Recently my Medicare supplemental insurance agent contacted me for the annual review of my policy. He found I could be saving >$100 per month by switching from Aetna to Cigna. We went through the application questions, I was contacted by Cigna with more questions and verifications, and a few days later I learned Cigna’s underwriting had declined me. The reason listed was that I had taken Sirolimus, which is on their “Declinable Drugs” list, based on it being normally prescribed for a “Declinable Condition” (presumably kidney transplants). I had started taking sirolimus in 2018, via Dr. Green, and stopped in March 2020 (due to concerns about it suppressing my immune system when the Covid epidemic was beginning). So the last prescription was over 4 years ago, but apparently they use some “RX database” from Milliman IntelliScript that lists all the prescriptions a given individual has ever had filled. I’m working with my agent to determine whether their decision can be appealed, based on the fact there was no kidney transplant involved. From Cigna’s declining letter, it sounds like appeals are possible, but no guarantee. And of course my agent is looking into other carriers that might save me almost as much in premiums.
I’m posting this new thread to ask whether this has happened to any other individuals who have filled prescriptions for sirolimus for longevity purposes, and subsequently switched carriers for Medicare Part B Supplemental coverage.
I did look up Cigna’s official “Declinable Drugs” list, and sirolimus is on there. Interestingly, I also looked at Aetna’s list, and sirolimus is NOT on theirs. But since I’ve had the Aetna policy since I turned 65, I don’t believe I would ever need to be re-qualified if I stay with them.
A sad commentary on the American healthcare system. I hope you still have health insurance.
Not surprised, honestly.
Husband switched our family insurance plan to Cigna in January.
Saved a bit of money each month, but costs us much more overall … it is by far the worst insurance we’ve ever had for doctors, prescriptions, preauthorizations, EVERYTHING.
Can’t wait to switch to something else next January.
I had a recent decline on new health insurance for similar - as I had meds that were optimizing health, without actually having a diagnosis of hypertension or hyperlipidemia, but on meds that would treat these. Of course no amount of explanation matters.
I guess one advantage of getting ones meds out of India … no records of being on meds!
As much as I dislike universal healthcare, it would fix some of these issues. Although I guess the government could then oversee all prescriptions and decline Rapamycin.
It’s all the more reason to buy your prescription drugs from India. Only in America are you penalized for being proactive with your health!
It makes me sick. 
As much as I like universal healthcare, and while it would help in this specific case cited above, we commonly hear from people in Canada and Europe that rapamycin is much, much harder to get than in the United States.
National healthcare systems help most people better as is suggested by longer lifespans in those countries, but they are also very conservative, and don’t like innovation (at least they seem to adopt innovations very slowly, like any large organization… but even worse without any incentive) with the result that a much smaller number of people in those countries are able to get rapamycin through legitimate channels. I I find to be the ultimate irony, because national healthcare systems would benefit the most with easy access to rapamycin by their populations; longer healthier lives, means lower sick care costs.
Every healthcare (sick care) system has issues… and unfortunately for people who are longevity enthusiasts, we are way too far out on the fringe for the systems to effectively deal with us.
I agree, in my almost 10 years in Australia - any physician doing care outside of the norm would be at serious risk of being reported to AHPRA - the national regulatory agency for physicians. I actively participated in the reporting of a physician along with multiple colleagues of a aberrant physician - but he had it coming - and was properly sanctioned. The customs controls going into AU is tight and you won’t get much through at all. They take their work VERY seriously!
Just to further confirm this… To the best of my knowledge there is not a single doctor prescribing rapamycin in Canada yet (at least publicly. some people have told me they have gotten prescriptions but that the doctor doesn’t want his or her name publicized), no confirmed doctors in western Europe, none in Japan, and only a single doctor in Australia.
Perhaps most amazing (at least to me), there are no prescribing doctors in the San Francisco / silicon valley… which is ridiculous as I would bet the highest density of rapamycin users is here. People here are very interested in all sorts of technological advancement and want to push the envelope… as Bryan Johnson’s “cult-like” following suggests in this post: Bryan Johnson Longevity Protocol Discussion (2024) - #13 by RapAdmin
With telemedicine and Indian suppliers this is less of an issue, but still… It reflects poorly on the silicon valley medical community.
I get Buck institute longevity researchers asking me how to get rapamycin. This is a messed up healthcare situation.
I had trouble buying extra life insurance last year for a similar reason. The underwriting department had no statical category for aggressive prevention. I learned to be very careful about what gets recorded in my medical records, so I feel that I have to hide things from my doctor.
Funny thing is, here in Hong Kong, I can walk into a doctor’s office and ask him to write me a prescription. 5 minutes later I have one for whatever I want.
But, then I usually default to buying Indian generics for 50-90% off the price.
This is really interesting. Did you get a sense for why they gave you trouble? Was it just medicine use that they didn’t like the association with, or fear that you would live too long?
