To Fight Superbugs, Health Insurers Play an Important Role

In the U.S., approximately a third of antibiotics prescribed in outpatient settings are unnecessary, and further research shows that patients often do not receive the recommended antibiotic for their condition. Such inappropriate prescribing accelerates the emergence of antibiotic resistance and puts us all at risk.  

To address this issue, representatives from U.S. health insurance companies, health systems, state health departments, academia, and the Centers for Disease Control and Prevention came together to explore effective ways that insurers can support efforts to improve antibiotic use in doctor’s offices and other outpatient settings. The meeting, held in Atlanta from Jan. 22-23, was hosted by The Pew Charitable Trusts as part of Pew’s ongoing work to combat antibiotic-resistant bacteria and preserve the effectiveness of life-saving antibiotics.

Because insurers have access to medical and pharmacy claims data, they are well positioned to support efforts to assess antibiotic prescribing practices and supply providers with feedback, which is an essential component of CDC’s core elements of outpatient antibiotic stewardship. Specifically, insurers can use this data to identify high prescribers within their networks and then take steps—such as providing tailored reports to providers on their prescribing practices, sharing educational materials with these individuals, and other proven stewardship strategies—to encourage more appropriate prescribing.

In order to support efforts from health insurers, experts at the meeting focused on identifying effective approaches that have already been implemented by insurers, health systems, and other health care stakeholders to track and report antibiotic prescribing. They also explored challenges they anticipate in implementing antibiotic stewardship.

As a follow-up to the January meeting, CDC, Pew, and other partners will collaborate on creating tools to help payers, health systems, and others implement data-driven antibiotic stewardship initiatives. Pew looks forward to continued collaboration with CDC, insurers, and other stakeholders on finding solutions to reduce inappropriate antibiotic use and combat antibiotic resistance.

David Hyun, M.D., is a senior officer and Rachel Zetts, M.P.H., is an officer with The Pew Charitable Trusts’ antibiotic resistance project.