MicyDs on the way home and then sit there over sized rears on the sofa to watch American Idol while the kids play video games or surf porn….doesn’t anybody think about personal responsibility…they cant make you take meds for ADHD
Ola Cooney
My granddaughter (11) has been diagnosed with ADD/ADHD. She despartely needs her meds, without them she cannot function. Before she was diagnosed she not only was a whirling dervish, but destructive, harmful both to herself and others, with no ability to sit still or focus on anyting for no more than a minute. She has also been diagnosed with being slightly autistic. She was put on abilify when she was 6yrs old with disastarous results. Despite a family history of diabetes and her uncle dying at the age of 20 from heart disease, she was still prescribed it. The abilify left her with 60lb weight gain within a 1 month period, with no change in her eating habits, pre-diabetic, and a heart murmmur. She was taken off the drug 4 months later. Her current pyschiatrist is livid that the drug was prescribed to her with the previous psychiatrist knowing her family history. Alas, there is no recourse for her because she was prescribed the drug while on the medicaid program. She is currently within the weight range for age and is still losing weight. It took a long time to get her weight under control, not because of her eating habits, (she is a vegetarian), but because the weight was a side effect of the medication. She has had to put up with the taunting of both kids and grown-ups, because of her weight gain. She has problems with socializing and trust; partially because of the emotional issues dealing with weight gain. Please if let the public aware of the side effects these drugs do to our kids.
Katy
It is overwhelming and awful that we are allowing the use of such drugs on children, especially young ones. As adults, and parents, our children trust us to help them. By drugging them, We consign these children to mind altering dependency, for how long? Our children are the future of our society and civilization.
With drugs we are not truly helping them. Drugs may cover current symptoms, but what do they SOLVE? Drugs are truly a dead end, and drugs kill, slowly or quickly.
The use of psychotropic drugs makes a lot of people and companies a LOT of money. Did we have such volume of these kinds of problems with children 50, 100, 150 years ago? NO! So what’s changed? Diet, food production, sugar, dyes, preservatives in food, lack of exercise, television, computers, video games the list goes on. So why aren’t doctors, and other health care givers, looking for OTHER solutions, simpler solutions to behavior problems in children such as diet, allergies, etc? Our children are the future, and we, as well as they, deserve better help from our supposed experts than this.
libertas falsus
You see, the idea is to take down America so that the goal of a one world government can be achieved, but before this can happen, there can’t be an America as we know it to be, because Americans as they are now wouldn’t allow it. What better way to take down a nation and bend it to your will than to pretty much chemically lobotomize the next generation. What many people don’t know is that many, if not all antidepressants and anti psychotic meds have high amounts of fluoride in them which not only is proven to take away motivation and make the person more manageable and docile, but can effectively reduce the IQ by up to about twenty points depending on dosage and duration and how early in the brains development the attack is begun. Research it. If you haven’t already figured it out, its all by design. Although profit is a bonus, it isn’t the main objective. If you have trouble finding leads on what I’m telling you, I’ll send you all kinds of info that is nearly beyond belief. I’m still in awe of this and other things that have been going on for generations. I’m not a fool or one of those tin foil hat wearing conspiracy theorist idiots. I’ve done hours upon hours of research and compared information from many different sources and historical references and it all checks out. Let me know what you think. I’m not easily offended in the least bit, so please pull no punches if you disagree, but try to stay civil as I am not one to hurl insults simply because I disagree with someone. I’m always open to any and all information and ideas, not that I accept it all, but please share what you think honestly. I would love to be wrong, but its very unlikely. I appreciate the way you have so passionately pursued the issue of drugging children. I only hope that the right people are alerted before much more damage is done.
November
She says it appropriate. Do you guys believe her. She is not even licensed to practice in the state of Florida nor her Cheif of Psychiatry, Dr. Ravij Tandon. They are a bunch of quacks, imposing on the minds of little children. May God curse them till their death. They put together a panel of doctors, all are probably receiving kickbacks from the drugging industry but the only way you are going to find out is by subpoenaed their financials like they did in congress. Then you will see these doctors don’t give a hoot about the health of your children. It’s all about how many kickbacks the state receives in psychiatric drugging, doctors get huge bonuses for prescribing and schools get huge bonuses when you vaccinate your kids with poisonus vaccines and if you really knew what was in those vaccinations you would “never” give it to your kids.
Grant
Disgusting…just when you thought having an adult zombie nation was bad enough, now FL is allowing us to have baby zombies. Seriously, that’s what this is.
Jo
This has been going on in the state of Alabama for at LEAST 10 years that I am personally aware of - I had a stepchild that took all of the above since around the age of 6 (he is 17 now) and Medicaid paid for it……