Hank's Underwriting Guide to Rx
Frequently Asked Questions
What is the source of the information contained in the Guide?
How do I find the report of a given drug in Hank’s Underwriting Guide to Rx?
When Hank’s Underwriting Guide to Rx suggests that pursuing medical records may be important
Why is the Guide offered on a licensing basis, rather than sold outright?
What kinds of companies are eligible to license Hank’s Underwriting Guide to Rx?
Why are service providers not eligible to license the Guide?
Is there a chance that the Guide could be unavailable at times because of high usage?
What happens if the site goes down?
What if I have questions not mentioned above?
Hank’s Underwriting Guide to Rx provides essential information on prescription pharmaceuticals. It also excludes underwriting-irrelevant information which makes up the vast majority of the content found in clinical Rx reference sources.
The essential information included in the Guide consists of all proprietary names, approved and “off-label” (unapproved) uses, effects of the drug on lab tests, and what we call CAUTIONS and RED FLAGS, which are specifically focused on insurability concerns.
Hank’s Underwriting Guide to Rx is intended as a reference resource, not an underwriting manual. Therefore, it does not recommend final underwriting actions. Such actions should always be based on the insurer’s manuals and usual underwriting practices, along with advice given by veteran underwriters, medical directors and reinsurer representatives.
What is the source of the information contained in the Guide?
The information used to create each drug’s profile came from a variety of sources including medication details published by pharmaceutical companies, studies and reports published in the world medical literature, reports from the Food and Drug Administration, information published on the Internet and Hank’s extensive knowledge base and experience as an author and educator specializing in this field for over 25 years.
To make sure that we have the latest information, we subscribe to almost 100 medical journals, as well as accessing major databases that provide research access to the medical literature. All of these sources are used on an ongoing basis to make certain we have the broadest feasible coverage of this subject in the Guide.
How do I find the report of a given drug in Hank’s Underwriting Guide to Rx?
Underwriters can search for drugs by either generic or proprietary (brand name) using the search engine, or by locating the drug’s name in the drug index.
Once you’ve found the drug you’re looking for, just click on the drug name and you will be linked to our report on that drug. That report will contain:
- Generic and proprietary names
- Approved and other (“off-label”) uses
- Relevant effects on laboratory tests
- CAUTIONS
- RED FLAGS
How is Hank’s Underwriting Guide to Rx organized?
The information about each drug is organized in the following manner:
The drug’s generic name is shown at the bottom of the report for each drug. In those uncommon situations where more than one generic name exists, both will be shown.
Approved uses are those sanctioned by the US Food and Drug administration (FDA).
These are the “off-label” uses, wherein the drug may be prescribed by physicians for disorders for which its use is not specifically approved by the FDA. Such uses may also be described as “unapproved” or “investigational.”
The Guide gives the underwriter the opportunity to compare possible uses of each drug to the rest of the facts of the case. This is especially important when the insured does not acknowledge a clear diagnosis for the condition in question or the medical records are ambiguous as to that diagnosis.
For example:
An applicant indicates he has anemia and that he is taking the drug epoetin alfa. A quick review of epoetin alfa in the Guide tells the underwriter that the potential causes of any anemia treated with this drug are highly significant to insurability.
By contrast, if the same individual reported anemia but was taking vitamin B-12, the implications would usually – but not always (case context matters!) – be less significant to risk.
Most drugs can potentially impact laboratory tests, for the most part by elevating test results outside the normal range.
Most medications exert such effects infrequently or even rarely.
Not all of these effects are meaningful in terms of insurability. Therefore, the Guide addresses only those drug effects on tests that are potentially relevant in a risk assessment setting.
The main focus is on tests included in routine blood and urine profiles, such as blood glucose, lipids and both liver and kidney function tests. The Guide also considers other tests that are frequently mentioned in medical records, such as the pancreatic enzymes amylase and lipase, the muscle enzyme CK (creatine kinase), the antinuclear antibody (ANA) test, components of the complete blood count (CBC) and so on.
Where reliable, underwriting-significant information is available on the incidence of drug effects on specific tests – such as the % of times a drug raises ALT based on published studies – the Guide will cite these data as well. The Guide also provides insight into the potential magnitude of elevations, whether the elevations are apt to normalize when the drug is withdrawn, the likelihood they could be related to an underlying disorder, etc.
