Piloting a new course to reimbursing antibiotics

Two European pilots and U.S. legislation aim to revamp the commercial market for antibiotics

The shockingly fast speed at which COVID-19 turned from a regional breakout to a global pandemic with no treatments has made it easy to imagine a similar epidemic arising from multi-drug resistant bacteria, adding new urgency to the need to fix the dysfunctional market for antibiotics.

Antibiotic development is stuck in a negative feedback loop -- with no viable commercial market for new therapies, R&D investment has nearly disappeared.

The market failure stems from strict stewardship practices dictating that new antibiotics are used only as a last line of defense. The idea is to avoid development of resistance to the new mechanism, but it ensures minimal sales unless there’s a substantial outbreak.

Another issue is the availability of cheap generics.

Industry consensus is that fixing the broken commercial model for antibiotics will require de-linking revenue from unit volume, a concept floated by numerous groups including then-FDA Commissoner Scott Gottlieb nearly two years ago

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