Background: Nearly two decades ago, increased use of ≥3 psychotropic classes (i.e., polypharmacy) in US Medicaid-enrolled youth was a national concern. There has been little research on more recent prescribing to determine if such patterns persist, and for which youth.
Objectives: To characterize psychotropic polypharmacy use from 2015-2020 among Medicaid-enrolled youth in one populous US state, stratified by eligibility group.
Methods: This annual cross-sectional study used Medicaid claims data for calendar years 2015-2020. Annual cohorts were created that included youth ≤17 years-old who had at least 1 psychotropic medication claim in the cohort year and had ≥90 continuous days of Medicaid enrollment in that year. For each year, we classified youth into one of 4 mutually exclusive groups under which they were eligible for Medicaid: low-income, Children’s Health Program (CHP), foster care, and disabled. Polypharmacy, defined as ≥3 psychotropic classes overlapping for ≥90 consecutive days and no >15-day gap between prescription fills, was identified in each study year. Psychotropic classes included antipsychotics, attention-deficit/hyperactivity disorder (ADHD) medications (e.g., stimulants, alpha agonists), mood stabilizers, antidepressants, anxiolytics, and sedatives. Polypharmacy prevalence was estimated for each year. Bivariate analyses assessed associations between Medicaid eligibility groups and polypharmacy use in 2015 and in 2020. Multivariate logistic regression fit with generalized estimating equations generated the odds of polypharmacy among Medicaid eligibility groups, adjusted for year and demographic characteristics.
Results: There were 126,972 unique youths with any psychotropic use across all years. Polypharmacy prevalence increased from 4.2% (2015) to 4.6% (2020). By Medicaid eligibility group, polypharmacy increased from 2015 to 2020 for foster care (10.8% vs. 11.3%), CHP (2.2% vs. 2.8%), and low-income (2.1% vs. 2.8%). In bivariate analyses, polypharmacy in 2015 was significantly higher among disabled (OR=5.4; 95% CI: 4.9-6.0) and foster care (OR=5.5; 95% CI: 4.9-6.3) than low-income (reference). Findings in 2020 showed a decreased odds (disabled OR=3.9; 95% CI: 3.5-4.3 and foster care OR=4.4; 95% CI: 3.9-5.0). Adjusting for sex, age, race, and region, the odds of polypharmacy increased by 1.06 (95% CI: 1.04-1.08) each year. The likelihood of polypharmacy was significantly higher among disabled and foster care youth than low-income youth, with an adjusted OR=3.8 (95% CI: 3.4-4.2) and 3.4 (95% CI: 3.0-3.9), respectively.
Conclusions: Polypharmacy in Medicaid-enrolled youth increased over time and remained disproportionally higher among foster and disabled youth.
