Program for the use of antipsychotics with metabolic monitoring in North Carolina medicaid children

Abstract

Introduction

Children are at greater risk than adults for weight gain and metabolic disorders including hyperlipidemia and diabetes with newer antipsychotics. A web-based safety-monitoring program using a prior documentation model required submission of patient safety data (prior documentation) for insurance coverage at the pharmacy point of sale. This program launched in April of 2011, covering all NC Medicaid and Health Choice recipients under age 18. Clinical monitoring parameters and interactive educational features were developed with pediatric psychiatric experts and key mental health stakeholder groups.

Objectives

Using a four-year run in period and a full 9 months of post implementation claims data, evaluate the rates of antipsychotic prescribing and safety monitoring before and after the implementation of the A + KIDS program.

Results

Implementation of this program was associated with a consistent monthly decrease in overall antipsychotic use and increases in patient monitoring of glucose and lipid (Figure. 1, Table 1).

Conclusions

The prior documentation registry was effective in decreasing antipsychotic use and increasing safety monitoring. The impact of changing to more traditional prior authorization on the same clinical endpoints is currently under evaluation.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Fig. 1 A+KIDS Population Antipsychotic Prescription Fills per 1000 Medicaid Enrollees Per Day

Table 1 Percent of A+KIDS Patients on an Antipsychotic with Metabolic Monitoring Recorded in Claims.