Variation in prices for an evidence-based pediatric preventive service

Abstract

Objective: To examine variation in prices paid by private medical insurers for fluoride varnish applications in medical settings, a newly reimbursed service that few children receive. Data Sources: Private-insurance medical claims from Connecticut, Maine, New Hampshire, and Rhode Island (2016–2018). Study Design: We examined prices paid for fluoride varnish by private insurers and compared these to prices paid by Medicaid. Data Collection/Extraction Methods: Private claims for fluoride varnish during medical visits for children aged 1–5 years. State Medicaid rates for fluoride varnish were obtained from the American Academy of Pediatrics. Principal Findings: Prices paid for fluoride varnish by private insurers varied within and across states, ranging from less than $5 to $50. Median prices closely followed Medicaid rates in three of the four states. In states covering a package of fluoride varnish plus additional preventive oral health services during medical visits, combined Medicaid rates were nearly double the median price paid by private insurers. Conclusions: Fluoride varnish is a recommended service, but few children receive it. Price variation may contribute to the low uptake of this service. Ensuring sufficient Medicaid and private insurance rates could increase fluoride varnish applications in medical settings and improve oral health.