AHRQ Publications Influence North Carolina Medicaid Policy

AHRQ's Technical Brief "Particle Beam Radiation Therapies for Cancer" was highly instrumental in changing North Carolina's Medicaid coverage policy to allow particle beam radiation treatment for some children with cancer. The technical brief was one of two AHRQ publications that influenced health policy in the State.

Particle beam therapy can target radiation to specific treatment areas, while sparing surrounding healthy tissues. North Carolina officials relied on AHRQ's publication to learn more about the effectiveness of particle beam radiation, which, because of its precision, is believed to be useful in treating tumors located near sensitive organs.

Coverage of particle beam radiation had been prohibited by North Carolina's Medicaid program until State officials became aware of AHRQ's publication. After receiving a request to provide particle beam radiation to a child with a malignant spinal cord tumor, North Carolina policymakers reviewed AHRQ's report and revised their policy in 2010 to allow coverage for children in certain cases.

Randall Best, MD, JD, Chief Medical Officer of the Division of Medical Assistance, North Carolina Department of Health and Human Services, says, "There was little expert opinion about particle beam radiation in 2010. AHRQ's brief offered a very comprehensive summary of research about this new form of treatment and provided the basis for our approving particle beam radiation treatment to children in certain cases. We were faced with the clinical question of whether this type of treatment was necessary for this child, and AHRQ's report pointed out that the treatment could be highly beneficial to children in particular."

AHRQ's publication notes that the therapy could be beneficial to pediatric patients, who are more susceptible to radiation side effects than adults, because particle beam radiation can target radiation dosage much more effectively than conventional radiation. However, the report does note that particle beam therapy's potential advantages over other types of radiotherapy have not been verified in long-term outcome studies. North Carolina's Medicaid program now covers particle beam radiation each year for as many as 10 children, who are treated out of State because no particle beam radiation facilities are located in North Carolina.

Additionally, AHRQ's comparative effectiveness review about using off-label atypical antipsychotics led North Carolina officials to more closely track prescriptions for children younger than 18 years of age. "Efficacy and Comparative Effectiveness of Off-Label Use of Atypical Antipsychotics" supports the idea that off-label use of atypical antipsychotic medications should be monitored because of numerous possible side effects.

According to Best, this publication helped persuade North Carolina officials to develop the Web site "Document for Safety," which is the home for the State's Medicaid medication-related safety and quality programs. Providers who prescribe antipsychotic drugs for off-label use in children younger than 18 years of age are required to register their patients on the Web site and track any side effects observed over time.