Private Client Services - High Net Worth Division

         

                Private Client Life Insurance Services                                                                         High Net Worth Division
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SPECIAL GERIATRIC EDITION
OF PHARMACY TUTOR
You will note that all medications in Pharmacy Tutor® are color coded with the following system:
The green coded medications present minimal underwriting concerns.
The yellow coded medications present underwriting concerns.
The red coded medications present the biggest underwriting challenge
Under each medication, you will find "Underwriting Comments". This section discusses the key underwriting issues. It also outlines what you will need to do to clarify these issues to arrive at an underwriting decision.
Brand or Trade Name
ARICEPT
Generic Name
donepezil
Drug Type
Alzheimer's therapy
Common Indicators
Primary use is for treatment of mild to moderate Alzheimer's to enhance activities of daily living, cognitive function, behavior, and general function.
Underwriting Comments
RED INDICATES:
UNDERWRITING PROBLEMS

This medication indicates underwriting problems.
How much of an underwriting problem will depend on the severity and progression of the underlying dementia (i.e. Alzheimer's disease). It is important to obtain the degree of cognitive and memory impairment as well as the impact of this medication on improving these impairments.
Brand or Trade Name
BUMEX
Generic Name
bumetanide
Drug Type
Loop Diuretic
Common Indicators
Treatment for edema associated with congestive heart failure, hepatic and renal disease, including the nephrotic syndrome.
Underwriting Comments
RED INDICATES:
UNDERWRITING PROBLEMS

This medication indicates underwriting problems.
Bumex is used in the treatment of edema associated with organ failure (i.e. congestive heart failure). The use of Bumex almost always precludes any offer for coverage on single life contracts.
Brand or Trade Name
COGNEX or THA
Generic Name
tacrine HCL
Drug Type
Alzheimer's therapy
Common Indicators
Primary use is for treatment of mild to moderate dementia of the Alzheimer's type.
Underwriting Comments
RED INDICATES:
UNDERWRITING PROBLEMS

This medication indicates underwriting problems.
How much of an underwriting problem will depend on the severity and progression of the underlying dementia (i.e. Alzheimer's disease). It is important to obtain the degree of cognitive and memory impairment as well as the impact of this medication on improving these impairments.
Brand or Trade Name
CORDARONE
Generic Name
amiodarone HCL
Drug Type
Antiarrhythmic Drug
Common Indicators
Treatment of recurrent life threatening ventricular arrhythmias when these have not responded to documented adequate doses of other available antiarrhythmics.
Underwriting Comments
RED INDICATES:
UNDERWRITING PROBLEMS

This medication indicates underwriting problems.
Cordarone is used in the treatment of "life threatening" ventricular arrhythmias. These kinds of arrhythmias are universally superimposed on significant underlying cardiac disease (i.e. CAD, cardiac valve disease). The use of Cordarone almost always precludes any offer for coverage on single life contracts.
Brand or Trade Name
COUMADIN
Generic Name
warfarin sodium
Drug Type
Anticoagulants
Common Indicators
This is a drug that prevents blood clots from forming in the veins, lungs and brain.
Underwriting Comments
YELLOW INDICATES:
UNDERWRITING CONCERNS

This medication indicates underwriting concerns.
Coumadin is always prescribed after an episode of abnormal clotting (i.e. stroke). How much of an underwriting problem will depend on the nature of the actual triggering episode (i.e. stroke versus a vein clot in the leg).
Brand or Trade Name
HALDOL
Generic Name
haloperidol
Drug Type
Antipsychotic agent
Common Indicators
This is used for psychotic disorders including schizophrenia. May also be used in the management of Alzheimer's disease.
Underwriting Comments
RED INDICATES:
UNDERWRITING PROBLEMS

