Volatility in Remdesivir prices ups claim rejection

Chennai: Huge variations in the prices of Remdesivir — a crucial drug in the treatment of severe cases of Covid — have resulted in a large increase in insurance claim rejection and also black-listing of hospitals by insurance companies. With Covid infections hitting a new high every day, there is a shortage of the antiviral Remdesivir. This is leading to emergency purchases of higher-priced drugs. As a result, insurers are now rejecting many more claims for cashless treatment than they used to earlier. General insurance companies like Bajaj Allianz General Insurance, Star Health and Max Bupa say the rejection rate of Covid claims have gone up from 2-3% last year to as high as 9%. Insurers have called for price controls for commonly used pharmaceutical products like anti-virals and anti-biotics on a war footing. Star Health and Allied Insurance is blacklisting a growing number of hospitals for price-gouging, its MD S Prakash said. “The MRP of important Covid drugs like Remdesivir is quoted differently by different hospitals, resulting in retail prices that are five-six times higher.

Prakash said, “We know the true cost and the MRP of Remdesivir by the same company is fixed differently for different hospitals, although the cost price is the same. The hospital with higher infrastructure fixes a higher MRP on these drugs and could go as high as 5x-6x from its original retail price.”

Insurers say that some unscrupulous providers are pushing patients into intensive care even when there is no requirement. All insurance companies are now facing a higher claims loss ratio, which has gone up by 4-5% YoY in April 2021.

With the physical of hospitals by insurers suspended due to the pandemic, Covid-related frauds have gone up and turned the underwriter cautious. “In evaluating Covid claims, we are unable to see the patients in hospitals due to no physical visits and this has made insurance underwriters cautious,” its director underwriting, products & claims Dr Bhabatosh Mishra said.

State authorities require that Covid patients isolate in a room with an attached bathroom. If such access to an exclusive bathroom is not available, state authorities require isolation in a facility. “We have seen many Covid patients who get hospitalised and discharged after three days without being given Remdesivir. According to ICMR guidelines, mild Covid patients are better to stay at home quarantine,” he said.

Source: The Times of India