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Adderall For Healthy Kids: A Cost Shift To Medicaid?

Doctors in Georgia are prescribing ADHD medications to help low-income children struggling in elementary school, even when they do not have an attention deficit disorder, reports a front-page article in Tuesday’s New York Times.

The story focused on Dr. Michael Anderson in Canton, Ga., who said he had little choice in the matter if he wanted to help students boost their academic performance in under-funded schools. “We’ve decided as a society that it’s too expensive to modify the kid’s environment. So we have to modify the kid,” he told Times reporter Alan Schwarz. Dr. Anderson, Schwarz writes, is “one of the more outspoken proponents of an idea that is gaining interest among some physicians.”  

Those extra prescriptions come at a high cost to both the state and the federal government. One of the mothers profiled in the article notes that Medicaid pays for nearly every penny of her children’s prescription costs. And it’s not just stimulants like Adderall — all four children in the Rocafort family profiled in the story are on also on clonidine, a nightly sleep med that helps to counteract the effects of the other drugs.

Georgia’s Medicaid program did not respond to requests for cost data. But Melissa Carter, executive director of the Barton Child Law and Policy Center at Emory University in Atlanta, says the program spends $28 million to $33 million annually on stimulants used to treat ADHD.  

She points out that prescribing stimulants to kids without attention disorder is not necessarily a mainstream trend, but what is clear is that “parents, teachers, caregivers and even entire systems have a growing appetite to use drugs. There’s an avalanche leading towards meds as the only solution.”  That may have something to do with the years of austerity cuts to education in Georgia, which have led to larger class size, shorter school days and furloughs for teachers, says Carter.

But she says that unlike investments in schools, which can give students lifelong skills for coping and adjusting, medications may offer “the immediate satisfaction of behavioral control, but you have side effects, and you’re not giving the child any skills to help them function. Are these kids going to have to be medicated for life?”

Tim Sweeney, director of health policy for the Georgia Budget & Policy Institute, a nonprofit think tank in Atlanta, adds that Dr. Anderson’s dilemma is “an indication of a big picture need for increased investment in secondary services around education, like tutors and counselors.” To the extent that additional costs are “being born by Medicaid for prescriptions that are replacing those services, there is potentially a cost shift.”

Unlike education, however, which is paid for by mostly by the state, Medicaid costs are shared by the federal government.

“The Medicaid programs spends significant dollars on medications for high-need populations like foster children, but I’d argue this is not the most cost-effective (or best) approach to treating these children,” Shadi Houshyar, who works for the child advocacy organization First Focus, wrote in an e-mail.

Instead, she asks, “why don’t we attempt to address the poverty, lack of school funding and social barriers that contribute to the poor academic performance of these children, rather than medicate them?”

Experts and advocates did not know of any studies comparing the cost of medication versus investing in schools.