Insurance coverage

Insurance coverage does not match evidence

Study results show that health plans paid for most drug costs, despite the lack of effect seen on COVID-19.

New study results suggest doctors are still prescribing ivermectin and health insurers are heavily subsidizing the cost of those prescriptions, even though clinical trials have not shown the drug effectively treats COVID-19.

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, procedures and tests.

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

As a result of this coverage, investigators estimate that US Medicare and private plans may have paid $2.4 million for ivermectin prescriptions for COVID-19 during the week of August 13, 2021. only.

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, investigators said.

“Insurers typically don’t cover ineffective treatments, or at least charge patients for most costs,” said Kao-Ping Chua, MD, PhD, a University of Michigan healthcare 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 vaccinations or evidence-based treatments.

Unless strong new evidence comes to light, insurers should require doctors to justify prescribing ivermectin during the pandemic by completing pre-authorization forms, investigators said.

While they acknowledge this could make it more difficult for individuals to obtain ivermectin for its FDA-approved indication, they believe the number of such individuals would be low, pointing to findings from a CDC study showing that only about 3600 ivermectin prescriptions were filled. every 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 COVID-19 treatment,” said Chua, a pediatrician at CS Mott Children’s Hospital of Michigan Medicine and Susan B. Meister Child Health Evaluation and Research Center. in the statement.

Both the FDA and the World Health Organization have said that oral ivermectin should not be used for COVID-19 purposes except in clinical studies.

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

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

The rest of the cost was paid by the individual.

Investigators 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, they estimated that Medicare and private plans paid $2.4 million for prescriptions in that week alone.

Reference

Ivermectin Rx for COVID-19: Insurance Coverage Doesn’t Match Evidence. Eurek alert. Press release. January 14, 2022. Accessed January 17, 2022. https://www.eurekalert.org/news-releases/940273