Foster care psychotropic prescribing regulations are complex and insufficient.

Introduction: Federal and state policymakers, accreditation organizations, and mental health agencies developed standards for evidence-based use of psychotropic medications among youth in foster care. Despite these efforts, foster youth are vulnerable to psychotropic polypharmacy, high dosing, and low rates of monitoring. This manuscript aimed to (1) analyze state-specific psychotropic oversight programs, and (2) examine specific state approaches and outcomes. Methods: State guidelines, including all 50 United States and Washington, DC, were identified via Google search and a Center for Health Care Strategies, Inc., 2018 technical assistance tool. For each state, authors documented whether guidelines were specific to foster care and whether they included thresholds related to polypharmacy, metabolic monitoring, age-based prescribing, maximum dosages, and any distinctive characteristics. Results: Most states (61%) have published a foster care psychotropic guideline; 9 states (18%) do not have a one, and the authors were unable to locate guidelines for the remaining 11 states (22%). More than one-third of foster care youth (38%) live in states with no psychotropic monitoring requirements. Sixty-three percent (n = 32) of states require a prior authorization (PA) or drug utilization review (DUR) for youth prescribed more than 1 psychotropic. Forty-seven states have age-based prescribing support in place, with PA (n = 28) and DUR (n = 9) being the most common oversight processes. Conclusions: States have a wide range of age restrictions, approaches to PA and DUR, and prioritization of monitoring. Some states lack guidelines entirely. Variability in state psychotropic oversight programs, reporting methods, and data collection contributes to barriers to successful optimization of psychotropic prescribing among youth in foster care.