Friday, March 21, 2008

Medicaid reviews drug spending on mental health

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Minot Daily News (North Dakota)

March 21, 2008

North Dakota’s Medicaid program has begun a two-year study of a class of medicines that has raised concerns in several other states.

However, the state’s review of prescribing patterns for atypical anti-psychotics is focused on the high cost of the medicines rather than the prescription controversies that exist elsewhere.

Ten state Medicaid programs, including one in Montana, have filed lawsuits against drug maker Eli Lilly, alleging the company illegally promoted Zyprexa, an atypical anti-psychotic. The first case went to trial in Alaska this month.

Eli Lilly has been under federal investigation since 2004 for its methods of marketing Zyprexa to doctors for treating mild bipolar disorder and dementia in elderly patients. Use in elderly patients has been linked to deaths.

Brendan Joyce, pharmacist with North Dakota Medicaid, said attorneys in a class action case have notified the state that some North Dakota patients are included in a lawsuit against Eli Lilly. Should defendants win an award, the Medicaid program would share a portion as reimbursement of its prescription costs.

Atypical anti-psychotic prescriptions in Medicaid dropped by about 66 percent after Medicare introduced a drug plan in 2006. Only 24 Medicaid patients aged 65 or older were prescribed Zyprexa in the year that ended June 30, 2007.

There are seven drugs in the class called atypical anti-psychotics, which emerged in the 1990s to replace the older, typical anti-psychotics. Diseases most commonly treated with the drugs are schizophrenia and bipolar disorder.

Medicaid officials in some other states have questioned the off-label prescription of these drugs because of possible serious side effects, such as weight gain, diabetes and movement disorders. Off-label refers to treating conditions or classes of patients without the U.S. Food and Drug Administration’s explicit approval.

Like a number of other drugs where studies in children are lacking, anti-psychotics are used in children even though the FDA hasn’t specifically approved the drugs in patients younger than 18.

A Medicaid review in Florida last year found 18,000 children on Medicaid received anti-psychotic drugs. What disturbed regulators was the study found 40 percent of prescriptions were for children whose primary diagnosis was attention deficit/hyperactivity disorder.

Joyce said North Dakota Medicaid doesn’t track the diagnoses associated with the prescriptions it fills.

State statistics show 22 Medicaid patients aged 5 or younger and 721 patients aged 11to 20 received anti-psychotics in the year that ended June 30, 2007.

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