During the week of August 13, 2021, around 88,000 ivermectin prescriptions were filled in the U.S. ... [+]
Even if you haven’t been taking ivermectin for Covid-19, you may still end up paying for it. A study described in a research letter published recently in JAMA estimated that ivermectin prescriptions cost private and Medicare insurance plans over $2.49 million during the week of August 13, 2021, alone.
And when insurers see a cost, are they going to really keep it to themselves? Chances are they’re going to pass it along at least to some degree. Take a wild guess as to who’s going to end up paying for such costs? Well, go to the bathroom, turn on the light, look straight in the mirror, point your finger forward, and you may find your answer. When people take an anti-parasitic medication in an attempt to prevent or treat Covid-19 despite lack of scientific evidence to support such use, it may not be just their problem. It can be your problem as well.
Here’s a tweet from JAMA about the study:
The team that conducted the study consisted of two faculty from the University of Michigan Medical School (Kao-Ping Chua, MD, PhD, an Assistant Professor, and Nora V. Becker, MD, PhD, also an Assistant Professor) as well as Rena M. Conti, PhD, an Associate Professor from the Questrom School of Business at Boston University. They used data from the IQVIA PharMetrics Plus for Academics database, which included a sample of five million patients with private insurance and 1.2 million with Medicare Advantage across the U.S. Of note, rather than a random or nationally representative sample, this was a convenience sample. That doesn’t mean that the sample was found in a convenience store. Instead, it was just a sample of folks who happened to be in the database. This sample consisted of a higher proportion of people from the Midwest and a lower proportion of folks from from the South than you’d expect if the sample were truly random and representative of the U.S. So take any results with an Ugg boot of salt.
They searched the database for all prescriptions for oral ivermectin. Of course, ivermectin does have its established legitimate uses. Spoiler alert, this doesn’t currently include Covid-19. Some people do need ivermectin to treat parasitic infections such as intestinal strongyloidiasis and onchocerciasis. So, the team excluded all prescriptions for those who had a diagnosis code for such parasitic infections. The week of August 13, 2021, saw about 88,000 ivermectin prescriptions. Not surprisingly there wasn’t an explosion of intestinal strongyloidiasis and onchocerciasis that week. People weren’t running saying, “what’s with all these parasites?” Only around 3,600 prescriptions that week seemed linked to parasitic infections. Therefore, the rest of the prescriptions were presumably for Covid-19.
The team then calculated how much was spent on such prescriptions and how much the insurers may have had to cover by taking a closer look at 5,591 of these ivermectin prescriptions. Most (84.1%) of these prescriptions were for patients with private insurance. On average, patients were 51.8 years of age. During the chosen week, patients with private insurance on average spent $22.48 out-of-their-pockets on ivermectin, with the insurers reimbursing $35.75 for a total cost of $58.23 (if you add the out-of-pocket expenses and the reimbursement). Those with Medicare Advantage spent $13.78 with Medicare Advantage reimbursing $39.13, for a total cost of $52.91. Total spending then was $273, 681.00 for privately insured patients with 61.4% of that being insurance reimbursement and $47 ,142.81 for Medicare Advantage patients with 74.0% of that being reimbursement.
Extrapolating these costs to the entire U.S. yielded total costs of $1, 568, 996.00 for private insurers and $924,720.16 for Medicare Advantage for ivermectin prescriptions for Covid-19 during the week of August 13. This added up to $2 ,493, 716.16 for the week.
That ain’t an insignificant amount of money. To put it in perspective, that’s well over 830,000 pieces of avocado toast, depending on what else happens to be on the toast. That’s also over 2.9 million toilet paper rolls, the good kind of toilet paper that doesn’t fall apart when you are using it. Projecting the total cost for a week to an entire year resulted in an estimated $129. 6 million. You could construct multiple, multiple toilet paper fortresses with that amount.
Of course, the $129.6 million figure assumed that ivermectin prescribing would remain throughout the course of a year at the same level as it was during the week of August 13, 2021. And it’s not yet clear how ivermectin prescribing levels may have fluctuated after that week in August. Dr. Chua did point out in a tweet thread the trends in ivermectin use leading up to August 2021:
According to the graph provided in the tweet, ivermectin prescriptions really began picking up in November-December 2020. That seemed to correspond with last Winter’s Covid-19 surge. In the ensuing months, the prescribing dropped down to levels that were still significantly higher than pre-pandemic times. Then these levels rose rather dramatically in July-August 2021. What happened in July-August 2021? Well, the answer rhymes with “Smovid-19 smurge.” If you recall, a Summer Covid-19 surge, potentially fueled by premature relaxation of Covid-19 precautions like face-mask wearing and the emergence of the Delta variant.
