State may limit paying for some kids’ drugs

Jun 26, 2008

The state’s healthcare agency is considering limiting payments for strong drugs prescribed to young children for illnesses such as autism and bipolar disorder.

Miami Herald--June 26, 2008

Florida’s massive healthcare agency may cut back on paying for powerful drugs now prescribed for young children, although a final decision could be weeks or months away.

Since late April, the Agency for Health Care Administration has required doctors to obtain permission before the state’s Medicaid program will pay for drugs prescribed to children under the age of six for autism, bipolar disorder or attention deficit hyperactivity disorder. Any new prescriptions must be evaluated by psychiatrists at the University of South Florida in Tampa.

The reason for the change: the increase in the number of children prescribed the drugs in the past several years, especially since the U.S. Food and Drug Administration does not recommend anymore the use of what are known as ”atypical antipsychotic” drugs in young children. Previous published reports have said that the number of children in Medicaid getting such drugs has grown from more than 9,000 kids in 2000 to more than 18,000 in 2006.

A state panel met Wednesday to consider whether Florida should craft a more detailed policy to decide when it should pay for such drugs. The meeting drew a smattering of attendance, in person and on the phone, including a representative of the Citizens Commission on Human Rights, an offshoot of the Church of Scientology, who said the state was violating its own rules by paying for drugs not recommended by the FDA.

Dr. Jerome Isaac, a Bradenton pediatrician on the panel, questioned whether the state was pushing the issue to save money, saying that Medicaid should pay for a medication if it is recommended by a doctor.

”I see this as a cost-containment measure by putting obstacles in the way of physicians,” Isaac said.

Others on the panel disagreed, saying that at a minimum the state should consider refusing to pay for any new prescriptions unless the child has previously been evaluated by a psychiatrist.

Anne Wells, the Medicaid Pharmacy Services bureau chief, said state officials were ”parents” and ”pharmacists” and that the right policy for children is a “bigger issue than cost containment.”