U-M study: Ivermectin doesn’t treat COVID, but insurers pay for it anyway

Ivermectin likely doesn’t work against COVID-19, according to most research to date. But that hasn’t stopped insurers — sometimes using taxpayers dollars — from covering it, according to two University of Michigan researchers and a third researcher from Boston.

Paying for treatments that are not yet shown to be effective isn’t just “wasteful spending,” the researchers wrote, but will have additional costs if consumers forgo proven COVID vaccines in favor of a drug that is not likely to work should they become ill.

It’s an unusual twist in the usual complaints against insurers, U-M’s Dr. Kao-Ping Chua, who led the study, told Bridge.

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“A lot of people get annoyed with (insurers) when they don't cover evidence-based treatments,” said Chua, a primary care pediatrician and health policy researcher at the U-M Medical School. “Here's an example where insurance is covering something that doesn't work.”

The team wrote about their findings in a research letter published this month in the peer-reviewed Journal of the American Medical Association.

Early in the pandemic, ivermectin seemed to show promise in the fight against COVID. The anti-parasitic drug has been used to treat a number of conditions for humans, including scabies, and veterinarians may use it to treat mites, scabies, and intestinal parasites such as hookworms and roundworms. The drug is cheap and accessible, too.

However, some of those early studies were based on small numbers of COVID cases or based in laboratory work rather than real-world patients; other early studies were criticized for lack of scientific vigor.

Research since then has overwhelmingly failed to show any meaningful differences between patients who had taken ivermectin to treat COVID and those who did not. In March, the World Health Organization warned against its use, saying that studies had been “inconclusive.”

Still, prescriptions for ivermectin surged again last summer as the delta variant drove another COVID surge.  About 3,600 ivermectin prescriptions were issued per week before the pandemic; in the week ending Aug. 13, 2021, more than 88,000 prescriptions were filled — a 24-fold increase, the Centers for Disease Control and Prevention noted in a health alert in August. The CDC noted a rise in “misuse and overdose” of ivermectin for COVID. 

The American Medical Association has joined the American Pharmacists Association and the American Society of Health-System Pharmacists to “strongly oppose” ivermectin’s use outside a clinical trial to treat COVID-19 and, further, to advise doctors instead to warn patients of its misuse. And the FDA issued a consumer alert about ivermectin, tweeting a week after the CDC alert: “You are not a horse. You are not a cow. Seriously, y'all. Stop it.”

It was the CDC alert that caught the attention of Dr. Chua and others.

“My first thought was, ‘I really hope that insurance isn’t covering this, because insurance should not pay for services that don't have evidence of efficacy,’” Chua told Bridge. 

Chua’s study team also included U-M health care researcher Dr. Nora Becker and Rena Conti, a Boston University researcher. Chua and Becker also belong to the U-M Institute for Healthcare Policy and Innovation.

The research trio pulled four months of insurance data covering ivermectin  prescriptions — a period from Dec. 1, 2020 to March 31, 2021.  They examined 5,600 prescriptions for oral ivermectin that weren’t written for a parasitic infection.

The total cost per prescription was $58 for private plans or $52 for Medicare Advantage plans. In both circumstances, the insurers agreed to pay for more than half of the prescriptions. In the case of government-run Medicare, that means taxpayers help foot the bill, Chua said.

That’s not a big price tag individually, given the drug’s cost, he acknowledged. But he argued that “the exact numbers themselves matter less than the principle that insurers are paying millions of dollars for an ineffective drug.” 

The billing data examined by the researchers is now old — in some cases more than a year old. But the CDC alert in August confirmed ivermectin’s continued use for COVID, he said.

Estimating that all but 3,600 of the 88,000 ivermectin prescriptions filled in the week of August 13 were for COVID-19, the authors further estimated that private and Medicare plans paid $2.4 million for prescriptions in that August alone. Assuming those prescribing levels remained the same, that amounts to about $130 million a year, they concluded.

Such prescribing may not be all that surprising. Doctors have repeatedly said that patients have demanded unproven therapies during the pandemic.

Those demands have, at times, grown increasingly angry, as the pandemic drags on, Dr. Gary Roth, chief medical officer for the Michigan Health and Hospital Association said Monday. 

“It has created quite a controversy to the point where it can become a very hostile discussion, where patients and families are demanding a treatment that a physician cannot ethically, morally, or certainly scientifically, provide,” he said.

Still, he said, he does not believe Michigan hospitals are prescribing ivermectin for COVID. In fact, the research letter noted that prescribers of the drug include family doctors and internists — clinicians outside the hospital setting.

The current and immediate past president of the Michigan Association of Family Physicians told Bridge in emails that they, themselves, long ago stopped prescribing ivermectin.

Others have wondered if dosing is the missing piece of the puzzle if ivermectin is to work, or if it must be used in combination with other medications. 

In one of the latest studies of ivermectin’s possible use against COVID, researchers scaled up the dosage, but still found no impact, according to the preprint version of the study in the International Journal of Antimicrobial Agents.

Whether the drug may have an impact at lower doses “remains debated,” according to the authors. 

For now, their findings “further support the recommendation of the (World Health Organization), suggesting that it is currently advisable to refrain from administrating ivermectin for the treatment of COVID-19 outside clinical trials,” the authors wrote.

More than three dozen clinical trials continue examining ivermectin and COVID, according to clinicaltrials.gov.

But unless new evidence upends the current doubt about ivermectin’s effectiveness, insurers should require doctors to justify prescribing the drug for COVID by essentially asking permission from the insurers first — known as prior authorization, the authors of the U-M-led letter wrote.

That wouldn’t preclude its use or bar clinicians from prescribing the drug; it simply would limit the number of insurance companies paying for it, said Chua.

Meanwhile, a bill being considered before the Michigan House Health Policy committee Thursday would extend Michigan’s “Right To Try” law that allows terminally ill patients access to experimental therapies.

By adding new wording, the law would hold harmless doctors or pharmacists who prescribe off-label drugs for COVID treatment as long as both the patient and doctor have agreed to the prescription, said Michigan Rep. Mary Whiteford, R- Casco Township, a former nurse who sponsored the bill.

Whiteford said she’s not taking a position on any drug, including ivermectin. Rather, she said, doctors should be protected as they try to save dying patients.

“There's always innovation in our medical world, and I think we need to be able to be very nimble in our responses, with safety always being number one,” she said.