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.