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Fam Pract Manag. 2007;14(8):14

Supply of free antibiotics grows

Another major chain has begun to provide free generic antibiotics to shoppers who come in with a prescription, and some doctors are worried about the giveaway's medical implications.

Publix, a Florida-based grocer that operates nearly 700 pharmacies in six Southern states, now offers unlimited 14-day supplies of amoxicillin, ampicillin, cephalexin, ciprofloxacin, erythromycin, SMZ-TMP and penicillin VK. Those same seven generics have been available free under the same terms at Meijer stores since October. Michigan-based Meijer runs 176 stores in five Midwestern states. Similarly, Wal-Mart offers more than 300 generic drugs for $4 per prescription.

The retailers say their primary interest is to help their customers, but economists see another motivation. “Retail outlets often feature so-called loss leaders to lure customers into their store,” Uwe Reinhardt, a professor of political economy at Princeton University, told ABC News. “This happens to be the ultimate loss leader.”

While acknowledging that the generic programs provide financial relief to families, some doctors have expressed concerns about the medical implications. “If these drugs are cheap, there is a natural tendency to take them only until you feel better,” Steven M. Donn, MD, professor of pediatrics at Mott Children's Hospital in Ann Arbor, Mich., told ABC News. “The rate of relapse can go up and complications are more severe.”

Officials challenge insurers' ratings of doctors

Health insurers' programs that attempt to rank physicians based on the quality and cost-effectiveness of the care they provide are being criticized for using questionable data and concentrating more on cost than quality.

In July, New York Attorney General Andrew Cuomo asked United Healthcare to halt a controversial physician ranking program planned to go into effect this month, and he warned legal action if the company does not comply.

When a similar United Healthcare program was piloted in Missouri in 2005, physician outrage forced the program to be suspended. Stephen Slocum, MD, president of the St. Louis Metropolitan Medical Society, said in the July 14 New York Times that the program was “dishonest. They were telling people that it was a quality metrics program when they were really just measuring cost.”

In August, Cuomo asked Aetna and Cigna to explain their physician-ranking programs as well and questioned their reliance on claims data, which do not contain complete clinical data to measure quality effectively, he said.

“The health care companies have an economic interest in seeing the customer go to the doctor or institution that charges the least amount of money,” Cuomo told the Associated Press on Aug. 16. “Cheaper is not necessarily better, and we don't want a health care system where we enter a race to the bottom.”

Earlier this year, Connecticut physicians filed a lawsuit against Cigna and United Healthcare accusing the companies of libel, unfair trade practices and breach of contract because of their physician-ranking programs.

Medical groups' profits surge in West

The annual Medical Group Compensation & Financial Survey, published by the American Medical Group Association, found that medical groups across the country were operating at an average loss of $119 per physician. There were regional differences, with the most dramatic being between the rising West and the sinking South.

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