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. 2022 Jan 13;327(6):584–587. doi: 10.1001/jama.2021.24352

US Insurer Spending on Ivermectin Prescriptions for COVID-19

Kao-Ping Chua 1,, Rena M Conti 2, Nora V Becker 3
PMCID: PMC8759024  PMID: 35024763

Abstract

This study examines insurer coverage of ivermectin prescriptions for COVID-19 in the US.


Ivermectin dispensing surged in the US in December 2020, even though evidence suggests ivermectin is ineffective for COVID-19.1,2 Studies have not assessed the degree to which insurers cover the costs of ivermectin prescriptions for COVID-19 or estimated wasteful US insurer spending on these prescriptions. We addressed these gaps by using national claims data from December 1, 2020, through March 31, 2021.

Methods

We conducted a cross-sectional analysis of the IQVIA PharMetrics Plus for Academics database. During the study period, the database included a convenience sample of 5 million patients with private insurance and 1.2 million with Medicare Advantage across the US. Compared with all US patients with private and Medicare Advantage insurance, the database contains a higher proportion of patients residing in the Midwest and a lower proportion of patients residing in the South. Because data were deidentified, the institutional review board of the University of Michigan Medical School exempted analyses from review.

We identified oral ivermectin prescriptions dispensed during the study period, excluding those for patients who lacked continuous enrollment or had a diagnosis code for a parasitic infection (B65.XXX-B89.XXX) during the 7 days before dispensing. We assumed the remaining prescriptions were for COVID-19. This approach maximized sensitivity because it captured prescriptions written during visits in which COVID-19 was not coded and during visits not billed to insurance.

For each payer type, we calculated mean insurer reimbursement, out-of-pocket spending (deductibles plus coinsurance and co-payments), and total spending (insurer reimbursement plus out-of-pocket spending) per prescription. To assess the degree to which insurers covered prescription costs, we divided aggregate insurer reimbursement across prescriptions by aggregate total spending.

To assess the potential magnitude of US insurer spending on ivermectin prescriptions for COVID-19, we estimated private and Medicare plan spending on these prescriptions during the week of August 13, 2021, the most recent week for which dispensing data were available.2 We assumed that all 88 000 ivermectin prescriptions dispensed that week were for COVID-19 except 3600, the average US weekly dispensing total in the 12 months before the pandemic2; that 52% (43 888) and 28% (23 632) of the remaining 84 400 prescriptions were paid by private and Medicare plans, mirroring the overall distribution of payer type for US prescriptions3; and that our estimates of insurer reimbursement per prescription generalized to all private and Medicare plans. We multiplied by 52 to estimate annual spending. Analyses used SAS version 9.4.

Results

Of 5939 ivermectin prescriptions, 348 (5.9%) were excluded. Of the remaining 5591 prescriptions, 4700 (84.1%) were for privately insured patients. Mean patient age was 51.8 years (SD, 15.7 years) (Table 1).

Table 1. Characteristics of Oral Ivermectin Prescriptions for COVID-19, December 1, 2020, Through March 31, 2021, PharMetrics Plus for Academics.

Characteristic Private insurance Medicare Advantage
Prescriptions, No. (%) Prescriptions per 10 000 patientsa Prescriptions, No. (%) Prescriptions per 10 000 patientsa
No. of ivermectin prescriptions 4700 (100.0)b 9.3 891 (100.0)b 7.6
Age, y
0-17 128 (2.7) 1.5 0 0.0
18-25 283 (6.0) 0.7 2 (0.2) 19.0
26-34 407 (8.7) 4.9 5 (0.6) 8.0
35-44 765 (16.3) 5.4 25 (2.8) 13.9
45-54 1296 (27.6) 15.4 18 (2.0) 4.2
55-64 1558 (33.1) 16.9 94 (10.5) 7.9
65-74 232 (4.9) 14.4 416 (46.7) 7.8
75-85 30 (0.6) 28.9 238 (26.7) 6.7
>85 1 (<0.01) 5.4 93 (10.4) 9.3
Sex
Male 2202 (46.9) 8.8 377 (42.3) 5.7
Female 2498 (53.1) 9.8 514 (57.7) 10.1
Region
Northeast 345 (7.3) 5.7 76 (8.5) 4.1
Midwest 802 (17.1) 4.5 361 (40.5) 6.9
South 1832 (39.0) 14.0 306 (34.3) 12.5
West 1706 (36.3) 12.9 144 (16.2) 6.8
Unknown 15 (0.3) 6.3 4 (0.4) 4.4
Plan type
Health maintenance organization 1363 (29.0) 13.7 540 (60.6) 6.8
Preferred provider organization 2431 (51.7) 18.0 246 (27.6) 7.9
Consumer directed 753 (16.0) 3.5 0 0.0
Point of service 73 (1.6) 2.9 0 0.0
Unknown 80 (1.7) 2.9 105 (11.8) 16.4
Month of dispensing
December 2020 1325 (28.2) 3.0 245 (27.5) 2.6
January 2021 1622 (34.5) 3.7 313 (35.1) 3.0
February 2021 997 (21.2) 2.3 166 (18.6) 1.6
March 2021 756 (16.1) 1.7 167 (18.7) 1.6
Prescriber specialty
Family practice 1393 (29.6) 257 (28.8)
Internal medicine 703 (15.0) 153 (17.2)
Nurse practitioner 633 (13.5) 179 (20.1)
Physician assistant 268 (5.7) 48 (5.4)
Emergency medicine 193 (4.1) 30 (3.4)
Pediatrics 142 (3.0) 24 (2.7)
Other 1065 (22.7) 164 (18.4)
Unknown 303 (6.4) 36 (4.0)
a

