Medications And Underwriting

    Underwriters always ask about medications being taken for an illness or disease, and often can tell a lot by what’s being prescribed and relating it to the possible severity of the disease. While a detailed APS usually answers most questions, this is particularly true in situations in which preliminary evaluations or “quick quotes” are requested.

    Sometimes, however, being on medication creates a more favorable underwriting outcome, and it isn’t always worse to be on a prescription, especially since in recent years, medication is readily available through online pharmacies similar to this .

    Statins, for example (known under trade names such as Lipitor, Crestor, Zocor and many others) are designed to lower cholesterol and alter the good to bad cholesterol ratio in a patient’s favor. Traditional thought was that if someone needed medication to keep cholesterol down, that made it more of a problem. This hasn’t proven to be the case. Cardiologists almost unanimously feel that statins actually cut the risk of heart disease and that many people will live far longer and avoid cardiologic compromise by taking them.

    Statins also appear to have other benefits: They decrease CRP levels, an inflammatory protein in the blood thought to promote atherosclerosis and abnormal blood vessel wall deposit formation. Some recent literature shows a favorable effect in preventing the onset of Alzheimer’s disease. Cardiologists often use statins as a preventive measure for patients who have certain risk factors but normal lipid levels. In fact, many insurers actually give underwriting credits for being on a statin, so it’s a medication that is actually beneficial in risk assessment.

    Antihypertensives are also medications that don’t have to have negative underwriting connotations. While they wouldn’t be prescribed to someone who didn’t have a problem with blood pressure in the first place, keeping a normal blood pressure is key in preventing strokes, heart attacks and heart failure. Underwriters are much more forgiving of applicants with blood pressure well controlled on medication than those whose blood pressures are elevated but are not taking anything for their problem. Preferred issues are common for treated hypertension.

    Antidepressants are often prescribed for patients, and not always for severe conditions. Managed care and the health system have made it difficult for doctors to spend the proper amount of time with people to get at the root of a problem. The impersonal world of Facebook and the Internet makes a good friend who will listen to a difficult situation a lot harder to find. As such, doctors are much quicker to prescribe antidepressants on very short visits to combat any emotional distress, even when the stressor is not a serious one. These medications are often not a harbinger of severe problems but rather, one in which the treatment reflects the health care system, not the true severity of the problem.

    There are cases in which medication sometimes lets an underwriter know the more serious form of a disease is being treated. Long term corticosteroids, for example, may be very helpful in treating certain cases of asthma, serologic arthritis and autoimmune diseases, but these medications have their own set of side effects which worsen other facets of overall health and also suppress the immune system to fight other diseases. In robbing Peter to pay Paul, the medication ameliorates some facets of disease but comes with a cost. They are reserved for the serious or stubborn cases of a disease.

    One disease in which it is difficult to decide how medication affects the overall picture is diabetes. Almost all doctors agree that diabetes must be well controlled to prevent life threatening complications, and while the degree of control is still under debate, the mantra that “whatever best controls blood sugar is best” still rules. That means having to take a pill to normalize blood sugars might actually be better than taking nothing and sacrificing a better degree of control. Insulin use generally still is reserved for cases in which diet, exercise and oral medication fail. While blood sugar control still reigns supreme, the insulin dependent diabetic generally doesn’t have as good an outcome, even given similar levels of control, as blood sugars are more brittle and variable in these individuals.

    Medication doesn’t always portend a worse underwriting outcome with any given disease, and in fact sometimes it is looked at favorably in the process of determining an offer. However, one thing to keep in mind is that disclosure is good. Nothing makes an underwriter more suspicious than a lack of candor or less than full disclosure. As such, those cases are treated with a higher index of suspicion and become steeper walls or worries to overcome.

    MD, FACE, FLMI, board certified internist and endocrinologist, is medical director for SBLI of Massachusetts. He has extensive brokerage and life insurance experience over 30 years with Pacific Life, MetLife Brokerage and Transamerica Occidental Life.

    Goldstone is board certified in insurance medicine and the inaugural recipient of the W. John Elder Award for Insurance Medicine Journalism Excellence. He was also honored as a fellow of the prestigious American College of Endocrinology and has written monthly for Broker World from 1991 to September, 2021.

    Goldstone can be reached by ­telephone at 949-943-2310. Emaill: drbobgoldstone@yahoo.com.