Pharmaceutical Benefit Management and the Use of Psychotropic Medication for Children and Adolescent

Approved by Executive Committee January 12, 2009
To be reviewed January 2014

Clinical research and the development of new and effective psychotropic medications have changed the practice of child and adolescent psychiatry. The informed uses of psychotropic medications have improved the lives of children and adolescents who suffer from psychiatric illness. However, many of these medications are used “off label” or carry cautions and “Black Box” warnings mandated by the Food and Drug Administration. Achieving the appropriate balance between clinical effective use and the known risks and side effects associated with these treatments requires individualized medical decision making. To provide the optimal treatment, the child and adolescent psychiatrist must have access to a full range of psychotropic medications. Restrictions and limitations placed upon a physician’s choice among medications expose children and adolescents to unnecessary medical risks and the potential for non-compliance. These complications ultimately impact the quality of the child’s life and result in an overall increase in health care costs.

Insurance companies and policy makers have turned to Pharmaceutical Benefit Management (PBM) as a means to control the escalating costs of medications and to reduce overall healthcare expenditures. PBM strategies may involve the restriction of formulary choices and the requirement of pre-authorization of treatment before a prescription can be filled.

The AACAP supports formulary design and benefit management practices that:

  • Maintain patient safety as a primary focus in the context of clinically driven risk/benefit analysis.
  • Recognize that the choice of a specific psychotropic medication must be based on the individual needs and circumstances of each child or adolescent.
  • Are informed by the best available evidence about outcomes and conform to the practice parameters endorsed by the AACAP
  • Make available to children and adolescents all psychotropic medications and preparations when deemed medically necessary, and
  • Make formulary information and restrictions readily available.

The AACAP opposes benefit management practices that:

  • Interferes with the doctor-patient relationship
  • Include pre-authorization and appeals processes that are so- time consuming they prevent optimal care
  • Are driven primarily by cost at the expense of efficacy, safety and other quality indicators

The Principles of Practice of Child and Adolescent Psychiatry (AACAP, 1982) require the primary concern of the physician be the welfare and optimal development of the child or adolescent. Child and adolescent psychiatrists affirm their ethical obligation to inform children and parents of the safest and most effective treatment available for their condition and to prescribe only the most appropriate medication for the patient.