By M.C. MOEWE
The Florida Agency for Health Care Administration plans to create a subcommittee to review its guidelines on payments for medications after questions were raised about antipsychotics being prescribed for children in the state's insurance program for the poor.
Medicaid will pay for a drug only if it is "medically necessary and prescribed for medically accepted indications," according to the agency's current guidelines.
The Daytona Beach News-Journal reported earlier this month that the number of Florida Medicaid children prescribed antipsychotics had nearly doubled -- from 9,364 seven years ago to 18,137 in 2006. Among those children, the most common primary diagnosis was attention deficit hyperactivity disorder -- an ailment not approved for treatment with antipsychotics by the Food and Drug Administration.
"The science of pharmacology has seen significant advances and we are revisiting this rule to see if it needs to be updated," said Fernando Senra, press secretary for the agency. "Federal law provides each state with the authority to cover medications that doctors prescribe for off-label purposes."
David Stallard, an assistant attorney general in Utah, said he believes the Federal Medicaid statute is clear that a drug not used for "medically accepted indications" is excluded from coverage if states want matching federal funds.
He has broached the subject with the agency that runs Utah's Medicaid program but has met strong opposition.
"I get the impression that they are under so much pressure from the doctors that they basically cave," Stallard said. "They say 'this is our most vulnerable population and we should protect access.' I turn that around and say this is our most vulnerable population and we should not experiment on them."
Currently, Utah is suing Eli Lilly after preliminary results indicate about a quarter of the state's Medicaid adults taking the antipsychotic Zyprexa developed diabetes, he said.
Florida Agency for Health Care Secretary Dr. Andrew Agwunobi requested creating a work group, under the Medical Care Advisory Committee, that will bring together experts in the field to determine whether changes to our current policies are appropriate, Senra said. The group's findings will be presented to the Pharmaceutical and Therapeutic Committee in March for review and recommendations.
The committee includes physicians, Medicaid recipients, and government department heads, Senra said.
In 2005 the Agency for Health Care paid $3 million for a study on the use of antipsychotics among Medicaid children. The contract with Dr. Robert Constantine with the Medicaid Drug Therapy Management Program for Behavioral Health at the University of South Florida also called for a panel of experts that developed guidelines for prescribing antipsychotics to children.
Agency officials reviewed and accepted those prescribing guidelines, which included the recommendation that antipsychotics should not be used primarily to target ADHD, Constantine said. Nor should antipsychotics be given to children under age 6 except under the most extraordinary circumstances.
That the agency is now looking at updating the guidelines on paying for medications after accepting the new prescribing guidelines seems appropriate, Constantine said.
"For example, they might consider under what circumstances should there be a special prior authorization," Constantine said. "They would really be looking at how their internal policies deal with prescribers."
Constantine's organization also monitors Florida Medicaid doctors prescribing antipsychotics, he said. Those with questionable prescribing patterns are sent letters and sometimes called and asked about the prescriptions they write.
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