Prior Authorization Policies for Pediatric ADHD Medication Prescriptions

According to the Centers for Disease Control and Prevention (CDC), an estimated 6 million US children 3-17 years old have received an attention-deficit/hyperactivity disorder (ADHD) diagnosis. ADHD diagnoses estimates in US children vary widely by state (6% to 16%), with even greater variation in medication treatment estimates across states for children with current ADHD (38% to 81%). Some state Medicaid programs have implemented policies to manage the use of ADHD medications and guide physicians toward best practices for ADHD treatment in children. These policies include prescription medication prior authorization requirements that restrict approvals to patients of a certain age or require additional provider involvement before approval for payment is granted. 

This map examines features of prior authorization policies in state Medicaid fee-for-service plans that pertain to pediatric ADHD medication treatment, including applicable ages, medication types, and criteria for approval in effect as of April 1, 2023. A separate dataset that focuses on state Medicaid managed care plans in a sample of five states is available on (see Prior Authorization Policies for Pediatric ADHD Medication Prescriptions - Managed Care Plans).   

This publication was supported by the Centers for Disease Control and Prevention of the U.S. Department of Health and Human Services (HHS) as part of a financial assistance award given to ChangeLab Solutions totaling $200,000 with 100 percent funded by CDC/HHS. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by CDC/HHS, or the U.S. Government. 

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