Dental Care for Kids on Medicaid Varies by Fees Each State Sets (HealthDay)

By Steven Reinberg
HealthDay Reporter by Steven Reinberg
healthday Reporter – Tue?Jul?12, 11:52?pm?ET

TUESDAY, July 12 (HealthDay News) -- Low reimbursements to dentists from Medicaid make getting dental care difficult for children and adolescents covered by the government health plan, new research suggests.

Sandra L. Decker, senior service fellow in the division of health care statistics at the U.S. Centers for Disease Control and Prevention, found that in states with the highest Medicaid payments, children were more likely to get dental care, although they received care less often than children with private insurance.

"This may be partly because a lot of dentists don't participate in the Medicaid program, so they don't treat children with Medicaid," Decker said.

"In a lot of states, Medicaid dental fees are very low, so a dentist doesn't want to treat a Medicaid patient," she said. "So, low fees affect whether children on Medicaid get care."

The good news is that in states that raised their Medicaid reimbursements more children were able to find dental care, Decker said. "Some of those children were receiving dental care at the same rate as privately insured children," she noted.

But this progress may be in danger as states look for ways to cut costs. At a time when state budgets are being slashed, it is likely that reimbursements for dental care won't go up and may even be reduced, she added.

The report was published in the July 13 issue of the Journal of the American Medical Association.

Dr. Judy Schaechter, associate chair of pediatrics at the University of Miami Miller School of Medicine, said that "the relationship between type of insurance and visiting a dentist is well established."

But, "what this paper adds is that it reveals the direct relationship between Medicaid fee and provision of care," she said.

The reasons connecting fees to access are many, Schaechter said. "Among them are that fewer dentists will accept the lower fees, which hardly cover their costs for cleaning let alone their responsibility when they find severe dental disease," she said.

A recent study showed that some dentists agree to participate in Medicaid, and then make it difficult for Medicaid patients to see them for dental care, Schaechter added.

"From the patient perspective, if that happens enough, they think no one will see them. They give up trying to find a Medicaid dentist," she said. "Finally, with little to no financial incentives, neither dentists nor the Medicaid dental insurers are motivated to do sufficient outreach and educate families about coverage and the need to get preventive care at least every six months."

States are obligated to provide children with the same access and quality of health care through Medicaid as they would get with private insurance, Schaechter said. "We simply can't do that if we are not willing to pay for it."

For the latest study, Decker used data from the National Health Interview Survey from 2000-2001 on 33,657 children and adolescents, along with data on Medicaid dental fees in 2000 and 2008 in 42 states and the District of Columbia.

She found that in 23 states, the 2008 Medicaid dental fees were lower than they were in 2000 (after adjusting for inflation). In 19 states and the District of Columbia, Medicaid fees were higher in 2008 than in 2000.

In Connecticut, Indiana, Montana, New York, Texas and the District of Columbia, Medicaid payments to dentists increased by at least 50 percent between 2000 and 2008, Decker said.

Whether a child or adolescent had seen a dentist in the past six months was dependent on the type of insurance they had, Decker found.

In 2008 and 2009, children on Medicaid were less likely to see a dentist compared with children with private insurance (55 percent versus 68 percent, respectively) in the past six-month period. However, both groups were more likely to see a dentist than children without any coverage (27 percent), the study found.

As payments for dental care increased, children on Medicaid were more likely to see a dentist, Decker said. For example, a $10 increase in Medicaid payments for a check-up, from $20 to $30 between 2000 and 2008, increased the likelihood that a child would see a dentist by 3.92 percent.

More than one-third of children in the United States are covered by public health insurance, primarily Medicaid and the Children's Health Insurance Program. Covering dental care for children and adolescents is required by these programs.

However, states can set payment rates for dentists, so these rates vary by state. In addition, dentists are not required to see Medicaid patients.

More information

For more on Medicaid dental care, visit the U.S. Centers for Medicare and Medicaid Services.

Supreme Court strikes down state drug data-mining law (Reuters)

WASHINGTON (Reuters) – The Supreme Court struck down a law that prohibits the use of prescription drug records for marketing, ruling for free-speech rights over a state government's medical privacy concerns.

The high court handed a victory to data-mining companies IMS Health, Verispan and Source Healthcare Analytics, a unit of Dutch publisher Wolters Kluwer, which had challenged the law. The companies collect and sell such information.

By a 6-3 vote, the justices on Thursday upheld a ruling by a U.S. appeals court that Vermont's law infringed on commercial free-speech rights in violation of the First Amendment of the U.S. Constitution.

The law, adopted in 2007, prohibited the sale, transmission or use of prescriber-identifiable information for marketing a prescription drug unless the prescribing doctor had consented.

Vermont, Maine and New Hampshire are the only states to have adopted such laws, although similar measures have been proposed in about 25 states in the last three years.

Pharmaceutical manufacturers use data about a doctor's prescribing habits to better inform their drug salespeople when they visit physician offices to market certain products.

According to evidence presented in the case, pharmaceutical manufacturers spend nearly $8 billion annually on marketing efforts directed at doctors.

