Insurance coverage does not match evidence


Newswise – Even though clinical trials haven’t shown it works against COVID-19, doctors are still prescribing ivermectin – and a new study suggests that health insurers heavily subsidize the cost of these prescriptions.

The study authors ask insurers to align their coverage of the drug with the level of medical evidence surrounding it, just as they do for other drugs, tests and procedures.

The study, published in JAMA by a team from the University of Michigan and Boston University, uses insurance data to study how much health plans paid for oral ivermectin in late 2020 and early 2021. They found that plans paid 61% to 74% of the cost, or about $36 to $39 per prescription.

As a result of this coverage, researchers estimate that US private and Medicare plans may have paid $2.4 million for ivermectin prescriptions for COVID-19 in the week of August 13, 2021 alone. If prescribing and insurance reimbursement were at this level for an entire year, insurers would spend nearly $130 million a year on the drug, despite the lack of evidence of its effectiveness.

“Insurers typically don’t cover ineffective treatments, or at least pass the bulk of the cost on to patients,” says Kao-Ping Chua, MD, Ph.D., the UM health care researcher who led the study. “Our study suggests that they treat ivermectin prescriptions for COVID-19 differently. In doing so, they are reducing barriers to an ineffective drug that some are using as a substitute for COVID-19 vaccination or evidence-based treatments.

Unless strong new evidence comes to light, the researchers argue that insurers should require doctors to justify prescribing ivermectin during the pandemic by completing a pre-authorization form.

While they acknowledge this could make it harder for patients to obtain ivermectin for its FDA-approved indications, they believe the number of such patients would be low. As proof, they pointed to a CDC study showing that only about 3,600 ivermectin prescriptions were filled each week in the United States before the pandemic.

“To be clear, clinicians can still prescribe ivermectin for COVID-19 and patients can choose to pay for those prescriptions themselves. Our point is simply that insurers should not cover these prescriptions unless ivermectin proves to be an effective treatment for COVID-19,” says Chua, a pediatrician at CS Mott Children’s Hospital of Michigan Medicine and Susan B. Meister Child Health Evaluation and Research Center.

the US Food and Drug Administration and the World Health Organization both stated that oral ivermectin should not be used for COVID-19 purposes except in clinical studies.

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Using private insurance and Medicare Advantage claims from December 2020 through the end of March 2021, the authors identified and reviewed 5,600 prescriptions for oral ivermectin that were not written for parasitic infection, the primary reason the ivermectin is prescribed other than COVID-19.

The total cost per prescription was $58 for private plans, which paid 61% of that amount, or about $36. The total cost per prescription was $52 for Medicare Advantage plans, which paid 74% of that amount, or about $39. The rest of the cost was paid by the patients.

The authors then estimated that all but 3,600 of the 88,000 ivermectin prescriptions filled during the week of August 13, 2021 were for COVID-19. Assuming the study’s findings generalize to these prescriptions, the authors estimated that private plans and Medicare paid $2.4 million for the prescriptions in that week alone.

The study team, which included a UM health care researcher Nora Becker, MD, Ph.D. and Rena Conti, Ph.D., research fellow at Boston University’s Questrom School of Business, previously published to research showing how much patients may have to pay now that insurers have stopped waiving bills for COVID-19 hospitalizations.

“It’s strange that insurers cover an ineffective treatment like ivermectin even though they try to cut costs by re-charging patients for hospitalizations related to COVID-19,” says Chua, who along with Becker is a member. from the UM Institute for Healthcare Policy and Innovation.

Quote: JAMA, DOI: 10.1001/jama/2021.24352,


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