Chronic Medication Use in Children Insured by Medicaid: A Multistate Retrospective Cohort Study

Abstract

Background and objectives: Little is known about the use of chronic medications (CMs) in children. We assessed the prevalence of CM use in children and the association of clinical characteristics and health care resource use with the number of CMs used.

Methods: This is a retrospective study of children ages 1 to 18 years using Medicaid from 10 states in 2014 grouped by the annual number of CMs (0, 1, 2-4, 5-9, and ≥10 medications), which are defined as a dispensed ≥30-day prescription with ≥2 dispensed refills. Trends in clinical characteristics and health care use by number of CMs were evaluated with the Cochran-Armitage trend test.

Results: Of 4 594 061 subjects, 18.8% used CMs. CM use was 44.4% in children with a complex chronic condition. Across all children, the most common CM therapeutic class was neurologic (28.9%). Among CM users, 48.8% used multiple CMs (40.3% used 2-4, 7.0% used 5-9, and 0.5% used ≥10). The diversity of medications increased with increasing number of CMs: for 1 CM, amphetamine stimulants were most common (29.0%), and for ≥10 CMs, antiepileptics were most common (7.1%). Of $2.3 billion total pharmacy spending, 59.3% was attributable to children dispensed multiple CMs. Increased CM use (0 to ≥10 medications) was associated with increased emergency department use (32.1% to 56.2%) and hospitalization (2.3% to 36.7%).

Conclusions: Nearly 1 in 5 children with Medicaid used CMs. Use of multiple CMs was common and correlated with increased health care use. Understanding CM use in children should be fundamentally important to health care systems when strategizing how to provide safe, evidence-based, and cost-effective pharmaceutical care to children.

Conflict of interest statement

POTENTIAL CONFLICT OF INTEREST: The authors have indicated they have no potential conflicts of interest to disclose.

Copyright © 2019 by the American Academy of Pediatrics.

Figures

FIGURE 1

Prevalence of CM use and associated health care spending in children insured by Medicaid. CM use was defined as a dispensed ≥30-day prescription with ≥2 dispensed refills. The shaded bars represent the percentage of all children in each level of CM use. The dashed line represents the cumulative percentage of all pharmacy spending. The continuous line represents the cumulative percentage of all other nonpharmacy health services spending (eg, inpatient, ED, and outpatient medical care; laboratory and/or radiographic testing; home health; durable medical equipment; and therapies). For example, the ∼1% of children who use ≥5 CMs (the 5–9 medication group and 10+ medication group) account for 20% of all pharmacy spending and 12% of spending on all other health services.

FIGURE 2

Chronic conditions associated with CM use in children insured by Medicaid. This figure reveals the distribution of the number of CMs used by children with specific chronic conditions and CCCs. For example, in children who rely on technology assistance, 15% used 1 CM, 27% used 2 to 4 CMs, 19% used 5 to 9 CMs, and 6% used >10 CMs. CM exposure was defined as a dispensed >30-day prescription with >2 dispensed refills. Chronic conditions of any complexity were identified with ICD-9-CM codes from the Agency for Healthcare Research and Quality Chronic Condition Indicator system. CCCs were identified from ICD-9-CM codes from the Feudtner and et al system (version 2).