In 2011, the American Academy of Pediatrics updated its guidelines for diagnosing and treating children with attention deficit/hyperactivity disorder, which is also known as ADHD. That same year, around 6.4 million US children ages 4-17 had been diagnosed with ADHD.
The new guidelines recommend that clinicians refer parents for training in behavior therapy first, and then treat with medication if that therapy fails to improve the child’s functioning. Data from the before the release of those guidelines showed that fewer than half of preschoolers with ADHD received behavior therapy.
Prior authorization policies for ADHD medication could guide physicians toward recommending behavior therapy. This study, by researchers from CDC and the Center for Public Health Law Research, used policy surveillance to inventory state Medicaid prior authorization policies for ADHD medication. Explore the policy surveillance data on ADHD medication prior authorization policies at LawAtlas.org.
As of 2015, 27 states had Medicaid policies that prevented approval of pediatric ADHD medication payment without additional provider involvement. Seven states required prescribers to indicate whether non-medication treatments were considered BEFORE Medicaid payment for ADHD medication could be approved.
The study finds a diverse landscape of Medicaid policies – some tied to diagnosis, others tied to AAP guidelines. The authors suggest that this study is a first step to understanding how policy interventions may guide families toward the use of behavior therapy as a first-line in ADHD treatment for young children.