High-Expenditure Pharmaceutical Use Among Children in Medicaid

Cohen, Eyal; Hall, Matt; Lopert, Ruth; Bruen, Brian; Chamberlain, Lisa; Bardach, Naomi S.; Gedney, Jennifer; Zima, Bonnie T.; Berry, Jay G.

doi:10.1542/peds.2017-1095

Cited by 20 publications

(18 citation statements)

References 22 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…These findings are consistent with previous research that revealed that 10 medication classes account for more than half of yearly Medicaid spending, with stimulant and antipsychotic prescriptions accounting for the highest aggregate expenditures. 15 Our results also align by revealing that when medications are dispensed frequently, the aggregate expense is used to approximate the most expensive medications (eg, coagulation and anticoagulation factors); however, the comparative per-administration cost is considerably lower.…”

Section: Health Care Use By Expenditure Categorysupporting

confidence: 71%

Medicaid Expenditures Among Children With Noncomplex Chronic Diseases

et al. 2018

Self Cite

View full text Add to dashboard Cite

BACKGROUND AND OBJECTIVES: Expenditures for children with noncomplex chronic diseases (NC-CDs) are related to disease chronicity and resource use. The degree to which specific conditions contribute to high health care expenditures among children with NC-CDs is unknown. We sought to describe patient characteristics, expenditures, and use patterns of children with NC-CDs with the lowest (≤80th percentile), moderate (81-95th percentile), high (96-99th percentile), and the highest (≥99th percentile) expenditures. METHODS: In this retrospective cross-sectional study, we used the 2014 Truven Medicaid MarketScan Database for claims from 11 states. We included continuously enrolled children (age <18 years) with NC-CDs (n = 1 563 233). We describe per member per year (PMPY) spending and use by each expenditure group for inpatient services, outpatient services, and the pharmacy for physical and mental health conditions. K-means clustering was used to identify expenditure types for the highest expenditure group.

show abstract

Section: Health Care Use By Expenditure Categorysupporting

confidence: 71%

Medicaid Expenditures Among Children With Noncomplex Chronic Diseases

et al. 2018

Self Cite

View full text Add to dashboard Cite

show abstract

“…Even prior to the approval of the newest high-cost medicines, a small group of medicines accounted for the majority of pediatric medicine expenditures. 12 Recognition of the ethical challenges has prompted institutional and professional society discussions about use and prescribing practices. [13][14][15] Our efforts highlight an innovative approach for decisionmaking with the advent of novel, complex, and highly expensive therapeutics in pediatric neurology.…”

Section: Discussionmentioning

confidence: 99%

Development, Implementation, and Use of a Neurology Therapeutics Committee

Clark

Butterfield

Filloux

et al. 2019

Child Neurology Open

View full text Add to dashboard Cite

Innovative therapeutics are transforming care of children with previously untreatable neurological disorders. However, there are challenges in the use of new therapies: the medicine may not be effective in all patients, administration may not be tolerated, and matching therapy choice to patient is complex. Finally, costs are high, which imposes financial burdens on insurance companies, families, and the health-care system. Our objective was to address challenges for clinical implementation of the new therapeutics. We sought to develop a process that would be personalized for patient and disease, encourage appropriate use of a therapeutic agent while mitigating pressure on a clinician to prescribe the therapy in all instances, and assist third-party payers in approving therapeutic use based on safety and efficacy. We report our creation of a Neurology Therapeutics Committee for pediatric patients. We review the committee's mechanisms, describe its use and report outcomes, and suggest the Neurology Therapeutics Committee's broader applicability.

show abstract

“…It would be advantageous to anchor these actions within local health policies. Of note, these systemic efforts are in line with health authorities and insurers' interest of cost-containment as *30% of pediatric pharmaceutical expenditure is attributed to antipsychotic medications (Cohen et al 2017) as well as excess health care utilization among antipsychotic-treated youth (Sikirica et al 2012).…”

Section: Interpretation Of Main Findings In the Context Of Available mentioning

confidence: 86%

Interventions to Improve Metabolic Risk Screening Among Children and Adolescents on Antipsychotic Medication: A Systematic Review

Melamed

LaChance

O’Neill

et al. 2021

Journal of Child and Adolescent Psychopharmacology

View full text Add to dashboard Cite

Objective: Antipsychotic use among youth is common and is associated with metabolic side effects such as weight gain. Guidelines recommend periodic screening of metabolic measures in youth prescribed antipsychotics; however, a guidelineto-practice gap exists. We systematically reviewed the literature to synthesize the knowledge from interventions that aim to improve antipsychotic metabolic screening. We described the interventions' effect on screening rates, the strategies used for improvement, and study quality. Methods: We conducted a systematic review of studies that attempted to improve antipsychotic metabolic risk screening practices among pediatric populations published between 2004 and August 2019. We included studies with an improvement intervention that compared screening rates before and after the intervention. We extracted data about study characteristics, screening rates in pre-and postintervention groups, strategies used to influence screening practices, and assessed studies' risk of bias. This review was prospectively registered with PROSPERO #CRD42018088241. Results: We identified six studies that demonstrated modest improvements in median metabolic screening rates for waist circumference (0%-16%), glucose (9%-39%), and lipids (11%-37%). Median postintervention screening rates were higher for weight and blood pressure (84% and 72.5%) compared with glucose and lipids (39% and 37%). Interventions used a variety of improvement strategies to address patient-, provider-, and organization-level barriers for screening, including increasing patient and provider knowledge regarding antipsychotic side effects, fostering social clinical environments that promote screening, and organizational commitment for screening antipsychotic-treated youth. All interventions were deemed at high risk of bias due to uncontrolled design and lack of adjustment for confounders. Conclusions: Included studies reported partial success in improving antipsychotic screening rates but were of poor methodological quality. Common improvement strategies may affect provider behavior to conduct metabolic screening, but these need to be tailored to local resources and organization structure. Future studies need to use rigorous methodology and theoryinformed improvement strategies aligned with organizational actions to prioritize safe and judicious practice of antipsychotics among pediatric populations.

show abstract

High-Expenditure Pharmaceutical Use Among Children in Medicaid

Cited by 20 publications

References 22 publications

Medicaid Expenditures Among Children With Noncomplex Chronic Diseases

Medicaid Expenditures Among Children With Noncomplex Chronic Diseases

Development, Implementation, and Use of a Neurology Therapeutics Committee

Interventions to Improve Metabolic Risk Screening Among Children and Adolescents on Antipsychotic Medication: A Systematic Review

Contact Info

Product

Resources

About