"Speech in aid of pharmaceutical marketing, however, is a form of expression protected by the Free Speech Clause of the First Amendment," Justice Anthony Kennedy wrote in the court's majority opinion.

PRIVACY OF DOCTORS AT ISSUE

The case did not involve the privacy rights of patients, as that already is protected under federal law. But Vermont said its law was aimed at protecting the privacy of doctors.

Companies that collect the data have said the information about doctors' prescribing patterns can be used to help monitor safety issues of new medications, to reduce costs, and for research purposes like studying treatment outcomes.

The law's supporters, including the Obama administration, said it helped protect medical privacy and control escalating healthcare costs by promoting cheaper generic drugs over more expensive brand-name drugs.

Vermont pharmacies must collect prescription drug information. The law bars pharmacies from disclosing the data and gives prescribing doctors the right to consent before any information is sold or used in marketing.

Attorneys for the drug companies said the law discriminated against the companies, making it harder for them to get their message to doctors. They argued the law unfairly favored views espoused by the state and insurance companies that favor generic drugs.

Kennedy agreed and said the law imposed content-based and speaker-based burdens on protected free-speech expression.

While Vermont's goals of lowering the costs of medical services and promoting public health may be proper, the state does not achieve those goals in a permissible way, he said.

"The state may not burden the speech of others in order to tilt public debate in a preferred direction," Kennedy concluded in the 25-page opinion.

"We're extremely pleased with the outcome," said Thomas Goldstein, an attorney who represented the data companies.

"It validates what the companies have been saying about the implications of information for healthcare," Goldstein told reporters in a press briefing. "The court agrees with us that the use of information here like in other contexts is a public good and that it will help healthcare."

"The court says here that information is extremely valuable for good decision-making in our society and that's true in medicine as well," Goldstein said. "And that if doctors want to hear from detailers, they need to be able to hear from them without the government getting in the way."

Justices Stephen Breyer, Ruth Bader Ginsburg and Elena Kagan dissented. Breyer called it a lawful governmental effort to regulate a commercial enterprise.

Vermont Attorney General Bill Sorrell expressed disappointment with the ruling. "We knew going in that this Supreme Court has frequently sided with large corporations," he said. He called the decision "a step back, but not the end of the story."

Senator Patrick Leahy, a Vermont Democrat who chairs the judiciary committee, denounced the ruling. "This decision is another example of this court using the First Amendment as a tool to bolster the rights of big business at the expense of individual Americans," he said.

The Supreme Court case is Sorrell v. IMS Health, No. 10-779.

(additional reporting by Lewis Krauskopf in New York; editing by Gerald E. McCormick, Maureen Bavdek, John Wallace and Gunna Dickson)

No state lawsuits on generic drugs: US Supreme Court (AFP)

WASHINGTON (AFP) – The US Supreme Court narrowly ruled on Thursday that people may not sue generic drug makers under state laws if they believe a generic drug label failed to adequately warn of side effects.

The 5-4 ruling handed a victory to drug makers Teva Pharmaceutical Industries Ltd of Israel, the US company Mylan Inc and Actavis Inc of Iceland by blocking three consolidated lawsuits against them.

Plaintiffs had argued that they suffered a neurological disorder called tardive dyskinesia after taking the generic anti-heartburn drug metoclopramide (Reglan, Metozolv), which they said did not contain adequate warning labels.

The plaintiffs were prescribed the generic drug for Reglan in 2001 and 2002.

As early as 1985, evidence began to surface that long-term use of the drug could have serious side effects, but strong warnings were not added to the brand name drug labels by federal regulators until 2004 and 2009.

In 2009, the Food and Drug Administration ordered its strongest black box label warning that "metoclopramide can cause tardive dyskinesia, a serious movement disorder that is often irreversible... treatment with metoclopramide for longer than 12 weeks should be avoided in all but rare cases."

Even though the plaintiffs were prescribed the generic drugs before the stronger labels were federally ordered, they argued that the state should have done more to protect them by changing the generic drug labels because there was evidence to suggest long-term use could be harmful.

They sued the generic manufacturers under state tort laws that said the companies should have taken steps to protect consumers.

However the US high court said that federal laws require generic drugs to have the same labels as the brand names they copy, so courts could not demand they meet a different state standard at the same time.

"State tort law places a duty directly on all drug manufacturers to adequately and safely label their products," said the decision read by Justice Clarence Thomas.

"If the manufacturers had independently changed their labels to satisfy their state-law duty, they would have violated federal law.

"Thus, it was impossible for the manufacturers to comply with both their state-law duty to change the label and their federal law duty to keep the label the same."

The four liberal justices -- Sonia Sotomayor, Ruth Bader Ginsburg, Elena Kagan and Stephen Breyer -- dissented.

"As a result of today's decision, whether a consumer harmed by inadequate warnings can obtain relief turns solely on the happenstance of whether her pharmacist filled her prescription with a brand-name or generic drug," said Sotomayor.

The decision affects 75 percent of all prescription drugs dispensed in the United States, the court said. When a generic is available to substitute for a brand name drug, the generic version is given out 90 percent of the time.