Medication Inadequacy Upends Treatment of ADHD in Medicaid
New research shows that nearly half of Medicaid beneficiaries prescribed ADHD drugs have not received follow-up care for the condition.
Children with attention-deficit hyperactivity disorder (ADHD) are prescribed medicines that can help address an impeded ability to focus or focus on the task at hand. The drugs are often used to treat ADHD and to help children who may have been referred for treatment.
While medication is very effective in some children, long-term treatment is most effective if it is well-managed, with in-person, nonprescription visits and reminders provided to all patients about their health.
Attention-deficit hyperactivity disorder is a brain disorder characterized by behavior that is either too impulsive or out of control. Most researchers agree that patients with ADHD show impaired cognitive functioning, including problems focusing their attention and being able to pay attention in class, talking in class, and sustaining attention at home and at work.
The ADHD Association of America estimates that one out of five children, or 8 million children, in the United States is affected by ADHD.
Overall, from 2011 to 2014, Medicaid beneficiaries in California were 43 percent more likely to be prescribed ADHD drugs than were California parents of children not on Medicaid. Researchers from the California Center for Public Health Advocacy (CCPHA) recently looked at whether beneficiaries with ADHD and their care providers were aware of how their ADHD treatment was being monitored.
The researchers found that 28 percent of beneficiaries who were prescribed ADHD medications didn’t receive follow-up care, compared to 18 percent of beneficiaries and their care providers who were not on Medicaid. Follow-up visits are important in promoting long-term treatment and are recommended by many developmental and behavioral experts.
Medication Treats ADHD
Most commonly prescribed in the U.S. are stimulants: methylphenidate (Ritalin, Concerta) and amphetamine (Adderall). Both medications work by regulating brain function to increase concentration and improve learning in the child’s brain.
Not all children respond to the medication. It is generally prescribed to children who demonstrate symptoms of symptoms of ADHD — including hyperactivity and impulsivity.
Adderall or Adderall Impulsin is a nondrug treatment for ADHD. Focused and short, it helps the child manage behavioral and distracting behavior and is best used to treat symptoms without disrupting school or other life activities. Adderall Impulsin is available to children without insurance for $500 to $2,000 per month.
Although the initial care for Medicaid beneficiaries on ADHD medications is mandatory, the Medicaid program, and most states, include a reduction in follow-up care for beneficiaries with a prescription for stimulants after two months, particularly children who are not responding to the medication and those who do not have an approved stimulant disorder diagnosis.
The research team found that 88 percent of children who received more than two months of treatment for ADHD were kept up to date with the prescribed medication, while only 54 percent of children who received more than two months were kept up to date with recommended care.
The researchers stressed that the costs of Medicaid are enormous, and they estimate that the cost of prescribing children stimulants by Medicaid is $100 per child per year.
“We acknowledge that Medicaid is the only public health insurance program that requires children with ADHD to have frequent follow-up visits,” said the study’s lead author, Dr. Vanessa Nicholas. “We think what you need to do is begin looking at what that schedule is, and what the reasons are, in order to see if you can adjust it.”
The costs for care are significant, and most Medicaid beneficiaries do not want to be placed in a position where they are responsible for paying the bill.
Of the more than 68 million Medicaid beneficiaries in the United States, 22.3 million are children, according to 2012 data from the Kaiser Family Foundation.
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