According to the Centers for Disease Control and Prevention (CDC), an estimated 6 million US children 3-17 years old have received an attention-deficit/hyperactivity disorder (ADHD) diagnosis. The number of ADHD diagnoses in US children vary widely by state (6% to 16%), and there is even greater variation across states in the estimated number of children with ADHD treated with ADHD medication (38% to 81%). Some state Medicaid programs have implemented policies to manage the use of ADHD medications and guide physicians toward best practices for ADHD treatment in children. These policies include prescription medication prior authorization requirements that restrict approvals to patients of a certain age or require additional provider involvement before approval for payment is granted.
This dataset examines 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. A separate dataset that focuses on state Medicaid managed care plans in a sample of five states is available on LawAtlas.org.