What the doctor ordered
The National Institutes of Health recently awarded Dr. Andersen $275,000 to study prescription drug utilization and health outcomes, as they relate to diabetes, urinary tract infections, and pneumonia.
He’s exploring the effects of utilization management – restrictions that insurance companies can place on medications, treatments, and procedures – on beneficiaries’ health outcomes.
“UTIs and pneumonia are quite common for Medicare subscribers – and major causes of morbidity and mortality. We track diagnoses, drugs dispensed, and patient outcomes. Different plans use different utilization management strategies, so we can compare how they’re doing,” he says.
“Since 2006, more than 30 million Americans have been enrolled annually in various Medicare Part D plans. Almost half of all drugs in these plans have some type of utilization management. Understanding these effects will provide insight into whether we should regulate utilization management.”
The Bryan School researcher is also exploring how the process is impacting prescribed opioid use, and by extension overdose rates. Preliminary results show that Medicare manages drugs with overdose risks more tightly – a positive impact. “Having a prior authorization or therapy requirement means you’re less likely to have an overdose.”
But, he adds, economists always look for the trade-offs. “This may mean some patients suffer more pain.”