ADHD and AAP Drug Safety Standards for Medicaid Children Health and Recovery Services Administration (HRSA) Dr. Jeffrey Thompson, Medical Director Fee-for-Service (FFS) Pharmacy Program
Background • Evidence-based medicine WAC 388-501-0165 defines how to grade and apply evidence to make coverage decisions. • ADHD and AAP drug reviews were performed by evidence-based practice centers OHSU, RAND, and CADIE. • The Mental Health Community experts join with HRSA in examining the studies and recommending ADHD and AAP safety edits for Fee-for-Service (FFS) Medicaid Children. • The Mental Health Drugs Work Group (MHDW) reviews evidence and examines current utilization practices within the Children’s Medicaid FFS population. • The MHDW partners with community experts and HRSA to assess evidence and utilization for appropriate use of ADHD and AAP drugs for children.
Some key Questions When Making Coverage and Safety Decisions • What is the quality of the research justifying the request? • What is the estimation of harm if the treatment was to occur? • What is the equally effective lower cost alternative? • Is there a vulnerable population that perhaps requires higher levels of evidence? • or IRB approval/informed consent?
Community ADHD Drug Prescribing Practices for Medicaid FFS Children Age 17 and under FY2005
Mental Health Drug Work Group Agrees on Safety Edits for ADHD and AAP • For endorsing and non-endorsing providers • Age limits • Dose limits • Combination limits • Sedatives • Second Opinion opportunities • For non-endorsing providers • Tried and failed two preferred, or • Some documentation of intolerance to starting with a preferred drug
Outcomes What are the Objectives • Improve Mental Health Therapy • Define Mental Health Therapies • Measure Mental Health Therapy by Reviewing: • Number of Rx’s • Assessments • Cognitive behavior • Poly-pharmacy • Poly-prescriber’s • Adherence • Coordination of care