New data examine pediatric ADHD medication prior authorization policies in Medicaid managed care plans

by Temple University Center for Public Health Law Research

edited by Gaby Clark, reviewed by Andrew Zinin

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New data published by the Center for Public Health Law Research (CPHLR) at Temple University Beasley School of Law offer an in-depth look at prior authorization policies that apply to children younger than 18 in Medicaid managed care plans. The data capture details of Medicaid managed care policies for the 50 U.S. states and the District of Columbia, describing policies governing access to ADHD medications as of Oct. 1, 2025, including prior authorization and age requirements and prerequisites for nonmedication alternatives.

According to 2024 data analyzed by the Centers for Disease Control and Prevention and Health Resources and Services Administration (HRSA), more than 7 million (11.7%) U.S. children ages 3–17 had a current attention-deficit/hyperactivity disorder (ADHD) diagnosis, with approximately half taking ADHD medication.

Data from the Medicaid and CHIP Payment and Access Commission (MACPAC) show that more than 85% of children enrolled in Medicaid are covered by managed care plans. As a key delivery system, managed care plans play a role in determining how Medicaid policies governing access to ADHD medications operate. These policies can include prior authorization requirements for prescription medication that restrict approvals to patients of a certain age or require additional provider involvement before approval for payment is granted.

As of Oct. 1, 2025, 158 Medicaid managed care plans across 31 states (including the District of Columbia) provide coverage for ADHD medications, according to the new data on LawAtlas. Within those managed care plans, 129 plans impose prior authorization requirements or age restrictions for ADHD medications prescribed to children younger than 18.

"These data are a first step in providing us with a better understanding of the barriers to access children face around the country," said Adam Herpolsheimer, JD, a law and policy analyst at the Center for Public Health Law Research. "Because each state approaches its managed care policies differently, it's important to continue evaluating the ways these policies disparately affect American children and their families seeking support for ADHD."

Other results from this research include:

• Pharmacy benefits for pediatric ADHD medications are included within 158 Medicaid managed care plans in the United States.
• Across 28 states, 129 managed care plans impose prior authorization or age restrictions for ADHD medications prescribed to children younger than 18.
• Seven managed care plans require concurrent behavioral therapy, a referral to behavioral therapy or proof of an impending appointment for behavioral therapy for medication to be covered.
• Fourteen managed care plans require a prior trial and/or concurrent failure of behavioral therapy for medication to be approved.

Diagnosis and treatment for ADHD can involve frequent interactions with the health care system and medical professionals and may include psychosocial treatment, pharmacological treatment or both. Telehealth can increase access to specialty care in communities with shortages of health care professionals, including rural areas.

A policy brief by CPHLR researchers released alongside this dataset considers state telehealth laws governing the use of telehealth for ADHD or Tourette syndrome diagnosis, monitoring or treatment. The policy brief summarizes the legal landscape and evidence and offers a research agenda and policy options for future consideration. It contributes to a more holistic understanding of how laws act as facilitators or barriers to supports and treatment for children with neurodevelopmental conditions.

The dataset was created using scientific legal mapping methods that support the creation of high-quality scientific legal data for research and practice. The data may be explored and downloaded for free on LawAtlas.org.

More information

Center for Public Health Law Research, Temple University (2026, August 21). Pediatric ADHD Medication Prior Authorization Policies in Medicaid Managed Care Plans. LawAtlas.org. lawatlas.org/datasets/pediatri … policies-in-medicaid

Key medical concepts

Attention Deficit Hyperactivity DisorderBehavior TherapyDrug Therapy

Clinical categories

PediatricsChildren's healthPsychiatryPsychology & Mental health Provided by Temple University Center for Public Health Law Research Who's behind this story?

Gaby Clark

MA in English, copy editor since 2021 with experience in higher education and health content. Dedicated to trustworthy science news. Full profile →

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Citation: New data examine pediatric ADHD medication prior authorization policies in Medicaid managed care plans (2026, September 11) retrieved 11 September 2026 from https://medicalxpress.com/news/2026-09-pediatric-adhd-medication-prior-authorization.html This document is subject to copyright. Apart from any fair dealing for the purpose of private study or research, no part may be reproduced without the written permission. The content is provided for information purposes only.