Some important core realities related to the effects of Rx on lab tests are important to keep in mind whenever this question arises:
- In 98% of situations where a medication could cause an altered (elevated, below normal) test result, it does not do so. Therefore, the vast majority of lab abnormalities in persons taking almost any drug are not related to the effects of that drug.
- As a rule, the greater the dose of the drug, the higher the probability that it will induce the abnormal test result.
- Most drug effects on lab tests are transient, tending to disappear (that is, the test going back within the normal range) the longer the drug is taken.
- If a medication induces clinically-significant adversity associated with Rx-induced abnormal lab tests, it usually does so within the first 1-3 months after use of the drug begins.
- There are certain drugs – such as methotrexate and the statin cholesterol-lowering drugs – are associated with a significant incidence of abnormal tests and, in some cases, elevations that are high enough to result in ordering more tests and/or adverse underwriting action. We try to address these situations in sufficient depth in the Guide.
- It is considered routine for physicians to perform the appropriate tests to see if the patient being considered for treatment already has abnormalities in the tests most likely to be affected by the drug under consideration.
- In addition, it is considered routine – and advised in clinical Rx guidelines – that physicians periodically monitor the levels of tests at risk for being impacted by the drug in question.
- The likelihood that a drug will induce an abnormal test result – especially one that could have health consequences – is usually greater if the insured has significant comorbidities that are also associated with the tests in question. For example, a person being treated with methotrexate who has a history of chronic hepatitis B or C, or fatty liver disease, or a pattern of excessive drinking, would be at much greater risk for liver damage when using methotrexate than another person free of any type of liver disorder or life-related risk factor.
- Some drugs may be synergistic in causing elevated lab tests. The combination of methotrexate and a statin is one example of this. Every time we are trying to assess the potential impact of a given drug on elevated lab tests, we need to consider all other drugs – and for that matter herbs and other over-the-counter remedies – being used by the proposed insured.
Hank’s Underwriting Guide to Rx uses only currently-accepted names and acronyms for laboratory tests. For example, ALT is not identified by its obsolete name SGPT. Please refer to your company’s resources if there are test names or acronyms cited with which you are unfamiliar.
The focus here is on information related to dosing, side effects and complications of potential underwriting significance for the specific medication in question, such as:
- How the drug is administered (tablet, injection, liquid, patch, etc.) and what could be the significance of this relative to why it has been prescribed?
- Is there any significance to the dosage prescribed? There are situations where the dosage (times taken per day or amount taken per day) will help determine the most likely reason for the drug’s use or the likely degree of severity of the impairment for which it is being prescribed.
- Are there significant side effects which may be reported by the applicant as symptoms?
- What are the serious side effects we must be aware of?
- Are there any other factors related to the drug that may help enlighten the underwriter
This is the truly unique feature of Hank’s Underwriting Guide to Rx.
It gives the underwriter a range of insurability-relevant insight related to the drug in question.
Examples of the information included in the RED FLAGS section are:
- Implications of the setting in which the drug was administered (inpatient, emergency care, etc.)
- Implications of the medical specialty of the physician prescribing the drug
- Major late drug effects that may directly impact insurability or how the underwriter approaches the case. For example, late effects of cancer chemotherapy that may be present in an applicant who was given the cancer drug many years earlier and is now a “standard” risk as far as the cancer history itself is concerned.
- How other information such as diagnostic tests completed or recommended, non-Rx interventions undertaken or recommended, physician advice as to daily activities may have specific implications when considered in context with the drug in question
- Implications of the use of other medications in conjunction with this drug
- Implications for the use of alternative and complementary remedies
- Risk implications of specific symptoms acknowledged by the applicant considered in the context of the medication under scrutiny
- When it is particularly important that the proposed insured be carefully questioned as to the (perceived) reason he/she thinks the drug was prescribed
- Scenarios where the underwriter may wish to consider ordering and APS or medical records (see below)
Many drugs have two or more proprietary (brand) names. Those no longer under patent (and, in many cases, are manufactured by various pharmaceutical companies) could have 20 or even more proprietary names. The Guide lists all US and Canadian proprietary names for each drug. They are all included in the alpha index as well.
This section may also indicate how the drug is administered (tablet, injection, liquid, patch, etc.).
This is the broad pharmaceutical class to which the drug belongs. Examples would be antianginals, alpha-glucosidase inhibitors and immunosuppressants …and there are many more.
