Peer Review Policy Leads to Decreased Use of Atypical Antipsychotics in Children

child drawing on a chalkboard
child drawing on a chalkboard
The use of atypical antipsychotics can be reduced with the implementation of a peer review prior authorization policy.

According to the results of research recently published in JAMA Psychiatry, atypical antipsychotic use in children younger than 8 decreased following implementation of peer review prior authorization policies by Medicaid in 4 states.

Researchers assessed atypical antipsychotic use in children using Medicaid administrative claims data from 4 states that implemented atypical antipsychotic-related peer review prior authorization policies for children under certain ages (cutoff between 5 and 8). Monthly and quarterly atypical antipsychotic use was evaluated during the 12 months before policy implementation, the 12-month transition period (6 months before and after implementation), and 12 months post-policy implementation.

In all 4 states, the mean monthly prevalence of atypical antipsychotic use in Medicaid-insured children within the given age bracket decreased significantly after peer review policy implementation.

In older children (up to 17), that average fell outside of the peer review range and monthly atypical antipsychotic use increased in 3 of the 4 states. In the fourth state, atypical antipsychotic use decreased in older children, but the decrease in children under the peer review cutoff age was significantly greater (P =.03).

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In an interview with Psychiatry Advisor, Julie M Zito, PhD, professor of pharmacy and psychiatry at the University of Maryland, Baltimore and lead study investigator, explained that this study was necessary because the risks associated with atypical antipsychotic use in children, “challenged the earlier clinical trial safety reports” due to the risk of treatment-emergent type 2 diabetes.

In conclusion, Dr Zito explained that the results suggest, “peer review prior authorization is a welcome addition to tools for assessing the appropriateness of antipsychotic use in children.”


Zito JM, Burcu M, McKean S, Warnock R, Kelman J. Pediatric use of antipsychotic medications before and after Medicaid peer review implementation [published online November 15, 2017]. JAMA Psychiatry. doi:10.1001/jamapsychiatry.2017.3493