How Much Did US Insurers Waste on Ivermectin for COVID?

Rena Conti, a Questrom School of Business associate professor of markets, public policy, and law, studied insurance claims and reimbursements data and found payments towards ivermectin for COVID-19, plugged by right-wing media despite its unproven efficacy, may have topped $130 million last year. 

News clips from here and here. 

Transcript

Dana Ferrante: This is Question of the Week, from BU Today. 

How much money did US insurers waste on ivermectin for COVID? 

Ivermectin is an anti-parasitic drug, often prescribed to humans in small doses to treat things like tropical diseases or head lice. More commonly used to treat livestock, ivermectin is toxic to humans in large doses. As the Delta variant surged last summer, so did calls to poison control centers as some Americans began purchasing and self-medicating with ivermectin intended for animals.

Newsclip: "CDC issuing an emergency alert to people who may be trying to self-treat or prevent COVID by using a medication that's intended for large animals..."

Ferrante: Despite lacking FDA approval, ivermectin prescriptions for COVID-19 have soared since late 2020, fueled by certain right-wing media that has continually promoted unproven coronavirus treatments, while casting doubt on vaccines and masks.

Newsclip: "Ivermectin has received a recent boost from online misinformation, prompting warnings from the FDA and other health officials. The FDA tweeting last month, ‘you're not a horse, you are not a cow. Seriously, y'all. Stop it.’”

Ferrante: In this episode, BU Today senior writer Rich Barlow, talks to Rena Conti, associate professor of markets, public policy, and law at Questrom. In a new study, Conti and her colleagues at the University of Michigan found that in 2021, health insurers, including Medicare, may have paid more than $130 million for prescriptions of ivermectin to treat COVID-19.

Rich Barlow: Thank you again, Professor Rena Conti, for joining us. I will just start with the big question. How much money did US insurers waste last year prescribing ivermectin for COVID?

Rena Conti: Approximately $130 million.

Barlow: And when we say waste, that's because the clinical evidence [has] disproven ivermectin as an effective COVID treatment.

Conti:  What we know is that there are no studies that suggest ivermectin is effective at treating COVID-19.

Barlow: And again, just to clarify, because I know some people have been popping animal ivermectin for COVID, in your study—since it focused on prescriptions and insurance payments—your study looks at the human version of the medicine, which is unproven as a COVID treatment.

Conti: Correct. So US pharmacies dispense human formulated ivermectin to American consumers, and our study looked at ivermectin for human treatment.

Barlow: Where did you find information on the amount spent on ivermectin for COVID?

Conti: We used an insurance claim database that contains information on approximately six million Americans. And we had both information about the rationale for their treatment and also the prescriptions that were dispensed and paid for.

Barlow: And to be clear, we're talking private insurers and Medicare prescriptions, or reimbursements, that you looked at?

Conti: That's right, we looked at people who are commercially insured in the small group, large group, and individual insurance markets.

And all of the data was publicly available and also is de-identified. So we can't see any of these people's names, where they live, their insurance information. All we could see is, did they or did they not get a prescription dispensed of ivermectin? How much did they pay for that?

How much did the insurer pay for it? And then, what was the clinical rationale? Was it for COVID or for some other potential diagnosis?

Barlow: Do I understand correctly: if anything, your $130 million spending figure for ivermectin last year may be an underestimate, as you didn't look at Medicaid, which also covers, pays for, or reimburses for ivermectin.

Conti: Right, so we didn't look at seniors who are insured by the federal government public program called Medicare. And we also didn't look at ivermectin prescriptions dispensed for COVID-19, and covered by state insurers through their own plans. We also know that people are getting prescriptions for ivermectin through vets and through some other intrepid means. And our study didn't account for that type of dispensing behavior and consumption either.

Barlow: Do you happen to know, before the pandemic hit us, how often ivermectin was prescribed?

Conti: It's actually a very rarely used drug for some very selected indications, and one of the advantages of our study design is we can actually see ivermectin prescriptions pre-COVID. We accounted for that non-COVID use in our analysis. So basically, what we're estimating are prescriptions for ivermectin that are for COVID specifically, accounting for that other potential indicated use.

Barlow: Got it. We're talking about a drug that has not been found to be effective against COVID. Why would doctors prescribe, and why would insurers pay for, a drug for COVID that has no proven clinical effectiveness?

Conti: Right, so this is really wasted spending, and really the thing that we're most concerned about is that not only is ivermectin not indicated for the treatment of COVID-19, but there are actually FDA-approved and indicated treatments for COVID-19 that people are using instead of this type of treatment, or instead of ivermectin. And so this suggests that there's some combination of patients demanding, and physicians acquiescing to, the use of ivermectin in a non-indicated setting. 

And really, again, this is waste. Waste because there are treatments available that do work both to prevent COVID-19 and also to mitigate the significant effects of COVID-19 when infected.

Barlow: Is it your speculation that basically doctors are just knuckling under to patient pressure? Are they figuring, it's not that expensive? And if the patient wants it, they'll avoid a scrap with them. What's going on?

Conti: So I would say, really, what we think is happening here is it's some combination of patients demanding and physicians acquiescing to patient demand for the use of these products even though they're unproven. The cost is really not what drives physicians or patients to use one product over the other.

Barlow: What about the insurers? Why would they fork over this money for an ineffective treatment?

Conti: Well, indeed, we know that there are many insurers who've actually restricted access to ivermectin for COVID use in the past 18 months. And have gently guided physicians and their patients to use more indicated preventives and treatment, including vaccines, but other types of treatments as well.

So I would say the good news of our study is that the spending is significant, but it could be much worse. We could be spending a lot more money on products that don't work in the middle of the pandemic. And if anything, our study suggests that maybe insurers might want to consider other types of supply-side tools or physician and patient education to really steer people towards using things that are actually proven.

Barlow: There is something that can be done about this. It sounds like education, more education of insurers and patients, is the way to fix this. Am I understanding you correctly?

Conti: What I would say is that insurers are doing their best with very imperfect information. And can they do more? Absolutely, and what our paper really suggests is that insurers might want to consider additional provider education and patient education to support the use of indicated treatments and preventives for COVID-19, as opposed to wasting money on things that don't work. We don't want to suggest that doctors are doing something wrong or that insurers are doing something wrong.

There's just imperfect information, and there's a lot of misinformation about what is effective both for preventing and treating patients with COVID. And just like patients can be subject to misinformation, so can physicians.

Barlow: Might a doctor listening to this say, 'Hey, we are permitted in our best professional judgment to write prescriptions for off-label use...Ivermectin is prescribed for other conditions, but if we think it's appropriate, we are legally allowed.' They're not breaking the law, I want to make clear—in other words, by prescribing something for a condition or a sickness for which it is not designed, that this is called off-label use.

Conti: Right, so I've written extensively about off-label use in many different settings. The drug is FDA-approved for other indications for which it has been established to be both safe and effective. Ivermectin is not FDA-approved or proven to be safe and effective for the treatment of COVID-19. The physicians can prescribe drugs for off-label uses. Usually, in this setting, insurers or pharmacies might restrain access to products for which there is no supporting evidence, even if a physician and a patient choose to go ahead and prescribe, dispense, and consume a product.

Barlow: Thank you for agreeing to do this. It was a really interesting study, which is why the editor asked that it be made the topic of our podcast.

Conti: Thank you so much.

Ferrante: Thanks to Rena Conti for joining us on this episode of Question of the Week.

This episode was edited by BU Today executive editor Doug Most, engineered by Andy Hallock, and produced by me, Dana Ferrante. 

Thanks for listening and see you in two weeks.