Arkansas Medicaid Antipsychotic Utilization in Children

Arkansas Children’s Behavioral Health Care Commission

AR DHS Division of Medical Services Pharmacy ProgramLaurence H. Miller, M.D., Senior Psychiatrist

Pamela Ford, P.D., MBASuzette Bridges, P.D., Pharmacy DirectorStacy Simpson, M.D., Child Psychiatrist

January 16, 2014

EDITS ON PSYCHOTROPIC MEDICATIONS

Outcomes from Antipsychotic Edits NON-FOSTER Children < 6 yrs of age Changes in Antipsychotic Utilization

May-11

Jun-11Jul-1

1

Aug-11

Sep-11

Oct-11

Nov-11

Dec-11Jan

-12

Feb-12

Mar-12

Apr-12

May-12

Jun-12Jul-1

2

Aug-12

Sep-12

Oct-12

Nov-12

Dec-12Jan

-13

Feb-13

Mar-13

Apr-13

May-13

Jun-13Jul-1

3

Aug-13

Sep-13

Oct-13

Nov-13

0

50

100

150

200

250

# children < 6 yoa on antipsychotic

# children < 6 yoa on C-II Stim.+ antipsychotic

# children < 6 yoa on both C-II Stim + AP with behavioral therapy his-tory in prior 6 months

# children < 6 yoa on both Strat-tera + Antipsychotic

# children < 6 yoa on both Strat-tera + Antipsychotic with behav-ioral therapy history in prior 6 months

Existing TD cri-teria & dose ed-its remained in

effect

Aug 31, 2011:Informed consent & lab Memo mailed

Nov 2011: New Starts Informed Consent & Labs implemented

June 2012: Incorporated established pts for Metabolic Labs q6mo

Jan 23, 2013: Letter mailed to providers regarding use of C-II stim. + antipsychotic combination

May-11Jul-11

Sep-11Nov-11

Jan-12Mar-1

2May-12

Jul-12Sep-12

Nov-12Jan-13

Mar-13

May-13Jul-13

Sep-13Nov-13

0

500

1,000

1,500

2,000

2,500

3,000

3,500

# children 6-12 yoa on Antipsychotic

# children 6-12 yoa on C-II Stim.+ an-tipsychotic

# children 6-12 yoa on both C-II Stim + Antipsychotic with behavioral therapy history in prior 6 months

# children 6-12 yoa on both Strattera + Antipsychotic

# children 6-12 yoa on both Strattera + Antipsychotic with behavioral therapy history in prior 6 months

Aug 31, 2011:Informed consent & lab Memo mailed

Nov 2011: New Starts Informed Consent & Labs implemented

June 2012: Incorporated established pts for Metabolic Labs q6mo

Jan 23, 2013: Letter mailed to providers regarding use of C-II stim. + antipsychotic combination

Existing TD cri-teria & dose

edits remained in effect

Outcomes from Antipsychotic Edits NON-FOSTER Children 6-12 yrs of age Changes in Antipsychotic Utilization

Outcomes from Antipsychotic Edits NON-FOSTER Children 13-17 yrs of age Changes in Antipsychotic Utilization

May-11

Jun-11Jul-1

1

Aug-11

Sep-11

Oct-11

Nov-11

Dec-11Jan

-12

Feb-12

Mar-12

Apr-12

May-12

Jun-12Jul-1

2

Aug-12

Sep-12

Oct-12

Nov-12

Dec-12Jan

-13

Feb-13

Mar-13

Apr-13

May-13

Jun-13Jul-1

3

Aug-13

Sep-13

Oct-13

Nov-13

0

500

1,000

1,500

2,000

2,500

# children 13-17 yoa on An-tipsychotic

# children 13-17 yoa on C-II Stim.+ antipsychotic

# children 13-17 yoa on both C-II Stim + Antipsychotic with behav-ioral therapy history in prior 6 months

# children 13-17 yoa on both Strattera + Antipsychotic

# children 13-17 yoa on both Strattera + Antipsychotic with behavioral therapy history in prior 6 months

Existing TD cri-teria & dose

edits remained in effect

Aug 31, 2011:Informed consent & lab Memo mailed

Nov 2011: New Starts Informed Consent & Labs implemented

June 2012: Incorporated established pts for Metabolic Labs q6mo

Jan 23, 2013: Letter mailed to providers regarding use of C-II stim. + antipsychotic combination

Outcomes from Antipsychotic EditsFOSTER CARE Children >6 yrs of age Changes in Antipsychotic Utilization

