TABLE 2b.

Single/two state medicaid pediatric psychotropic polypharmacy studies using state-based data.

Data source, Study period, References	Age, yrs.	Other	Psychotropic concomitants	Overlappingdays	Outcome
Kentucky Medicaid, 2012–2015, Lohr et al. (18)	<18	N = 273,393, continuously enrolled w/ behavioral diagnosis across 4 years	≥2 inter-class	≥90	39.5% of the cohort had ≥2 inter-class concomitants for 90 or more days. 57.2% had 2 classes; 10.2–13.4% had 3 classes for ≥90 days.
Connecticut, 1999, Medicaid, Martin et al. (32)	<19	N = 9,447 with any psychotropic dispensing	≥2 inter-class	≥7	Among those with a psychotropic dispensing, 13.6% had 2 or more classes concomitantly.
Ohio Medicaid, 2002–2008, 7 year trends, Fontanella et al. (33)	<18	N = 26,252–50,311, continuously enrolled w/ any psychotropic dispensing	Any ≥3 classes, within or inter-class by eligibility group	Codispensed: 1) any meds 2) inter-class	1) *FC: 19.8–27.3%; **SSI 18.0–24.9%. 2) *FC: 17.0–22.3%; **SSI 14.3–19.5%, illustrates that interclass is more prevalent than within class polypharmacy.
New York, point prevalence, Essock et al. (34)	<18	N = 46,828 Prescribed psychotropic classes on 4/1/2008, w/ >90 days duration	≥3 inter-classes defined as clinically questionable	≥90	12.7% of 25,727 had long use (>90 days) of ≥3 psychotropics that triggered a flag for questionable practice by expert advisory board.
Texas Managed Care, 2013–2015, to assess single/multiple providers associated w/ pediatric psychotropic polypharmacy, Medhekar et al. (35)	<19	N = 24,147 w/ single or multiple prescribers and a mental health diagnosis	≥2 inter-class	≥60	20.1% of youth had 2 or more psychotropic classes. Patients with a psychiatrist involved in the treatment had 5.3 and 3.6 times higher odds of receiving polypharmacy as single or multiple prescribers, respectively.
2 abutting mid-Atlantic states, 1999, Medicaid & SCHIP, dosReis et al. (36)	<20	N = 8,953 (State A); 48,080 (State B), any continuously enrolled	≥2 inter-class within same month	Duration of overlapping months	Any months of 2 or more classes for State A (27.9%) and State B (29.7%); 5–12 months of concomitant use for A (43.2%) & B (37.5%).
Mid-Atlantic Medicaid,2014, Zito et al. 2020 (20)	<20	N = 237,393, continuously enrolled w/ any antidepressant dispensing	ATD + 1 class; ATD + 2 classes; ATD+ ≥3 classes	≥60	***ATD + 1 class=22.1%; ATD + 2 classes=14.2%; ATD+ ≥3 classes=5.65%. 25% of ATD-medicated youth had a behavioral diagnosis. Examples: ATD + ATP, ATD+stimulant, and ATD+α-agonist.

^*FC, Foster Care;

^**SSI, disability insured;

^***ATD, Antidepressant.