Medicare Reimbursement Changes May Lead to More Antibiotic Use

With improved drug coverage under Medicare Part D, the use of antibiotics by beneficiaries—particularly brand name, new, and more expensive drugs—is on the upswing, according to a study from the University of Pittsburgh Graduate School of Medicine.

In particular, the study, which appears in the Aug. 9/23 issue of the Archives of Internal Medicine, suggests recent Medicare reimbursement changes in drug coverage improved, for instance, the use of antibiotics for pneumonia. However, this also could lead to unnecessary spending for expensive broad spectrum antibiotics and possible overuse of inappropriate antibiotics.

"Overuse of antibiotics is a common and important problem that can lead to medical complications and drug resistance," said the study's lead author, Yuting Zhang, PhD, assistant professor of health economics at the University of Pittsburgh Graduate School of Public Health.

The study reviewed about 35,000 Medicare beneficiaries and examined their use of antibiotics two years before and after the implementation in 2006 of Medicare Part D, which reduced out of pocket drug spending between 13% and 23%. Increases were seen most among those seniors who did not previously have drug coverage.

Use of the broad spectrum antibiotic subclasses of quinolones and macrolides increased more than the use of other subclasses, especially for those with prior drug coverage.

Researchers said that the use of antibiotic treatment for pneumonia had tripled among seniors who previously lacked drug coverage. They noted that this was encouraging in light of the high mortality associated with community acquired pneumonia among the elderly.

They found, however, increases also in antibiotic use for other acute respiratory tract infections—such as sinusitis, pharyngitis, bronchitis and non specific upper respiratory tract infection—for which antibiotics generally were not indicated.

"Although many interventions have helped curb antibiotic prescribing for acute respiratory tract infections and other conditions, our study indicates there may still be substantial room for improvement through education and changes in reimbursement practices to reduce inappropriate use of these drugs," Zhang said.