Use of Health Insurance to Cover Rapamycin?

First sorry about my broken English I am not a native speaker :slight_smile:

Can people use their health insurance to cover the off-label use of Rapamycin in America?

I am very interested in this problem because it indicates how will the health insurance industry react to the increasing longevity market.

Currently I know American insurance companies only approve drug & therapy when people have the symptom and are diagnosed with a disease. But as for ageing you don’t have a specific symptom and it is not seen as a disease. Say if there is a super expensive anti-ageing drug (more likely a gene therapy) which can prevent age-related illness, will the insurance companies cover it? If they do, then how do they decide if you are qualified to use it (everyone wants to use the most high-end product)?

What do you think of the future longevity tech and health insurance industry?

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American insurance companies, as it stands now, will not cover off-label treatments not prescribed by a doctor. If you can convince a doctor to prescribe an anti-aging drug for a “medical condition” then insurance would probably cover it.

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I’m on medicare w a supplementary policy w United Healthcare. I had a long conversation with the United agent about this about 6 months ago & he felt strongly that this was covered as long as I have a prescription. The price was fantastic as well. I haven’t used it yet but may give it a try soon. My main fear is that United may change their mind & attempt to bill me for past uses. Not sure if that’s a realistic fear though.
Jim

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I’m paying an online pharmacy a small monthly fee ($25) for the prescription, however my insurance covers the cost of the drug completely.

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Jim, FWIW last year(2022) forum member “Ross Pelton” DrRoss, wote/posted comments about medicare paying for his prescription.

Search his postings you should be able to locate the posting.

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You are getting a prescription for $25.00 for compound?

If so could you provide source?

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I would be interested to know the diagnosis these doctors are using to get it covered. Thanks for your help.

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The online pharmacy is Better Health which is based out of NYC according to the website. I pay $79 for 3 months of prescriptions getting 30mg/ month.

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Great price,Ben. Do you happen to know the diagnosis used? Thanks.

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I just told them it was for preventative medicine. I was thrilled and surprised that my insurance covered the $500+ per month it’s costing.

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I think that generally, insurance companies will try to avoid paying for anything they can possibly deny. The fewer drugs they pay for, the more money they make. Most customers don’t stay on a given healthcare insurance program long enough for the Health Insurance companies to consider the longer term benefits; they focus on the short term costs to them. Perhaps you’ve seen the Pixar movie “The Incredibles” …

So - I doubt that we will see any significant coverage of longevity drugs for a very, very long time… its got to be “standard of care” with large clinical trials proving efficacy, and we are a decade or two away from that I suspect.

Some people may be able to sneak rapamycin by them, but I think the vast majority of people will not.

There is also the issue that in the US, there is the concern that if you have a drug on your medical records that is used for organ transplantation and cancer (rapamycin’s most common applications), it might be used to deny future health insurance coverage claims (or health care insurance coverage itself) due to an “pre-existing condition” that you haven’t notified the insurance company about…

For the foreseeable future I think pretty much all “longevity” oriented drugs and treatments are going to be self-pay.

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I agree that getting the drug covered by insurance is probably unlikely. I gave it a shot fully thinking that the India pharmacy route would be the only way, but was completely surprised that my work’s primary insurance fully covered. It’s worth a try if someone has decent employer insurance.

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I tried, couldn’t find anything. Also tried ‘prescription’. Am I doing it wrong?

medicare drRoss

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I couldn’t find it either… @DrRoss , can you help Len here, I think he’s wondering what he needs to say to get medicare to cover his rapamycin prescription :slight_smile:

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Hello Everyone,
Let me try to clear up this confusion. First, realize that a) I’m only reporting my personal experience and b) I am a pharmacost. so I do have some insight into how “the system” works. I never said Medicare will pay for a rapamycin Rx. Rapamycin is only FDA-approved for preventing organ transplant rejection, and for treatment of several types of solid-tumor cancers.

I am 80-years old. I have Medicare Part A (inpatient/hosptial coverage) and Medicare Part B (Outpatient/medical coverage). I also have a secondary Medicare supplemental prescription drug plan. In order to get prescriptions covered on Medicare, you must have Medicare Part D (prescription drug coverage). I am also still working full-time, and I have an insurance plan that my company pays for. and this is the plan that covers my rapamycin Rs. (sorry, I do not want to disclose which insurance plan I have). IF a person had Medicare Part D, I no not know if a rapamycin Rx would be covered.

My primary care MD is a regular allopathic MD. However, she listens to me, she trusts me and I have educated her about many functional medicine-related topics. After I educated her about rapamycin and explained the difference between daily dosing vs once weekly dosing, she was willing to write me a prescription for rapamycin. I do not know what my MD wrote in my chart for a diagnosis. My Rx just said: Rapamycin 2 mg, #12 tablets. Take 3 tablets once weekly. Pharmacists do not need a diagnosis code. They just look at the name of the drug, pull the bottle off the shelf, count the pills and slap a lable on the vial.

I took my rapamycin Rx to my local independently-owned pharmacy. The pharmacist had never heard or rapamycin. He looked it up and said, “Yup, it’s available from our drug wholesaler, but I’m not going to order it for you.” He explained that the wholesale price for a bottle of #100 2 mg tablets was well over $3,000. My Rx was only for 12 tablets, which means he would have a lot of $$ tied up in inventory sitting on the shelf. So, I took my rapamycin Rx to the large national chain pharmacy in my town. They ordered it and one week later they filled my rapamycin Rx. They have all of my insurance info on file. My rapamycin Rx was covered on my insurance plan through my company and the copay is $20. I get my rapamycin Rx filled once every month, for a $20 copay. I hope this helps clarify things. I would love to hear from someone who has Medicare Part D coverage to know if a rapamycin Rx gets covered.

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Thank you for joining us DrRoss.

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Read your book. Thanks for that. Have recommended it to several people. I am in the Ageless RX clinical trial. I am on the same Medicare plan as you. I am pretty sure my doctor would write me a prescription, but I will have to wait till I am off the trial. I would definitely try my Part D.

Hi Caligirl,
Nice to hear from you. I do not get my rapamycin Rx covered on Medicare…it is a $20/month copay on the insurance plan I have through the company I work for. However, shen you eventually do get an Rx for rapamycin…please let us know if you get it covered on your Medicare Part D plan.

Increasing healthspan & lifespan, Ross

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Lets face it, most doctors are out to make a buck. Many get kickbacks from drug companies to push their drugs. So if you healthy and want something to keep you healthy and even extend your wellness, that isn’t going to get the doctor any extra payments. Plus Most doctors stick to what they know. Their not going to risk a patients health buy writing a RX for a drug that they only know is for kidney and other types of transplants. Remember most doctors prescribed covid shots and we know now the shots didn’t protect you but to many it actually killed them. JMOP Oh and just wanted to add that I am also on the Agelessrx Rapamycin trial. Age 75 and am taking the compound formula. Started at 5gm and I expect to be bumped up to 10gm perhaps the next subscription.

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