Red Flag Medications in Underwriting: Part 1

The U. S. population is the most medicated population in the history of medicine. Over 2 billion legal prescriptions were written in 2001 and the number is expected to continue to increase. A significant portion of these medications (greater than 30%) is taken by persons 65 and older.

It is essential to ask every client about his or her medications. However, knowing the medications is only the first step. You also need to know what they mean in the specialized world of underwriting. Normal medical references (i.e. PDR) offer little insight into the underwriting implications of a given medication. Life insurance and LTC agents need to develop other resources that can help immediately clarify the impact of a medication on the underwriting outcome. In simple terms, an underwriting reference needs to answer the following question: does this medication mean preferred, standard, rated or decline?

The following groups of medications cause significant problems (potential declines) for both the life and LTC agent. This list offers both agents and support staff a key reference on drugs that are common to an aging population. In next month’s issue, a second list of problematic medications in terms of underwriting will be reviewed.

Pharmacy Tutor is RiskTutor’s most used feature because it provides a color-coded system (red, yellow and green) for assessing the impact of any drug on underwriting

Underwriting Comment: Look for heart disease with this group of nitroglycerin based medications. This could include a history of chest pain, heart attack (MI), coronary-angioplasty (PTCA) or bypass surgery (CABG). In any of these scenarios, the use of any of the medications on this list usually spells a decline for life of LTC coverage. In simple terms, the heart disease is usually "unstable" signaled by the return of chest pain and the client is at high risk for another "cardiac event."

Reference: See these medical sites for additional information on heart disease:

Angina: http://www.nhlbi.nih.gov/health/public/heart/other/angina.htm
Heart Attack: http://208.133.254.45/search/display.asp?Id=417
Coronary Angioplasty: http://www.hgcardio.com/ptca.htm
Coronary Bypass Surgery: http://heart-surgeon.com/coronary-bypass.html

Underwriting Comment: Look for irregular heart rhythms, heart attacks, TIAs (transient ischemic attacks or pre-strokes) strokes or any other source of blood clots (i.e. heart valve disease). All of these medications are designed to stop clotting and prevent a primary of secondary event (i.e. heart attack, stroke, blood clot to the lung, etc.). These medications do not preclude life or LTC coverage, but they beg the essential underwriting question of the medical history that led to the need for anti-clotting medication. In the case of simple irregular heart rhythms (i.e. atrial fibrillation or AF), the client may be rated standard for life or LTC coverage. In the case of a stroke or a previous heart attack, the client may be rated or declined. In simple terms, find out why the medication is being taken.

Reference: See these sites for additional information on common causes of clotting disorders:

Atrial Fibrillation: http://www.nlm.nih.gov/medlineplus/tutorials/atrialfibrillation.html
Transient Ischemic Attack (TIA): http://www.mayoclinic.com/invoke.cfm?id=DS00220
Stroke: http://www.ninds.nih.gov/health_and_medical/disorders/stroke.htm

Underwriting Comment: Look for a history of pain in the legs with walking (and relieved at rest) that is the result of block arteries. This is called "intermittent claudication" (the pain comes with walking and goes away with rest). Blockage of leg arteries usually means trouble for other arteries in the body (i.e. heart, brain and kidneys). These medications do not preclude life or LTC coverage, but they beg the essential underwriting question of the medical history that led to the need for the medication. Be careful to find out about "other" medical problems. As important, find out if the client smokes. Smokers with intermittent claudication are generally declined for life and LTC coverage. In simple terms, this kind of leg pain is not benign and may reflect bigger health and underwriting problems.

Reference: See this site for additional information on intermittent claudication:

http://www.hgcardio.com/periph.htm