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Dana Ferrante: This is Question of the Week, from BU Today.
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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.
>> Clip: "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..." >> 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.
>> Clip: "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. >> 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?
>> Conti: Approximately $130 million.
>> And when we say waste, that's because the clinical evidence
[has] disproven Ivermectin as an effective COVID treatment.
>> What we know is that there are no studies that suggest
Ivermectin is effective at treating COVID-19.
>> 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.
>> Correct, so US pharmacies dispense human
formulated Ivermectin to American consumers, and
our study looked at Ivermectin for human treatment.
>> Where did you find information on the amount spent on ivermectin for COVID?
>> We used an insurance claim database that contains
information on approximately 6 million Americans.
And we had both information about the rationale for their treatment and
also the prescriptions that were dispensed and paid for.
>> And to be clear, we're talking private insurers and
Medicare prescriptions, or reimbursements, that you looked at?
>> 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?
>> 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.
>> 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 count for
that type of dispensing behavior and consumption either.
>> Do you happen to know, before the pandemic hit us,
how often Ivermectin was prescribed?
>> 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.
>> Got it, got it.
We're talking about a drug that is 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?
>> 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.
>> Is it your speculation that basically doctors are just
knuckling into 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?
>> 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 costs is really not what drives physicians nor
patients to use one product over the other.
>> What about the insurers?
Why would they fork over this money for an ineffective treatment?
>> 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.
>> 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?
>> 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.
>> 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 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.
>> 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.
>> 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.
>> Thank you so much.
>> 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.
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