Insurers Target Antibiotic Overuse
Twenty-four of the nation's "largest health insurers," including Aetna Inc., Cigna Corp. and WellPoint Health Networks Inc., are preparing to unveil a "concerted strategy" to combat the overprescription of antibiotics, using "reams of medical-claims and pharmacy data that will tell them which U.S. doctors continue to prescribe too many antibiotics," the Wall Street Journal reports. The campaign aims to slow the growing number of bacteria that become resistant to antibiotics. Researchers blame the advent of these "superbugs" partly on the overprescription of antibiotics, estimating that more than 40% of the 110 million courses of antibiotics prescribed each year -- including 17 million for the common cold -- are "unnecessary."
The insurers' campaign involves "flood[ing]" doctors' offices and workplaces with posters and pamphlets that include CDC antibiotic prescription guidelines and describe the "dangers" of antibiotics. To determine whether the campaign works, the insurers plan to "direct particular scrutiny" to providers in San Diego, Norfolk, Va., and Connecticut to monitor the number of prescriptions they write for patients under age 16 who have sore throats. In particular, insurers will determine whether doctors first take a throat culture to determine if an antibiotic is necessary, the Journal reports. If insurers discover that providers still are overprescribing antibiotics after the campaign has begun, some health plans might "take more active measures" such as visiting the "prescription-happy" providers to "persuade them to change their practices," the Journal reports.
The insurers say they have no plans to "punish" doctors who overprescribe, but rather believe "that just making doctors aware of where they stand next to other doctors [in terms of prescription habits] will goad most of them into better prescription use." Aetna launched a similar program two years ago, sending "friendly letters" that detailed the "dangers of resistant bacterial strains" and a copy of the CDC antibiotic guidelines to 3,200 doctors who prescribed antibiotics more than their peers. One year after the letters were sent, the doctors in question wrote 20% fewer antibiotic prescriptions, the Journal reports.
The health plans say the campaign "is for the public's good," but the Journal reports that it also is a way to contain rising health care costs. Antibiotics "are an obvious target" because insurers, patients and employers spend $15 billion annually on prescription antibiotics. However, the health plans' strategy might "not go over well with doctors and patients," the Journal reports, noting that patient groups have become "more critical about insurers muscling in on doctor-patient relationships," and doctors "wince at any suggestion that their judgment might be second-guessed by insurers." Insurers also will have to be vigilant "not to run afoul of" patient privacy rules currently being considered by the Bush administration, the Journal reports. The health plans say the information they use from the Norfolk, San Diego and Connecticut doctors and patients will be stripped of doctor and patient names and then given to a third-party research firm to process (Martinez, Wall Street Journal, 4/9).This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.