In the tweet right before the one with the graph, Chua offered the following, “if ivermectin dispensing follows COVID-19 case counts, then it’s quite possible that there are way more ivermectin prescriptions per week right now than 88,000 given that the U.S. currently has > 700k cases/daily.” Sure, this relationship between case-counts and prescription patterns is speculation. Yes, the study relied on a convenience sample. And yes, as indicated earlier, take this study’s specific year-long estimate with an Ugg boot of salt or two.
Nonetheless, an average of $2.5 million a week even over the course of just 40 weeks would already exceed the total cost of other much more legitimate treatments for other important conditions, such as low back pain, as Chua tweeted:
In the end, any amount that equates to over 2.9 million rolls of toilet paper in a week isn’t something to sneeze about, so to speak.
So who’s going to pay for all of the past and future insurance costs for ivermectin being used to treat and prevent Covid-19? Will insurance company executive take out their credit cards or crack open their piggy banks to pay for them? Will private insurers say, “don’t worry we’ve got this?” Or will they spread out such costs to others in the form of increased insurance premiums for all? Or at least most? Well, any additional costs to Medicare are subsequently shouldered by tax payers because ultimately tax payers pay for the Medicare program. Therefore, unless you somehow managed to avoid paying taxes and don’t pay for insurance, you may at some point pay for some portion of that $2.49 million or so during the week of August 13, 2021.
And remember this is all for use of a medication that’s not been supported by scientific evidence. The National Institutes of Health (NIH) Covid-19 Treatment Guidelines clearly state that, “There is insufficient evidence for the Covid-19 Treatment Guidelines Panel (the Panel) to recommend either for or against the use of ivermectin for the treatment of Covid-19. Results from adequately powered, well-designed, and well-conducted clinical trials are needed to provide more specific, evidence-based guidance on the role of ivermectin in the treatment of Covid-19.”
This raises the question: why have insurers been reimbursing for such use of ivermectin? Why haven’t they been restricting such reimbursements instead? In his tweet thread, Chua suggested that “imposing prior authorization for ivermectin may be one of the rare policy solutions with a lot of potential benefits and few potential costs.” Prior authorization, otherwise known as pre-authorization, prior approval, precertification, or more informally “tell-me-why-you-need-it-and-we’ll-think-about-paying-for-it,” is when an insurance plan requires patients or doctors to submit evidence that a health care service or product is medically necessary before the insurance plan will consider any reimbursement for that service or product. The emphasis here is on the word “consider.”
Many insurance plans already impose such prior authorization requirements for a number of procedures, medical devices, and medications, including those that have way more evidence supporting their use than ivermectin has for Covid-19. For example, as the American Cancer Society website explains, “Prior authorization is often used with expensive prescription drugs. It means that your doctor must explain that the drug is medically necessary before the insurance company will cover it.” The American Cancer Society didn’t list this on its website just for the fun of it. Insurers can require prior authorization for various very legitimate cancer treatments. The website continues with, “The company may want you to use a different medicine before they will approve the one your doctor prescribes. They may also limit how much of the drug you can have, or how many refills.”
Before anyone yells the words “freedom” and “liberty,” Chua emphasized that imposing prior authorization wouldn’t mean that doctors couldn’t still prescribe ivermectin for Covid-19:
It would just mean that the patient getting ivermectin would have to pay for the medication himself or herself. This is similar to what happens when someone tries to buy leg warmers, a sweater vest, or low riding pants, despite recommendations not to do so.
This is not to say that insurers haven’t been supporting legitimate Covid-19 prevention measures or treatments throughout the pandemic. But the study results do highlight the potential costs of misinformation. And that misinformation has continued throughout much of the pandemic, like a continuously running shower hooked up to a bunch of toilet bowls as a source. As I’ve already covered for Forbes, some politicians and TV/podcasting personalities as well as a merry band of anonymous social media accounts continue to push the use of ivermectin for Covid-19. For example, the following Now This video covered some of what FOX News host Tucker Carlson has said about ivermectin:
Now, it’s not clear how many of these personalities and accounts are quietly making money from such use of ivermectin. But if they are, take a guess as to who’s paying them. Still haven’t figured it out yet? Again, walk into the bathroom, turn on the light, and look straight into the mirror.
