Tenn. Project to Monitor Behavioral-Disorder Medications

Tennessee will pilot-test a children’s-health program in an effort to lower the number of children who take antidepressants and other medications used to treat behavioral disorders, particularly attention deficit hyperactivity disorder.

Alarmed by double-digit percentage increases in recent years in the numbers of children who were prescribed medications for such disorders, state health officials suspect that those expensive drugs may be unnecessary in many cases, and potentially harmful in some if the child does not receive a more appropriate treatment.

The pilot program is intended to see if that supposition is correct.

“Tennessee has seen dramatic increases in potentially harmful levels of utilization, with unproven therapies, to treat children with ADHD or depression in our program,” said J.D. Hickey, the deputy state commissioner for TennCare, the state’s health-insurance program for poor residents.

Psychotropic drugs, he added at an Oct. 27 news conference announcing the program, are mainly being prescribed by physicians who do not have specialties in behavioral health.

The pilot is being implemented next year through TennCare. About 640,000 children are insured through the state program, and about 217,000 children in East Tennessee will take part in the research portion of the pilot. About 25,000 of those have been prescribed drugs for depression or ADHD.

Marilyn Elam, a spokeswoman for the TennCare bureau, said the state has not yet budgeted for any savings.

“We would expect some cost savings, but the main thrust is better quality of care for children,” she said.

Children’s Treatment

As part of the effort, Tennessee officials have partnered with a health-care company, Magellan Behavioral Health, based in Columbia, Md. Magellan will be educating providers about evidence-based approaches to treatment, and working with the children and their parents or guardians to understand the best treatment options.

In addition, researchers from the University of Tennessee’s pharmacy school will use a $25,000 grant from TennCare to monitor the prescribing practices of physicians. The researchers will study medical claims, prescription claims, and nonmedical interventions to monitor if the children involved should be kept on prescription drugs or if other treatments might be more effective.

“This is essentially a targeted effort to get physicians to use best practices when treating children with ADHD and depression,” Tom Cantron, the director of the Governor’s Office of Children’s Care Coordination, said in a statement. “The most beneficial outcome would be to positively affect physician prescribing patterns and ultimately improve the behavioral health of children in TennCare.”

The pilot program is to begin Jan. 1 and last eight months, after which TennCare officials will analyze the results and decide whether to expand the program statewide.