When Hank’s Underwriting Guide to Rx suggests that pursuing medical records may be important
When we designed this Guide, we were frankly undecided as to whether or not we should include these recommendations. After discussing the “pros and cons” of doing so with veteran underwriters, it was clear that the majority of Guide users would consider these recommendations to be an asset. Hence, we have included our recommendations under RED FLAGS.
We make three types of recommendations in the Guide:
Recommend
Where we think an APS would be helpful in many cases involving that medication, subject to what the underwriter already knows about the case
Strongly recommend
Where we believe the use of this drug has a high probability of being associated with significant mortality and/or morbidity
Medical records essential
This is used only for drugs (such as cancer chemotherapy) wherein attempting to assess risk without medical records would be unwise simply because that drug was used.
Even though we make these recommendations, we believe underwriters should always follow their company’s guidelines and practices when deciding whether or not to seek further evidence of insurability. If in doubt, it is always ideal to discuss one’s views with a veteran underwriter or a medical director.
How often is Hank’s Underwriting Guide to Rx updated?
Continuously…adding all new prescription drugs as well as making relevant changes affecting all of the drugs covered in the Guide.
The length and breadth of changes in pharmacology is huge. New potential uses are discovered all the time, as well as effects on tests, late complications and so on.
Therefore, even if you reviewed a drug’s report in the Guide even a short time ago, it is well worth taking a moment to revisit that report each time you have another occasion where you encounter the drug.
For companies with 5 or more underwriters: A one year license of the Rx Guide is a flat fee of $5000.
For companies with 1-4 underwriters: A one year license of the Rx Guide is $1000 per underwriter.
You can receive package discounts if you order the Rx Guide in conjunction with either our Initial Education (IE) or Continuing Education (CE) programs. To learn more, please visit smart solutions.
To order Hank’s Underwriting Guide to Rx (alone or as part of a Smart Solution package), please visit our order page. If you have questions or need help placing an order, please contact Esther (414-328-9010).
Can I tryout Hank's Guide before licensing?
A 60-day free look can be initiated by the chief underwriter (or designated representative) from any direct-writing life or health insurer or reinsurer in the world. To request a no obligation, no risk, and completely free trial of the Guide, please contact Esther.
Why is the Guide offered on a licensing basis, rather than sold outright?
The Guide is not a “static” product or one that needs only widely-spaced updating, as would be the case with medical underwriting manuals. Rather, the sheer volume of changes in clinical pharmacology affecting the topics covered in the Guide mandates continuous updating. For this reason, annual licensing of access makes more sense functionally than selling the Guide, as is, on a onetime sale basis.
What kinds of companies are eligible to license Hank’s Underwriting Guide to Rx?
The Guide was designed primarily for use by direct-writing life, health disability, critical illness and long-term care insurers. All direct-writing individual and group insurers are eligible to license the Guide. Reinsurers and brokerage agencies doing in-house case management may also license the Guide.
Why are service providers not eligible to license the Guide?
Except in the context of outsourced underwriting, industry service providers do not get into the assessment of risks and would realize few if any benefits from the Guide. In the case of outsourced underwriting services, we do provide a basis for insurers who use outsourcing/TPA services for underwriting purposes to arrange to have access to the Guide provided to those who perform this function for the licensee.
Is there a chance that the Guide could be unavailable at times because of high usage?
We have full-time IT support committed to the Rx Guide. The website has been designed to handle the anticipated volume and any adjustments and debugging will be handled immediately.
Since this is a new product we can’t 100% guarantee that there won't be any downtime, however we’ve built this into our contingency planning including a backup copy of the guide on another server to minimize the risk of any loss of service.
Finally, our license agreement includes a statement granting specific benefits to any company that experiences significant problems with access.
What happens if the site goes down?
In the event that the site is available please visit www.rxguide.info.
Please follow the "Request new password" link on the homepage.
How do I use the Bookmark feature?
To add a bookmark:
- Click on “quick link” in your bookmarks menu.
To delete a bookmark:
- Click on the “cancel” symbol next to the bookmark you wish to delete.
Who do I contact if I am having technical problems?
Please email all technical problems to: technical@hankgeorgeinc.com.
What if I have questions not mentioned above about Hank’s Underwriting Guide to Rx?
For technical support questions, contact admin@hankgeorgeinc.com
For pharmacology and underwriting related questions, contact Hank at hankgeorge@aol.com