Use and cost of psychotropic drugs among recipients with autism in a state Medicaid fee-for-service programme.
Medicaid covers a lot of pills for autism; antipsychotics eat the biggest share of the budget.
01Research in Context
What this study did
McGeown et al. (2013) looked at every Medicaid drug claim for people with autism in one state.
They counted how many people filled at least one psychotropic prescription and what it cost.
What they found
Two out of three people with autism had a claim for mind-altering drugs.
Antipsychotic pills were the biggest slice of both use and spending.
How this fits with other research
McCauley et al. (2018) later saw the same heavy pill use in privately insured autistic adults.
Parish et al. (2012) show that state parity laws can cut family out-of-pocket costs, but R et al. remind us the drug bill still lands on Medicaid.
Tonnsen et al. (2016) map 50 different Medicaid autism waivers; together the papers paint a patchwork where drugs are common but other services vary wildly.
Why it matters
If two-thirds of your Medicaid clients already take psychotropics, behavior plans may need to account for side effects like sedation or weight gain.
Use the data when you advocate for more hours of ABA instead of another antipsychotic increase.
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02At a glance
03Original abstract
BACKGROUND: There has been a significant increase in the prevalence of autism in the USA in the past few decades. The purpose of this study was to provide recent estimates of psychotropic drug use and costs among individuals with autism enrolled in Medicaid programme. METHOD: A cross-sectional analysis of 2007 Mississippi (MS) Medicaid fee-for-service (FFS) programme administrative-claims data was performed. Study sample included recipients (<65 years) who had a medical services claim with a diagnosis of autism in 2007. Psychotropic drug patterns of use and costs were studied. Factors predicting the use of psychotropic drugs were identified using logistic regression analyses. Average number and cost of psychotropic drug claims per recipient were reported. Costs were reported from the perspective of MS Medicaid. RESULTS: In 2007, there were 1330 recipients with a diagnosis of autism in MS Medicaid FFS programme. Among these recipients, 66.32% had a claim for psychotropic drug during the year. Roughly 39% of recipients with autism had a claim for antipsychotics, 31.58% for stimulants, 19.55% for antidepressants, 19.40% for other psychotropics and 14.81% for anxiolytics/hypnotics/sedatives. Results from regression analyses highlighted variation in psychotropic drug use by demographic and co-morbid factors. There were a total of 12,618 claims for psychotropic drugs filled by recipients with autism in 2007, at an average of 14 (±12) claims per recipient. The total cost of these claims paid for by MS Medicaid FFS programme was ∼$2 million. Antipsychotics accounted for more than half (∼58%) of the total costs, and had the highest average cost per claim ($291 ± 205). CONCLUSIONS: The results of this study indicate a high use of psychotropic drugs among individuals with autism enrolled in a state Medicaid programme. There is an urgent need to study the risk-benefit profile of these drugs in this growing population. Psychotropic drug use was found to vary by demographic and co-morbid factors. Among the different classes of psychotropic drugs, antipsychotics were the most commonly used and had the highest cost per claim.
Journal of intellectual disability research : JIDR, 2013 · doi:10.1111/j.1365-2788.2012.01563.x