I have to believe with all the press the past few years about longevity drugs, that the actuarial scientists are concerned about losing out on policies for people that live much longer than they had planned…
A news item on this issue (out of Canada):
increased life expectancy is a challenge for financial institutions, because when people live longer than expected, they get more pension and health insurance payouts and, in some cases, life insurance payouts. That means increased liability for insurance companies and pension plans.
In the past, when insurance companies sold people policies, they underestimated how much more longevity could improve. Even a slight underestimation can have a big impact, says Li.
“If you manage a pension plan and you have, say, 10,000 retirees, and every year you have to pay a pension of, say, $20,000 per retiree… if people are living one year longer than expected, your plan has to pay $200 million additionally,” says Li, who holds the Fairfax Chair in Risk Management.
“Twenty years ago, people expected human longevity to stop improving at some point in time or at least slow down. But it turns out it hasn’t.”
Related:
But they should be able to hedge this risk
Longevity insurance
Insure against the possibility that plan members live longer than expected.
These are probably the only people that COVID brought happiness to. 
This is really a problem - the people that are optimizing their health and are likely the lowest risk get penalized. If I could just get insurance that is for trauma and malignancy - I’d be happy. My likelihood of stroke or heart disease is near zero. But nothing is that specific. They just assume if you have certain meds on your profile it means you have disease.
For my patients, I have to justify writing an Rx and put in Htn, Hyperlipidemia, overweight … etc — but these patients are managing their conditions pro-actively. Whereas the patient who avoids medical care, has no diagnosis, yet has the conditions ends up skating through in many situations.
There needs to be a situation where someone can optimize and be rewarded, not punished for it.
I don’t know the entirety of their concerns because I was able to appeal the decision and resolved it before I had to ask for a copy of the internal report (one has a legal right to this in the United States). But what I do know is that it seemed to be focused on all the tests that I had been ordering through my doctor. Though I don’t disclose everything I’m trying with my doc, she is very generous about ordering labs for me because she’s onboard with the concept of monitoring biomarkers for prevention.
There were a couple notes and tests in particular that spooked the underwriter. One was a request, but not a result, for genetic cancer screening. I had a parent who was a carrier for a common mutation, and I wanted to know my status. The underwriter did not understand this concept and was very suspicious that my doctor thought I had cancer and that we were concealing that. The other item was related to a deep dive into immune function and inflammation. I simply wanted more information to see if there was anything to work on, but the underwriter implied that ordering the labs suggested that I was hiding a known autoimmune condition.
With my doctor’s help, the appeal was successful, but simply trying to collect data about my health caused a lot of trouble. The underwriter never really believed our explanations, acting like he had never seen medical records like mine (healthy but with lots of uncommon tests), but by the end of the process the insurance company had no documented basis for denial so they had to back down.
I now use Marek Diagnostics for anything out of the ordinary, and I show the results to my doctor but do not give her a copy.
Yes, well put. I was very frustrated by what happened, and I suspect that it wasn’t just the extra labs that I have ordered, but also some of the preventative medications that my doctor does help me with that caused the underwriter to be concerned (see my other reply). Apparently being very proactive is so rare that those working in the current system simply cannot comprehend it.
The meds are a real problem as it seems almost impossible to block a central database from knowing all meds you picked up at a pharmacy. I was looking into this last night and don’t see an effective one stop way to essentially remove my consent for pharmacies to share my data.
I understand for controlled substances the need, but for all drugs, we’ve had a loss of privacy. Furthermore, when you give consent to the insurance company to get your medical records - all of this is included. It really incentivizes people to do things to fly under the radar and not use standard care, self order, etc. There is a real risk with this.
I got my life insurance when I was in much worse health, but on no meds, and formally had no conditions. No problem getting through and being rate well, despite being 50 lbs heavier than I am now and likely meeting criteria for metabolic syndrome, being borderline on lipids and BP.
Now I’m dramatically better, optimized in every way - and there is no possibility anyone would write a new policy for me. My list of meds would make the uninformed think I have severe health problems and might be ready to die any day now!
Incidentally, lab results do not have a similar central database and are local to the lab company. Now if ordered by your doctor and pulled into your EMR … sure. But you can self order via UltaLabs, for example, and there will be no record unless you share into a system with your doctor and they import into your EMR.
Spot on. I agree with everything you’re saying 100%.
Yes, what you described above re: EMR is what happened and why I’m using Marek Diagnostics for many things now.
Causation or correlation do you think?
Why on planet earth would you tell an insurance company that you are taking or took Rapamycin? or am I missing something (i.e: you wanted them to pay for it? which doesn’t quite make sense since you could get it for very cheap from india)
p.s aha i didn’t read the part where you explain how they might have got that info (through the lab work). That is scary that these mf-ers are even allowed to look that deep into someone’s health history.