Irdai asks insurers to review claims denied for antibody cocktail therapy

IRADI said it had come across instances where claims were denied/ there was a deduction in expenses incurred towards "antibody cocktail therapy", under the pretext that it's an experimental treatment

The Insurance Regulatory and Development Authority of India (Irdai) has asked general and health insurance companies to review the claims related to “antibody cocktail therapy” for Covid-19 which were denied by them.

In a circular dated January 7, addressed to the chief executive officers (CEOs) of the general and health insurance companies, the regulator has said, “ … insurers are advised to review the claims denied/ deductions made in such claims and take appropriate action for ensuring that the claims are settled as per terms and conditions”.

The insurance regulator said that it has come across instances wherein claims were denied or there was deduction on expenses incurred towards “antibody cocktail therapy” treatment for Covid-19, under the pretext that it is an experimental treatment.

“However, it may please be noted that the antibody Cocktail (Casirivimab and Imdevimab) has been given emergency use authorisation (EUA) in May, 2021, by Central Drugs Standard Control Organisation (CDSO) in our country”, the insurance regulator said in the circular directed to the CEOs of insurance companies.

Antibody cocktail is a combination of two types of genetically engineered antibodies. They are similar to the antibodies produced in a human body but different because they are made in a lab. The antibody cocktail is to be administered for the treatment of mild to moderate coronavirus disease in adults and paediatric patients (12 years of age or older, weighing at least 40 kg) who are confirmed to be infected with SARS-COV2 and who are at high risk of developing severe Covid-19 disease and do not require oxygen at that stage.

Swiss major Roche had got approval for its antibody cocktail comprising two antibodies: casirivimab and imdevimab. Cipla had launched the medicine here at the price of Rs 59,750 per patient.

The insurance regulator has asked the insurance companies to put in place an effective claim settlement procedure to update the developments/ approvals given by relevant authorities so that all claims are settled as per terms and conditions.