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Objective: Recent evidence suggests that children are increasingly diagnosed as having bipolar disorder, yet no studies have quantified treatment costs for pediatric patients. The objectives of the study were to identify one-year health services utilization and treatment costs among youths newly diagnosed as having bipolar disorder.Methods: MarketScan administrative claims from 2005 to 2007 were used to construct a retrospective person-level cohort of children ages zero to 17 to identify one-year health services utilization and costs among privately insured youths with a bipolar diagnosis. Inpatient and outpatient services were categorized as mental health related or non–mental health related. Pharmacy costs were classified as psychotropic or nonpsychotropic.Results: In the sample (4,973 youths), one-year mean reimbursements for health services were $10,372, and patient out-of-pocket spending was $1,429 per child. Mental health services accounted for 71% of all health care spending, with psychotropic medications and inpatient care contributing the largest proportions of total spending (24% and 27%, respectively) .Conclusions: The costs of care among privately insured children with bipolar disorder are similar to those of adults. However, spending on children is concentrated on mental health–related services. Because private insurance plans have historically limited mental health service benefits, the concentration of spending on mental health services may place a greater burden on families for out-of-pocket payments. As mental health parity is adopted by private insurers, monitoring its impact on patient utilization and costs of health services will be important, particularly for children with serious mental illness. [ABSTRACT FROM AUTHOR]

OBJECTIVE: This study examined the extent to which children with bipolar I disorder received recommended treatment of mood-stabilizer or second-generation antipsychotic monotherapy and factors associated with its receipt. METHODS: Administrative claims data collected from January 1, 2005, to December 31, 2007, were used to construct a cohort of 412 privately insured children with bipolar I disorder. The primary outcome measure was the receipt of mood-stabilizer or second-generation antipsychotic monotherapy within 90 days of an index diagnosis of bipolar disorder. RESULTS: Only 82 (20%) children received recommended first-line treatment for bipolar I disorder within 90 days of the index diagnosis, and 130 (32%) received no psychotropic medications. Of children receiving any medications, 200 (71%) received nonrecommended pharmacotherapy, most commonly antidepressant monotherapy (N=67, 24%) and combination pharmacotherapy (N=51, 18%). Youths who had been treated by a psychiatrist on the day of or 180 days before the fill date of medication were more likely to receive guideline-recommended care (risk ratio [RR]=1.64, 95% confidence interval [CI]=1.10-2.45) and to receive any psychotropic medications (RR=1.13, CI=1.02-1.24). Nevertheless, only 51 of the 209 (24%) children who visited a psychiatrist and 31 of the 203 (15%) who visited a nonpsychiatrist received recommended pharmacotherapy. CONCLUSIONS: This study highlights significant gaps in the treatment of pediatric bipolar disorder. Most children in this sample received either no medications or nonrecommended pharmacotherapies. Additional research is needed to further assess factors related to the nonuse of recommended psychotropic medications and to the persistent use of nonrecommended pharmacotherapies for children with bipolar disorder. (Psychiatric Services 62:1443-1449, 2011). [ABSTRACT FROM AUTHOR]

Objective: The purpose of this study was to examine whether medication refill behavior varies by the number of prescribers of antipsychotic medication a patient has.Methods: A total of 7,868 patients with schizophrenia were identified from North Carolina Medicaid records for the period 2001-2003. Medication switching and adherence outcomes in 2003 were constructed from Medicaid pharmacy claims. Adherence was categorized into four levels (nonadherence, partial adherence, full adherence, or excess filler). Patients were stratified into four groups on the basis of the number of providers who prescribed antipsychotics in 2002 (one prescriber, two prescribers, three prescribers, or four or more prescribers). Medication switching was modeled via logistic regression, and the four-level adherence outcome was modeled via ordered logistic regression, with both regressions controlling for the number of prescribers, age, gender, race, and comorbidity. Medication switching in 2003 was also controlled for in the adherence regression. Predicted probabilities of being in the four adherence groups were estimated to examine the impact of the number of prescribers on adherence.Results: Fifty-seven percent of Medicaid patients with schizophrenia had one prescriber for antipsychotic medication, 29% had two prescribers, 10% had three prescribers, and 4% had four or more prescribers in 2002. Patients with more prescribers were significantly more likely than patients with one prescriber to switch medications (p<.01 for patients with three prescribers) and to be either fully adherent or excess fillers (p<.001).Conclusions: Patients with schizophrenia who received medication from multiple prescribers frequently changed medications and filled prescriptions too soon. Care coordination, such as with medical homes, may be effective in improving medication use in this vulnerable population. [ABSTRACT FROM AUTHOR]

This study examined medication use among Medicare beneficiaries and dually eligible beneficiaries before and after the implementation of Medicare Part D on January 1, 2006. Nationally representative 2004-2006 data from the Medical Expenditure Panel Survey were used. Two large classes of psychotropic medications (antidepressant and antipsychotic medications) and two large classes of nonpsychotropic medications (lipid-lowering and antihypertensive agents) were examined to determine whether changes in prescription patterns occurred as a result of the implementation of Part D. There was no strong evidence that Part D was associated with large changes in access to medications in the four classes of medications examined here. [ABSTRACT FROM AUTHOR]