HealthDay News — For young children, implementation of a peer review prior authorization (PA) policy can reduce the use of atypical antipsychotic (AAP) medications, according to a research letter published online in JAMA Psychiatry.

Julie M. Zito, PhD, from the University of Maryland in Baltimore, and colleagues used Medicaid administrative claims data from 4 geographically diverse states to examine the impact of peer review PA policies on AAP use among Medicaid-insured youth. Monthly and quarterly use of AAPs was assessed pre-policy, during the transition period, and post-policy. Peer review policies were implemented for children younger than 8 years in state A, younger than 6 years in states B and C, and younger than 5 years in state D.

The researchers found that there was a significant decrease in AAP prevalence after policy implementation compared with the pre-policy period for children younger than 8 in state A (from 0.25% to 0.17%; odds ratio [OR], 0.68); younger than 6 in states B and C (from 0.09% to 0.05%; OR, 0.57 and from 0.09% to 0.07%; OR, 0.76); and younger than 5 in state D (0.03% to 0.02%; OR, 0.64). In states A, B, and C, AAP use among older youth (lacking peer review) increased significantly, while a non-significant decrease was seen in state D.

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“These findings are consistent with recent national estimates suggesting that the rapid increase in AAP use among publicly insured young children had stabilized since 2008,” the authors write.


Zito JM, Burcu M, McKean S, Warnock R, Kelman J. Pediatric use of antipsychotic medications before and after Medicaid peer review implementation [published online November 15, 2017]. JAMA Psychiatry. doi:10.1001/jamapsychiatry.2017.3493