The misuse of antibiotics continues apace, with many physicians inclined to prescribe broad-spectrum antibiotics for conditions that might need a drug with a narrower focus or that require no antibiotic at all. There seems to be a tie-in with insurance coverage, as well, says a study in the Journal of Antimicrobial Chemotherapy.

“We … found that physicians more frequently prescribe broad-based agents to patients with private insurance,” the researchers note. “This may reflect physicians’ awareness of the financial burdens, including prescription copays.”

Broad-spectrum antibiotics were prescribed 60% of the time between 2007 and 2009. Researchers looked at about 100 million ambulatory visits per year.

“In our study, broad-spectrum antibiotics were selected during almost 80% of visits for respiratory conditions for which antibiotics rarely provide benefit,” says the study “Antibiotic Prescribing for Adults in Ambulatory Care in the U.S.A., 2007–09.” It continues: “This amounts to nearly 27 million prescriptions annually, and collectively is more than one out of every four ambulatory antibiotic prescriptions, driven predominately by macrolides and quinolones.”

Other broad-spectrum antibiotics included broad-spectrum penicillins like amoxicillin and clavulanate, cephalosporins, and lincomycin derivatives.

“The use of antibiotics for respiratory conditions where they are rarely indicated remained high (46%) even when we excluded patients with comorbidities,” the study states. “Additionally, there was substantial regional variability in antibiotic use for these conditions; antibiotics were prescribed during only 38% of visits in the West compared with 60% of visits in the South.”

The authors say that this should be investigated. “This may reflect regional differences in the impact of national interventions focused on judicious antibiotic use.”

Education can work, they argue. The rate of visits to doctors’ offices that have resulted in an antibiotic being prescribed has declined in the last two decades.

What’s happening in ambulatory care needs to be addressed, since overuse of “can cause adverse events without providing any benefit.”

Managed Care’s Top Ten Articles of 2016

There’s a lot more going on in health care than mergers (Aetna-Humana, Anthem-Cigna) creating huge players. Hundreds of insurers operate in 50 different states. Self-insured employers, ACA public exchanges, Medicare Advantage, and Medicaid managed care plans crowd an increasingly complex market.

Major health care players are determined to make health information exchanges (HIEs) work. The push toward value-based payment alone almost guarantees that HIEs will be tweaked, poked, prodded, and overhauled until they deliver on their promise. The goal: straight talk from and among tech systems.

They bring a different mindset. They’re willing to work in teams and focus on the sort of evidence-based medicine that can guide health care’s transformation into a system based on value. One question: How well will this new generation of data-driven MDs deal with patients?

The surge of new MS treatments have been for the relapsing-remitting form of the disease. There’s hope for sufferers of a different form of MS. By homing in on CD20-positive B cells, ocrelizumab is able to knock them out and other aberrant B cells circulating in the bloodstream.

A flood of tests have insurers ramping up prior authorization and utilization review. Information overload is a problem. As doctors struggle to keep up, health plans need to get ahead of the development of the technology in order to successfully manage genetic testing appropriately.

Having the data is one thing. Knowing how to use it is another. Applying its computational power to the data, a company called RowdMap puts providers into high-, medium-, and low-value buckets compared with peers in their markets, using specific benchmarks to show why outliers differ from the norm.
Competition among manufacturers, industry consolidation, and capitalization on me-too drugs are cranking up generic and branded drug prices. This increase has compelled PBMs, health plan sponsors, and retail pharmacies to find novel ways to turn a profit, often at the expense of the consumer.
The development of recombinant DNA and other technologies has added a new dimension to care. These medications have revolutionized the treatment of rheumatoid arthritis and many of the other 80 or so autoimmune diseases. But they can be budget busters and have a tricky side effect profile.

Shelley Slade
Vogel, Slade & Goldstein

Hub programs have emerged as a profitable new line of business in the sales and distribution side of the pharmaceutical industry that has got more than its fair share of wheeling and dealing. But they spell trouble if they spark collusion, threaten patients, or waste federal dollars.

More companies are self-insuring—and it’s not just large employers that are striking out on their own. The percentage of employers who fully self-insure increased by 44% in 1999 to 63% in 2015. Self-insurance may give employers more control over benefit packages, and stop-loss protects them against uncapped liability.