Monday, January 28, 2008

Is Medicaid Being Used As Front For The Drug Industry?


The Daytona Beach News-Journal printed this editorial entitled Drugs for children? on January 16, 2008, which suggested medical fraud might be afoot in Florida.
Prescriptions of anti-psychotics troubling

Parents at their wits' end, wearing long sleeves to hide bruises and bite marks inflicted by their own offspring. Psychiatrists struggling to cope with children as young as 2 who show intractable behavior problems. Drug companies ready to suggest powerful drugs that can produce marked changes in a child's behavior -- getting heavily involved in state-level determinations of which drugs should be prescribed for which conditions. And a state struggling to keep up with rapid changes that have pushed Medicaid costs for powerful anti-psychotic drugs from $9 million seven years ago to almost $30 million in 2006.

Something doesn't add up. Do all these children need the drugs they're being prescribed? Without a careful review of individual medical records, it's difficult to say -- but the trend is disturbing. Other states are already pushing hard for answers, and Florida should join in.

The drugs in question are known as atypical anti-psychotics and include Risperdal, Abilify, Geodon and Seroquel. Originally intended to treat major mental illnesses like schizophrenia and bipolar mania, they have become increasingly widely prescribed for children with autism and attention-deficit disorder with tics.

Yet, the U.S. Food and Drug Administration has approved few of these drugs for use with children -- especially in conjunction with many of the conditions for which the powerful drugs are prescribed. There's little research on the effects of the drugs, and a growing number of reports suggest that the medication could be responsible for deaths or serious side effects, including tardive dyskenisa (involuntary jerking of the limbs and grimacing).

State Medicaid programs across the country have found themselves paying for increasing quantities of these drugs. In Florida, the number of child Medicaid recipients taking atypical anti-psychotics has doubled since 1999, despite a lack of evidence suggesting that they're any more effective than other cheaper drugs.

Twenty-six states are exploring legal action against drug companies for unfair trade practices or consumer-protection violations (Florida is one of them; the Attorney General's Medicaid Fraud Control Unit served drug manufacturer Eli Lilly with a request in 2005 for information regarding its marketing of the drug Zyprexa.) Other states are being more aggressive; several have actually filed suit seeking to reclaim some of the millions spent on these drugs.

But Florida owes a more important duty to the thousands of children across the state who are taking powerful medications. Immediately discontinuing Medicaid reimbursement for the medications would be a mistake -- too many children are currently stabilized on drugs and might actually be benefiting. But the state should move to develop better standards for when the drugs should be prescribed. And this time around, the state should look first to public-health officials and the FDA.
If drug companies are making deals with Medicaid providers to push powerful mind altering drugs on the poor, that would be quite a disturbing revelation wouldn't it? If doctors are getting any kind of kickbacks from these drug companies for their prescriptions, that would be equally disturbing. The question is why has the dissemination of these powerful drugs practically exploded over the past 5 to 7 years? And do all these kids really need to be on such powerful mind altering medications? I am no doctor, but the statistics are quite alarming. Moreover, are these poor children on Medicaid being used as "test cases" and "guinea pigs' for the drug companies? We are talking about Medicaid practitioners doling out drugs to children that have not been approved for children by the FDA!

I just have to share this letter from Researcher Ken Kramer, written to the Governor of Florida:
Office of Governor Charlie Crist
State of Florida Jan 23, 2008
The Capitol
400 S. Monroe St.
Tallahassee, FL 32399-0001

COMPLAINT

Dear Governor Crist,

Sorry to have to contact you on this but we’ve got a serious problem in our State with drugging kids. I know you can make something happen immediately on this. On Feb. 13, 2006 the Florida Agency for Health Care Administration announced in a press release:

“In 2005, close to 18,000 children in Florida Medicaid were prescribed antipsychotic medications and more than 475,000 prescriptions for antipsychotic drugs were written in the past 5 years. Many of these antipsychotic medications have not been FDA-approved for use in children.”

Over 50% of the antipsychotics in Florida for Medicaid young children are being prescribed for ADHD yet antipsychotics are not FDA approved for ADHD nor are there supporting citations for this use in any of the drug compendiums specified by Florida Medicaid reimbursement rules.

Over a year ago I filed a complaint with Florida government officials regarding Medicaid funded psychiatric drugging of children. This was after I obtained Medicaid records showing that millions in tax dollars were being spent by the State on expensive atypical antipsychotic drugs prescribed to young children. So far, I have been notified of zero developments.

Even an attempt for many months to obtain a simple answer from AHCA to a question (see attached) on Medicaid reimbursement of these unapproved antipsychotic drugs has been fruitless. Fruitless even when AHCA Inspector General personnel were hot on the case pursuing an answer.

The last person I was referred to was Craig H. Smith, General Counsel, Agency for Health Care Administration who has had this question pending for the last 2 months and who continues to ask me to be patient, in spite of the fact that AHCA should be able to answer this question immediately without hesitation.

Can you please help me get this question answered? That would be a good start!

Sincerely,
Ken Kramer
Researcher
Citizens Commission on Human Rights of Florida
727-461-1955
datasearch@earthlink.net


Looks like the state agencies are not being too forthcoming with information on these drug investigations. I wonder what it is they have to hide.

More here and also here in the St. Petersburg Times.

1 comment:

Elisheva Hannah Levin said...

It would interesting to know what dosages on the atypicals are being prescribed to childen with ASD.

Sub-clinical dosages of Risperdal and other atypicals do have a beneficial effect on the balance of neurotransmitter (NT) in the synapse, and do have a synergistic effect on the function of all three NTs important to some of the deficits seen in ASD.

In general, however, these dosages are very small. It's hard to imagine what a subclinical dose would be for a 2 year old.

At the sub-clinical level--dosages that would not be effective in severe psychosis--the side-effects you mentioned are extremely rare. But continued follow-up is still needed to prevent problems.

My concern, though, is who is prescribing these drugs. If it is a primary care provider, it is extremely unlikely that the kids are getting the level of follow-up scrutiny required to see if the drugs are effective and if there are side-effects.

Another concern is how the children who are being prescribed these drugs are being diagnosed. The diagnoses we are talking about should be made by specialists, and often, to be accurate, ought to be made by a team of specialists. Does this really happen in medicare recipients? There is a nationwide shortage of child psychiatrists, who are the doctors most qualified to diagnose these pathologies and prescribe and monitor drugs.

Just some thoughts. I am not against the use of drugs in children who have a legitimate diagnosis and whose symptoms warrant them. But I do worry that drugs are often used as a quick-fix, with little regard for the complexities involved.