Polypharmacy Common in Medicaid-Enrolled Youth With Behavioral and Mental Health Diagnoses

Although uncommon, contraindicated drug pairs have been prescribed

By Lori Solomon HealthDay Reporter

MONDAY, Sept. 9, 2024 (HealthDay News) — Contraindicated drug pairs are uncommon in youth with Medicaid coverage filling combinations of behavioral and mental health (BMH) medications, according to a study published online July 30 in BMC Primary Care.

Laura M. Borgelt, Pharm.D., from the University of Colorado Anschutz Medical Campus in Aurora, and colleagues characterized the pharmaco-epidemiology of BMH medications among children, adolescents, and young adults and assessed the prevalence of contraindicated drug pairs within this population. The analysis included 2.4 million New York State Medicaid managed care and fee-for-service enrollees (younger than 21 years) in 2014.

The researchers found that 17.4 percent of the enrollees had a visit associated with a BMH diagnosis and 5.8 percent received one or more BMH medications. Polypharmacy was common (37.8 percent of individuals with a prescription filled), generating 11,115 distinct drug combinations. A contraindicated pair of two or more BMH medications was filled by 392 individuals for 30 days or longer. The risks for a prolonged QT interval and serotonin syndrome (378 and 250 patients, respectively) were increased with the most common contraindicated pairs of medications. Ziprasidone was involved in most combinations (3,247.1 per 10,000 ziprasidone prescriptions filled).

“The fact that only a small (and therefore manageable) minority of children receive such prescriptions provides reassurance that monitoring for such prescription patterns, done at the level of the health maintenance organization, would not be onerous or lead to extensive warnings, but rather is likely to identify a very small number of real concerns, and help inform a granular review with the prescriber,” the authors write.