The denominator in the first row is the number of privately insured and Medicare Advantage patients in the database who were enrolled with medical and pharmacy benefits at any point from December 1, 2020, through March 31, 2021. The denominators for age, sex, region, and plan type are the number of patients in the database who were enrolled with medical and pharmacy benefits at any point from December 1, 2020, through March 31, 2021, and who were in the demographic or plan type categories in question. The denominator for month of dispensing is the number of patients enrolled in the database with medical and pharmacy benefits during the month in question. Prescription rates by specialty are listed as NA because it is unclear how the denominator would be calculated.

b

Of 5939 oral ivermectin prescriptions dispensed from December 1, 2020, through March 31, 2021, to privately insured and Medicare Advantage patients, 55 (0.9%) were excluded owing to lack of continuous enrollment in the 7 days prior to the prescription, whereas 293 (4.9%) were excluded owing to a diagnosis of a parasitic infection during this period, leaving 5591 prescriptions in the sample.

Among ivermectin prescriptions, mean (SD) out-of-pocket spending was $22.48 ($24.78) for privately insured patients and $13.78 ($26.24) for Medicare Advantage patients; mean insurer reimbursement was $35.75 ($50.63) and $39.13 ($40.18), respectively; and mean total spending was $58.23 ($51.47) and $52.91 ($42.47), respectively. Aggregate total spending was $273 681.00 for privately insured patients and $47 142.81 for Medicare Advantage patients, of which insurer reimbursement represented 61.4% and 74.0%, respectively (Table 2).

Table 2. Estimated Insurer Reimbursement per Ivermectin Prescription for COVID-19, December 1, 2020, Through March 31, 2021.

Outcome Private insurance Medicare Advantage
No. of dispensed ivermectin prescriptions 4700 891
Out-of-pocket spending per prescription, $
Mean (SD) 22.48 (24.78) 13.78 (26.24)
Median (IQR) 15.00 (11.82) 2.33 (14.06)
Insurer reimbursement per prescription, $
Mean (SD) 35.75 (50.63) 39.13 (40.18)
Median (IQR) 21.31 (49.59) 29.57 (40.70)
Total spending per prescription, $a
Mean (SD) 58.23 (51.47) 52.91 (42.47)
Median (IQR) 42.19 (38.76) 41.85 (44.12)
Aggregate insurer reimbursement across all prescriptions, $ 168 025.00 34 864.83
Aggregate total spending across all prescriptions, $ 273 681.00 47 142.81
% Of aggregate total spending accounted for by insurer reimbursement 61.4 74.0
a

Defined as the sum of insurer reimbursement and out-of-pocket spending.

In the week of August 13, 2021, private and Medicare plans paid an estimated $1 568 996.00 (43 888 × $35.75) and $924 720.16 (23 632 × $39.13) for ivermectin prescriptions for COVID-19. The weekly total of $2 493 716.16 extrapolated to $129 673 240.30 annually.

Discussion

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. For perspective, this total exceeds estimated annual Medicare spending on unnecessary imaging for low back pain, a low-value service that has received extensive attention.5 The true amount of waste is even higher because estimates did not include Medicaid spending. Moreover, by reducing barriers to a drug that some individuals use as a substitute for COVID-19 vaccination or other evidence-based care, insurance coverage could increase spending for COVID-19 complications.

Limitations of this study include unclear generalizability to all private and Medicare plans. Despite this, findings suggest insurers could prevent substantial waste by restricting ivermectin coverage; for example, by requiring prior authorization. Although these restrictions might impede ivermectin use for non–COVID-19 indications, low prepandemic levels of dispensing suggest this use is infrequent.2 Consequently, the restrictions could reduce wasteful spending, and the number of patients who would experience barriers to evidence-based treatment for ivermectin would be small.

Section Editors: Jody W. Zylke, MD, Deputy Editor; Kristin Walter, MD, Associate Editor.

References

  • 1.López-Medina E, López P, Hurtado IC, et al. Effect of ivermectin on time to resolution of symptoms among adults with mild COVID-19: a randomized clinical trial. JAMA. 2021;325(14):1426-1435. doi: 10.1001/jama.2021.3071 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 2.Centers for Disease Control and Prevention . Rapid increase in ivermectin prescriptions and reports of severe illness associated with use of products containing ivermectin to prevent or treat COVID-19. Published August 26, 2021. Accessed October 1, 2021. https://emergency.cdc.gov/han/2021/han00449.asp
  • 3.IQVIA Institute for Human Data Science . The Use of Medicines in the US. IQVIA Institute; 2021. [Google Scholar]
  • 4.Chernew ME, Rosen AB, Fendrick AM. Value-based insurance design. Health Aff (Millwood). 2007;26(2):w195-w203. doi: 10.1377/hlthaff.26.2.w195 [DOI] [PubMed] [Google Scholar]
  • 5.Schwartz AL, Landon BE, Elshaug AG, Chernew ME, McWilliams JM. Measuring low-value care in Medicare. JAMA Intern Med. 2014;174(7):1067-1076. doi: 10.1001/jamainternmed.2014.1541 [DOI] [PMC free article] [PubMed] [Google Scholar]

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