Off-label use of antipsychotic medications in Medicaid

Douglass L. Leslie, Robert Rosenheck

Research output: Contribution to journalArticle

39 Citations (Scopus)

Abstract

Objectives: To determine how often antipsychotics are prescribed off-label to adults without schizophrenia or bipolar disorder who are enrolled in Medicaid, which pays for more than 70% of antipsychotic prescriptions in the United States. Study Design: Retrospective analysis of 2003 administrative data from 42 state Medicaid programs. Methods: Continuously enrolled patients with at least 1 prescription for an antipsychotic medication were identified. For these patients, inpatient and outpatient records were checked for any diagnosis of schizophrenia or bipolar disorder; those without any such diagnoses were considered to have received these medications off-label. Offlabel antipsychotic use was compared across sociodemographic groups (age, race/ethnicity, sex). Multivariate logistic regression models identified characteristics associated with off-label use. Results: Of the 372,038 individuals given an antipsychotic medication, 214,113 (57.6%) received these agents for off-label disorders. Offlabel use among patients receiving an antipsychotic was more prevalent among individuals under age 21 years (75.9%) and those 65 years and older (64.8%) than it was among those aged 21 to 64 years (49.0%). Rates of off-label use were relatively high for Hispanics (65.7%) and low for African Americans (52.3%) compared with whites (58.2%). Off-label use was most common among patients receiving risperidone and least common among patients receiving clozapine. Conclusions: Off-label use of antipsychotic medications is common, particularly among the elderly and children/adolescents. Given that these drugs are expensive, have potentially severe side effects, and have limited evidence supporting their effectiveness off-label, they should perhaps be used with greater caution.

Original languageEnglish (US)
Pages (from-to)e109-e117
JournalAmerican Journal of Managed Care
Volume18
Issue number3
StatePublished - Mar 1 2012

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Off-Label Use
Medicaid
Antipsychotic Agents
Bipolar Disorder
Prescriptions
Schizophrenia
Logistic Models
Risperidone
Clozapine
Hispanic Americans
African Americans
Inpatients
Outpatients
Retrospective Studies
Age Groups
Pharmaceutical Preparations

All Science Journal Classification (ASJC) codes

  • Health Policy

Cite this

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title = "Off-label use of antipsychotic medications in Medicaid",
abstract = "Objectives: To determine how often antipsychotics are prescribed off-label to adults without schizophrenia or bipolar disorder who are enrolled in Medicaid, which pays for more than 70{\%} of antipsychotic prescriptions in the United States. Study Design: Retrospective analysis of 2003 administrative data from 42 state Medicaid programs. Methods: Continuously enrolled patients with at least 1 prescription for an antipsychotic medication were identified. For these patients, inpatient and outpatient records were checked for any diagnosis of schizophrenia or bipolar disorder; those without any such diagnoses were considered to have received these medications off-label. Offlabel antipsychotic use was compared across sociodemographic groups (age, race/ethnicity, sex). Multivariate logistic regression models identified characteristics associated with off-label use. Results: Of the 372,038 individuals given an antipsychotic medication, 214,113 (57.6{\%}) received these agents for off-label disorders. Offlabel use among patients receiving an antipsychotic was more prevalent among individuals under age 21 years (75.9{\%}) and those 65 years and older (64.8{\%}) than it was among those aged 21 to 64 years (49.0{\%}). Rates of off-label use were relatively high for Hispanics (65.7{\%}) and low for African Americans (52.3{\%}) compared with whites (58.2{\%}). Off-label use was most common among patients receiving risperidone and least common among patients receiving clozapine. Conclusions: Off-label use of antipsychotic medications is common, particularly among the elderly and children/adolescents. Given that these drugs are expensive, have potentially severe side effects, and have limited evidence supporting their effectiveness off-label, they should perhaps be used with greater caution.",
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Off-label use of antipsychotic medications in Medicaid. / Leslie, Douglass L.; Rosenheck, Robert.

In: American Journal of Managed Care, Vol. 18, No. 3, 01.03.2012, p. e109-e117.

Research output: Contribution to journalArticle

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