Managed Healthcare Executive - October 2008 - (Page 29)

“I don’t like to see an increased need for intervention, but realize that there is an opportunity to change lifestyle behavior delaying or mitigating complications from obesity,” he says. “On the other hand, I am concerned that medications will be used instead of diet and exercise.” According to Michael S. Jacobs, national clinical practice leader with Buck Consultants in Atlanta, treating children with drugs designed for adult diseases has the potential to send a message that unhealthy behavior is acceptable because the responsibility to treat the problem lies with other sources or the problem will be solved by science at the expense of employers or the government. “The drugs have a tendency to work to resolve an immediate health condition,” Jacobs continues, “but they do not work to solve the underlying problems—an unhealthy diet and lack of exercise. So lowering the cholesterol in a child, for example, is not the solution, but might buy time to get the child to solve the problem.” According the General Accountability O ce (GAO) in a paper released in 2007, only about one-third of the drugs that are prescribed for children have been studied and labeled for pediatric use. “The use of medications in the pediatric population that have been approved for use in adults for the treatment of ‘adult diseases’ has been a topic of controversy for decades,” Tegenu says. “It has been a rather hot topic for the past 10 years with a signi cant number of legislative and FDA initiatives enacted to provide more information on the effects of these drugs in infants, adolescents, and teens.” One of the concerns is that medications prescribed for adults at certain dosages do not always translate to children, who are physiologically di erent. Tegenu says doctors walk a ne line every time they use a drug in a child that has little or no clinical evidence to suggest that: 1) the drug will have the same positive e ect on a child that it has on an adult, and 2) that the side e ects the child might su er as the result of taking the drug are limited to those observed in adults during the clinical trials for a particular product. He attributes the lack of clinical trials on children to safety issues and insu cient nancial incentives for manufacturers. EXECUTIVE VIEW Weigh risks and beneﬁts when considering use of typical adult drugs for children. Adult drugs might be a last resort when other treatments have been tried. Advocate lifestyle changes as much as possible to treat children. “Our experience, however, is that physicians are extremely cautious when prescribing ‘adult drugs’ to their pediatric patients,” he continues. “These drugs are typically reserved for those situations when all the drugs, if any, that have been studied in kids for a particular condition have been tried and failed. There is also a signi cant amount of personal experience with di erent drug products that physicians make available on the Internet and through non-peerreviewed medical literature.” PerformRx has put precautionary processes in place to prevent the use of inappropriate amounts/dosages of these drugs for pediatric populations. For the vast majority of these cases, the physicians have exhausted the traditional treatment options. Over the last decade, however, more research has been done on the e ects of drugs on children, providing more guidance for physicians, Dr. Weisbart says. As more and more children require drugs to treat chronic illnesses, doctors will spend more time considering their appropriateness. The age at which children should be treated for elevated cholesterol, for example, does not have a valid answer. ADDITIONAL FACTS Tegenu notes that research on about 200 drugs not typically used in kids have provided additional information to physicians considering the use of these drugs for their pediatric patients. The information is not always enough to provide adequate guidelines for use but can provide some additional clinical facts, he says. “The challenge is the lack of guidelines for use of certain drugs in children and the handful of clinical trials a rming their e cacy and e ectiveness,” adds Lynn Nishida, director, clinical pharmacy services for Regence headquartered in Portland, Ore. She recommends nonmedical interventions rst for conditions such as high blood pressure, along with earlier screenings of children and edits to manage use when appropriate. In July, the America Academy of Pediatrics recommended that children as young as eight should be given cholesterollowering drugs and that high-risk children should be screened as early as two years old. A recommendation from the American Heart Assn. re ects a similar stance: statins as rst-line treatment for children who meet criteria for starting lipid-lowering drug therapy based on family history, obesity and heart-disease risk factors. The National Heart, Lung and Blood Institute is currently developing a new integrated guideline, which will address all the known risk factors for development of atherosclerosis as part of routine pediatric care. MHE FOR MORE INSIGHT See more Pharmacy Best Practices on managedhealthcareexecutive.com OCTOBER 2008 29 http://www.managedhealthcareexecutive.com

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Managed Healthcare Executive - October 2008 For Your Benefit Editorial Advisors Contents News Analysis State Report Politics &�Policy Healthcare Reform Trends in 2009 Cost Control Strategies Predicted Premium Increase Top Challenges in 2009 IT System Integration Technology Innovation Disease Management Health Management Pharmacy Best Practices Technology Desktop Resource Ad/Edit Index Managed Care Outlook Statement of Ownership

Managed Healthcare Executive - October 2008

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