May-11

Jun-11Jul-1

1

Aug-11

Sep-11

Oct-11

Nov-11

Dec-11Jan

-12

Feb-12

Mar-12

Apr-12

May-12

Jun-12Jul-1

2

Aug-12

Sep-12

Oct-12

Nov-12

Dec-12Jan

-13

Feb-13

Mar-13

Apr-13

May-13

Jun-13Jul-1

3

Aug-13

Sep-13

Oct-13

Nov-13

0

5

10

15

20

25

# FOSTER children <6 YOA on Antipsychotic

# FOSTER children <6 YOA on C-II Stim.+ antipsychotic

# FOSTER children <6 YOA on both C-II Stim + Antipsychotic with behavioral therapy history in prior 6 months

# FOSTER children <6 YOA on both Strattera + Antipsychotic

# FOSTER children <6 YOA on both Strattera + Antipsychotic with behavioral therapy history in prior 6 months

Aug 31, 2011:Informed consent & lab Memo mailed

Nov 2011: New Starts Informed Consent & Labs implemented

June 2012: Incorporated established pts for Metabolic Labs q6mo

Jan 23, 2013: Letter mailed to providers regarding use of C-II stim. + antipsychotic combination

Existing TD criteria & dose edits remained

in effect

Outcomes from Antipsychotic EditsFOSTER CARE Children 6-12 yrs of age Changes in Antipsychotic Utilization

May-11

Jun-11Jul-1

1

Aug-11

Sep-11

Oct-11

Nov-11

Dec-11Jan

-12

Feb-12

Mar-12

Apr-12

May-12

Jun-12Jul-1

2

Aug-12

Sep-12

Oct-12

Nov-12

Dec-12Jan

-13

Feb-13

Mar-13

Apr-13

May-13

Jun-13Jul-1

3

Aug-13

Sep-13

Oct-13

Nov-13

0

50

100

150

200

250

300

# FOSTER children 6-12 YOA on Antipsychotic

# FOSTER children 6-12 YOA on C-II Stim.+ antipsychotic

# FOSTER children 6-12 YOA on both C-II Stim + Antipsychotic with behavioral therapy history in prior 6 months

# FOSTER children 6-12 YOA on both Strattera + Antipsychotic

# FOSTER children 6-12 YOA on both Strattera + Antipsychotic with behavioral therapy history in prior 6 months

Aug 31, 2011:Informed con-sent & lab Memo mailed

Jan 23, 2013: Letter mailed to providers regarding use of C-II stim. + antipsychotic com-bination

Existing TD criteria & dose edits remained

in effect

Nov 2011: New Starts Informed Consent & Labs implemented

June 2012: Incorporated established pts for Metabolic Labs q6mo

Outcomes from Antipsychotic EditsFOSTER CARE Children 6-12 yrs of age Changes in Antipsychotic Utilization

May-11

Jun-11Jul-1

1

Aug-11

Sep-11

Oct-11

Nov-11

Dec-11Jan

-12

Feb-12

Mar-12

Apr-12

May-12

Jun-12Jul-1

2

Aug-12

Sep-12

Oct-12

Nov-12

Dec-12Jan

-13

Feb-13

Mar-13

Apr-13

May-13

Jun-13Jul-1

3

Aug-13

Sep-13

Oct-13

Nov-13

0

50

100

150

200

250

300

# FOSTER children 13-17 YOA on Antipsychotic

# FOSTER children 13-17 YOA on C-II Stim.+ antipsychotic

# FOSTER children 13-17 YOA on both C-II Stim + Antipsychotic with behavioral therapy history in prior 6 months

# FOSTER children 13-17 YOA on both Strattera + Antipsychotic

# FOSTER children 13-17 YOA on both Strattera + Antipsychotic with behavioral therapy history in prior 6 months

Existing TD criteria & dose edits remained

in effect

Aug 31, 2011:Informed consent & lab Memo mailed

Nov 2011: New Starts Informed Consent & Labs implemented

June 2012: Incorporated established pts for Metabolic Labs q6mo

Jan 23, 2013: Letter mailed to providers regarding use of C-II stim. + antipsychotic combination

Impact in Antipsychotic Utilization as a Percent Changer for Each Group

Comparing antipsychotic utilization from 4Q8 (no edits in

effect) to most current 3 months (Sept., Oct., Nov. of 2013):

Age GroupFoster Care

ChildrenNon-Foster Care

Children<6 YRS -86.02% -92.69%

6-12 YRS -38.80% -49.35%13-17 YRS -17.54% -31.23%