A new research letter in JAMA Network Open by Chua, Conti and Becker attempts to estimate the cost of spurious and needless ivermectin prescriptions in the United States. They estimate for the commercially insured and Medicare Advantage markets (roughly ~56% to 61% of the population depending on how ACA exchanges are counted) that over $129 million dollars in needless ivermectin prescriptions were filled in 2021. They then make a claim about the economics of insurers:
Findings suggest that insurers heavily subsidized the costs of ivermectin prescriptions for COVID-19, even though economic theory holds that insurers should not cover ineffective care.4 Wasteful insurer spending on these prescriptions, estimated at $2.5 million in the week of August 13, 2021, would extrapolate to $129.7 million annually.
I have a problem with this sentence. I think it is too simplistic. Let’s assume that their data applies to 56% of covered lives in the US. That means their population of interest is at least 182 million people. Insurers think in terms of per member per month (PMPM) when they do cost analysis. Taking the Chua et al estimates of $129.7 million dollars in wasteful spending, this is a per member cost of 71 cents per member per year. Assuming full year enrollment this means ivermectin is about $0.06 PMPM.
Setting up a hold that routes to a prior authorization queue is not cost-free. The actual set-up is fairly straightforward but it does require analyst time as well as system validation time. Administering a queue where some of the prescriptions are legitimate and likely need a person at the insurance company to either look at a request with an appropriate diagnosis code or an actual conversation with an in-network PCP. This is not cheap. It won’t take that many conversations to make the cost of running the prior authorization process a break even at best proposition for a short term idiosyncratic spike of a dirt cheap generic being used for an off-label and dumb use.
The business case to deny ivermectin is iffy.
And that business case excludes the almost guaranteed political and media shitstorm that would likely ensue once the first prescription is denied. Insurance companies don’t like being on the front page of a newspaper or a good chunk of the 2nd block of the local 6 o’clock news. Avoiding that shit show is likely worth a few pennies per member per month.
Another Scott
Interesting numbers – it’s too early for me to think about them though.
But I wonder, given the horrorshow of the opioid epidemic, if insurance companies shouldn’t look beyond the PMPM and the possible RWNJ freakout and consider the possibility of successful civil (and maybe criminal) lawsuits from not doing sensible due-diligence?
IANAL.
Thanks.
Cheers,
Scott.
Nicole
And then when these fools die from their misuse of an ineffective medication, they’re off the health insurance company’s roll, so really, win-win for the company.
One of the reddit forums had a horrifying story from a woman whose own mother gave the woman’s 6-month-old son Ivermectin in his bottle as a “preventative” from Covid. The kid nearly died. She reported her mother (and stepdad) to the police for it.
Anon in NC
I agree – 129 million doesn’t seem large given the context.
Mousebumples
The prescription benefits manager that I work for implemented a Prior Authorization on Ivermectin in September. Covered (approvable) health issues include all FDA approved uses and those with compedial off label support. (IIb or better in Micromedex, for those that understand that reference)
I can’t speak to the larger “on the front page of the newspaper component” but it’s also cheap enough that a patient could just use a discount card and the cost may be similar to their copay anyhow. May not be worth making that much of a stink?
The Castle
So it’s death by a thousand cuts?
If any one source of medical spending waste is a small number, but an infinite number of bs medical interventions are possible, is the problem that a small number times a large number equals a large number?
David Anderson
@Another Scott: The due diligence is on the prescriber. And off-label prescriptions happen all the time for all sorts of reasons.
In the context of opioids, insurers are reasonably aggressive in restricting opioid initiation (for good and bad outcomes).
Feathers
I worked for an economist working on healthcare issues. He was horrified to learn about the monthly doctor visits required for refilling stimulant prescriptions for ADHD. They put huge costs onto the medical system, don’t appear to have lessened the abuse of the drugs, and make the lives of people who have trouble dealing with exactly this sort of time based paperwork and bureaucracy even more difficult.
I made a suggestion that these office visits should be billed to the local police department, as it was a law enforcement, not medical requirement, but that was seen as frivolous.
jonas
But think of all the savings from people synthesizing their own invermectin from livestock dosages from the local tractor supply store, cutting out that silly middleman in the white lab coat.
Soapdish
So is the argument that it is simply cheaper giving those idiots that want ivermectin the drug than it is to try to keep from giving it to them?
David Anderson
@Soapdish: That is a plausible argument, especially if we think that it will be a fad drug and the anti-vaxxers move onto something else in a few months.
Brachiator
Can I get a prescription for Wicca remedies, love potions, homeopathic concoctions, written faith-healing prayers?
Matt
Last I checked, they gave exactly zero fucks about denying claims for things like insulin – despite repeatedly _being_ on the news about it.
Let’s be clear, this is insurers worried about becoming the target of domestic terrorism.
The Pale Scot
I’d be promoting ivermectin, let the stupid die off. There will be fewer cases of long COVID, and shorter ICU stays, and fewer lawsuits over not paying for it. The insurance companies pay for a lot of other WOO WOO because it’s cheaper than therapies that work. “You want to have your chiropractor treat your cancer? Hey, your call, no problem. The prices of chemotherapy are ridiculous and who can say if its actually works anyway, don’t let science be the boss of you”
APPROVED
delk
Yeah, who needs the shitstorm when there are countless non-political drugs they can drop instead and save way more than 130 million. I know one of my non-political drugs was dropped this year.
VOR
@David Anderson:
Some have already moved on to drinking their own urine. I doubt you could get a prescription for that so insurance is off the hook.
Can confirm from personal experience getting ADHD meds is a PITA, even if you are a white middle-aged professional living in the burbs with a stable job.
Quaker in a Basement
And yet they’ll willingly endure the shit show of not covering birth control? Shouldn’t these companies be practicing medicine along with their economic considerations?
Kent
My wife is a physician with Kaiser Permanente. The other day I asked her what would happen if she tried to prescribe Ivermectin for Covid.
She laughed hysterically and then said she would probably get a phone call from their office of Quality Control in about an hour’s time asking WTF she was thinking.
But then Kaiser is vertically integrated and electronically integrated. The doctors, clinics, hospitals, pharmacists, and pharmacies are all in-house and part of the same system. So I doubt any of these Ivermectin prescriptions are coming out of the Kaiser system.
Kent
In some states you can. For some of those things. Why do you think there are so many homeopathists here on the west coast? It is because insurance is required to pay for it by law.