Data published by the Center for Public Health Law Research explore state regulations across the US in places that manage access to ADHD prescription medications for children under 18 years old. These include prior authorization requirements that restrict approvals to patients of a certain age or that require additional provider involvement for specific medications before approval for payment is granted.
According to the new, open-access legal data on LawAtlas.org, 34 states had a policy requiring prior authorization for ADHD medication as of April 1, 2023, an increase from 27 states in November 1, 2015. Of these 34 states, 28 states (82%) restricted preferred drugs, 30 states (88%) restricted non-preferred drugs, and 24 states (71%) restricted both preferred and non-preferred drugs. Both are typically covered by insurance, however in some circumstances, non-preferred drugs are only authorized after patients meet other criteria, such as the failure of preferred drugs.
Among the 28 states requiring prior authorization for preferred drugs, important findings include:
- Twenty states required prior authorization for all children 3 years and younger.
- Five states required prior authorization for all children 17 years and younger.
- Twenty-three states had specific criteria when requiring prior authorization including ADHD diagnoses (17 states), prescriber consultation (7 states), and consideration/failure of medication and non-medication alternatives (3 states).
Among the 30 states requiring prior authorization for non-preferred drugs, important findings include:
- 19 states required prior authorization for all children 3 years and younger and 8 states required prior authorization for all children 17 years and under.
- 26 states had specific criteria including ADHD diagnoses (20 states), prescriber consultation (7 states), and consideration/failure of medication and non-medication alternatives (17 states) when requiring prior authorization.
“The United States has faced a nationwide shortage of ADHD medication since October 2022, so it’s important for us to understand the broad landscape of requirements families may face as they seek this medication with support from their providers,” says Amy Cook, JD, a senior law and policy analyst at CPHLR and lead researcher on this project. “These legal data provide a comprehensive review of the regulatory environment and can support providers, families, and others as they navigate based on their needs, and researchers and officials seeking to continue improving access to care.”
The data examined features of prior authorization policies in state Medicaid fee-for-service plans that pertain to pediatric ADHD medication treatment, including applicable ages, medication types, and criteria for approval in effect as of April 1, 2023, in all 50 states and the District of Columbia. These data updated an earlier version of the dataset that included policies in effect as of November 1, 2015.
A supplemental dataset exploring prior authorization policies for ADHD medication prescriptions for Medicaid managed care plans is also available through this project. These data show the policies in five states (Georgia, Illinois, Nevada, New Jersey, and South Carolina) as of April 1, 2023.
In those five states, 11 of the 23 managed care plans required prior authorization, with nine requiring for non-preferred drugs. With the non-preferred drugs, all nine plans required specific criteria. Eight plans required an ADHD diagnosis, six plans required failure of medication alternatives, and two plans required failure of non-medication alternatives.
The data were created using a scientific legal mapping method called policy surveillance developed by CPHLR. The database was created with support from the Centers for Disease Control and Prevention of the U.S. Department of Health and Human Services (HHS) as part of a financial assistance award given to ChangeLab Solutions totaling $200,000 with 100 percent funded by CDC/HHS.
The Center for Public Health Law Research at the Temple University Beasley School of Law supports the widespread adoption of scientific tools and methods for mapping and evaluating the impact of law on health. Learn more at http://phlr.org.
Explore more of the updated findings at LawAtlas.org.