Datapoints: use of multiple psychotropic drugs by Medicaid-insured and privately insured children.

Dr. Martin, Dr. Stubbe, Dr. Scahill, and Dr. Leslie are affiliated u.;'ith the Yale Univers'itlj School of Medic'ine, 230 South Frontage Road, P.O. Box 207900, New Haven, Connecticut 06520-7900 (e-mail, [email protected]). Ms. Sherwin and Dr. Van Hoof are with Qualidigm in Middletown, Connecticut. Harold A. Pincus, M.D. and Terri L. Tanielian, M.A., are editor.s ofthis column. No published studies have addressed combination treatments. To that end, we analyzed 1999 data from two sources: the Medicaid Managed Care (MMC) database, maintained by the Connecticut Department of Social Services, and MEDSTAT's MarketScan database, which compiles nationwide claims information from private health insurance plans of large employers. As depicted in Figure 1, the rate of psychotropic drug use was approximately double among the Medicaidenrolled children. The higher prevalence in the older group is consistent with epidemiologic data and reflects the greater use of stimulants among school-age children. As shown in Figure 2, the rate of multiple psychotropic pharmacotherapy was also higher in the Medicaid population. (It should be noted that there is a tenfold difference in the vertical scale for the two figures.) A larger proportion of MedicaidenrolIed children were given prescriptions for lllUltiple psychotropics-even as fewer of them received outpatient mental health services. This finding suggests that they were treated more aggressively. The differences may be related to more severe psychopathology or psychosocial adversity; to variation in coverage for medications, copayment structure, or practice practices across treatmcnt settings; or to other unmeasurcd plan-specific characteristics.•