MEDICAID KIDS IN PSYCH-RX $URGE
By SUSAN EDELMAN firstname.lastname@example.org and MELISSA KLEIN
February 3, 2008 -- New York state's Medicaid program paid $82.8 million in 2006 for two dozen psychiatric drugs for tens of thousands of children - with many of the meds not FDA-approved for kids, records obtained by The Post show.
Use of the powerful antipsychotics, anticonvulsants and antidepressants once prescribed only for adults has skyrocketed as more New York kids are diagnosed with mental illnesses and behavioral disorders.
But experts fear some children may be misdiagnosed, overmedicated and at risk for horrendous side effects such as diabetes, breast growth in boys and suicidal tendencies. Most of the drugs have not been thoroughly tested or studied on kids. The psychiatric drugs are generally used - and can be effective - in treatment of schizophrenia, depression, bipolar disorder, autism, attention deficit-hyperactivity disorder, aggression and other behavior problems.
But state Health Department officials say they do not know what illnesses the children in the Medicaid program are suffering.
"Pharmacy claims do not require a diagnosis," a state Health Department spokeswoman said.
Claims are paid without question based on a doctor's judgment that the drug is "medically necessary," even when it's not approved for kids, Medicaid officials said. But they added that the state plans to look closer at how and why some drugs are prescribed.
The lucrative sale of the drugs also has drawn scrutiny from law-enforcement authorities in New York and other states. Several states are investigating whether pharmaceutical companies are illegally promoting the drugs to doctors "off label" - for uses not FDA approved.
Eli Lilly & Co. said last week it was subpoenaed by a federal grand jury in Pennsylvania seeking documents on the marketing of its best-selling antipsychotic, Zyprexa, which was prescribed to 2,647 New York Medicaid kids in 2006. Connecticut's attorney general has joined the probe.
John Milgrim, a spokesman for state Attorney General Andrew Cuomo, would not comment on the Zyprexa case, but told The Post: "We currently have open investigations regarding this kind of conduct. Marketing of pharmaceuticals for off-label usage may be a fraud on the state Medicaid program."
Risperdal was given to 17,393 New York Medicaid kids in 2006, making it the most heavily prescribed psychiatric drug in the program. It was recently approved by the FDA to treat autism but is also often prescribed for bipolar disorder in kids. It's blamed in lawsuits nationwide for side effects including diabetes caused by weight gain, Parkinson's-like movement disorders and gynecomastia, in which males grow breasts.
Stephen Sheller, a Philadelphia lawyer, said he has filed suits in New Jersey on behalf of four boys, ages 14 to 16 - two who underwent mastectomies.
"You blitz the kids, and they're under control," Sheller said, noting that the drugs often cause drowsiness. "They're out of it."
Dr. Mark Olfson, a psychiatry professor at Columbia University Medical Center, led a study published in September that found outpatient treatment of kids for bipolar disorder rose 40-fold from 1994 to 2003. Doctors frequently prescribed the kids mood stabilizers, antipsychotics and antidepressants. The study found an "urgent need" to evaluate the drugs' safety and effectiveness.
Olfson said Friday that many kids need help. "The much greater problem is that we have large numbers of young people in the United States with mental-health problems who receive no treatment," he said.
Medicaid's 2006 expenditure of $82 million on psychiatric drugs for children was up $8 million from the previous year and $15 million from 2004. In all, Medicaid counted more than 85,000 child recipients of psychiatric drugs in 2006 but said that number duplicates kids who got two or more drugs.