Pharmacologic management of Autism in Texas Medicaid and commercial pediatric populations

The objectives of this study were to 1) report the prevalence of Autism within a Texas Medicaid and rural Texas Commercial population and 2) describe the psychotropic medication utilization patterns within these populations. Pediatric patients (<21 years), initially diagnosed with Autism between 2009 and 2012, were identified using the Texas Medicaid claims database as well as the Scott & White Health Plan claims database. Study participants had no Autism-related medical claims within 6 months before the initial Autism diagnosis. Claims were reviewed for 12 months following the initial diagnosis. After matching, pairwise comparisons were conducted to assess population differences between the two cohorts. A total of 8,535 individuals were included in the pre-matched study population (8,260 in the Medicaid group and 275 in the Commercial group), approximately 80 percent were male in both groups. Although the mode age was similar between the 2 groups (Medicaid = 4, Commercial = 5), the average age was lower for the Medicaid population (6 vs. 10 years p <0.01). ASD prevalence in the Commercial population ranged from 0.08% in 2009 to 0.41% in 2012; and from 0.39% to 0.50% in the Medicaid population (p<0.01 for each year). A 2:1 match on age and gender was used to compare utilization patterns (N = 550 Medicaid; 275 Commercial). Twenty-eight percent of the overall sample population (n=231) received a prescription for at least one FDA approved anti-psychotic within the study period. The use of an approved antipsychotic was significantly greater in the Medicaid population (32%) when compared to the rural Commercial population (23%; p< 0.01). Specifically, risperidone utilization was greater in the Medicaid population (22%) when compared to the Commercial population (15%; p<0.01). The use of non-FDA approved antipsychotic medications was also significantly greater in the Medicaid population (13%) compared to Commercial patients (9%; p=0.01). Based on the results of this study, over one-fourth of the Autistic population was being treated with medications that have been FDA approved for the treatment of Autism. However, despite limited evidence related to long term safety and efficacy, several off-label psychotropic medications continue to be used in this population.