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Prescription Drug Use and Cost Trends Among Medicaid-Enrolled Children with Disruptive Behavioral Disorders

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Abstract

Disruptive behavior disorders (DBDs) are the most common mental health conditions in children. These conditions profoundly affect healthcare utilization and costs. Service use, costs, and diagnostic trends among pediatric Medicaid beneficiaries provide information regarding healthcare quality and potential for smarter spending. Using nationwide Medicaid administrative data, this study investigates diagnoses, prescription drug fills, and payments in 49 states and D.C. from 2006 to 2009 in Medicaid beneficiaries age 20 and under. Psychotherapeutic drug prescriptions and payments were calculated as a proportion of prescription totals. Results were considered by age, gender, race, and state. The results show a trend of increasing DBD diagnosis. Among prescription claims for children with diagnosed DBD, psychotherapeutic drug claims represented 30–40% of prescription claims but over half of prescription costs. This study indicates increasing clinical and financial needs for Medicaid-enrolled children with DBDs. Medicaid could potentially foster reforms in pediatric DBD treatments, particularly regarding medication use.

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Notes

  1. Although ADHD was classified as a behavior disorder with ODD and CD in the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders, it has been reclassified as a neurodevelopmental disorder in DSM-V.53 Because of the high level of comorbidity and similarities in pharmacological treatment profiles, and because the DSM-IV was in use during the study period, the DSM-IV definition of DBD is used in this paper.

  2. Maine is not included because it is not in the data system the authors are using.

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Acknowledgements

The authors acknowledge our CMS colleagues William D. Clark, Sophia Chan, David Bott, Renee Mentnech, John O’Brien, John Coster, and Renee Hilliard for their input and review.

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The contents of this article are solely the responsibility of the authors and do not necessarily represent the official views of the US Department of Health and Human Services or any of its agencies.

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Authors and Affiliations

  1. Research and Rapid-Cycle Evaluation Group, Center for Medicare and Medicaid Innovation, Centers for Medicare & Medicaid Services, 7500 Security Blvd., Mail Stop: WB-06-05, Baltimore, MD, 21244, USA

    Lirong Zhao MS, Caitlin Cross-Barnet PhD & Vetisha L. McClair PhD

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  1. Lirong Zhao MS
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Correspondence to Lirong Zhao MS.

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Zhao, L., Cross-Barnet, C. & McClair, V.L. Prescription Drug Use and Cost Trends Among Medicaid-Enrolled Children with Disruptive Behavioral Disorders. J Behav Health Serv Res 45, 550–564 (2018). https://doi.org/10.1007/s11414-018-9605-z

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