This medication indicates underwriting problems.
How much of an underwriting problem will depend on the severity and progression of the underlying mental health disorder (i.e.dementia, schizophrenia). Combined use with other psychiatric medications indicates serious underwriting concerns.
Brand or Trade Name
IMDUR
Generic Name
isosordide mononitrate
Drug Type
Vasodilator
Common Indicators
Treatment of angina pectoris due to coronary disease.
Underwriting Comments
RED INDICATES:
UNDERWRITING PROBLEMS

This medication indicates underwriting problems.
How much of an underwriting concern will depend on the severity and progression of the underlying coronary artery disease (CAD).This is especially true of patients who have a history of previous myocardial infarction (heart attack), coronary angioplasty or coronary bypass surgery. With these clients the current use of Imdur almost always precludes any offer for coverage on single life contracts.
Brand or Trade Name
ISORDIL
Generic Name
isosorbide dinitrate
Drug Type
Cardiovascular Nitrates
Common Indicators
Primary use is for angina both its prevention and treatment.
Underwriting Comments
RED INDICATES:
UNDERWRITING PROBLEMS

This medication indicates underwriting problems.
How much of an underwriting problem will depend on the severity and progression of the underlying coronary artery disease (CAD). This is especially true of patients who have a history of a previous myocardial infarction (heart attack), coronary angioplasty, or coronary bypass surgery. In these clients the current use of Isordil almost always precludes any offer for coverage on single life contracts.
Brand or Trade Name
LANOXIN
Generic Name
digoxin
Drug Type
Cardiovascular Antiarrhythmics Heart Failure
Common Indicators
This is used for heart failure, as well as a wide variety of cardiac arrhythmias.
Underwriting Comments
YELLOW INDICATES:
UNDERWRITING CONCERNS

This medication indicates underwriting concerns.
How much of a concern will depend on the underlying cardiac disease necessitating its use. In the cases of simple cardiac arrhythmias (i.e. paroxysmal atrial fibrillation), the use of Lanoxin will have minimal underlying impact. However, in cases of advanced heart disease (i.e. congestive heart failure) the use of Lanoxin almost always precludes any offer for coverage on single life contracts.
Brand or Trade Name
LUPRON
Generic Name
leuprolide acetate
Drug Type
Analog of GnRH
Common Indicators
Palliative treatment of advanced prostatic cancer. Alternative treatment for prostatic cancer when orcheitomy or estrogen administration not acceptable to patient.
Underwriting Comments
RED INDICATES:
UNDERWRITING PROBLEMS

This medication indicates underwriting problems.
Lupron is used primarily for the treatment of advanced prostate cancer. It is a palliative agent whose primary benefit is to slow down the progression of the metastatic process. The use of Lupron almost always precludes any offer for coverage on single life contracts.
Brand or Trade Name
MINITRAN
Generic Name
nitroglycerin
Drug Type
Cardiovascular Antianginal agent
Common Indicators
Primarily used for angina.
Underwriting Comments
RED INDICATES:
UNDERWRITING PROBLEMS

This medication indicates underwriting problems.
How much of an underwriting problem will depend on the severity and progression of the underlying coronary artery disease (CAD). This is especially true of patients who have a history of a previous myocardial infarction (heart attack), coronary angioplasty, or coronary bypass surgery. In these clients the current use of Minitran almost always precludes any offer for coverage on single life contracts.
Brand or Trade Name
TICLID
Generic Name
ticlopidine HCL
Drug Type
Anticoagluent
Common Indicators
Primary use is for reduction of risk of fatal or nonfatal thrombotic stroke in patients who have experienced stroke precursors and those who have had a completed thrombotic stroke. Also used in prevention of thrombus (clot formation) post angioplasty procedure that included a placement of a stent.
Underwriting Comments
YELLOW INDICATES:
UNDERWRITING CONCERNS

This medication indicates underwriting concerns.
Ticlid is prescribed after an episode of abnormal clotting (i.e. stroke) or to prevent an anticipated abnormal clotting event (i.e. coronary angioplasty with the placement of a stent). How much of an underwriting concern Ticlid represents will depend on the nature of the actual triggering event (i.e. stroke versus a vein clot in the leg) or preventative condition (i.e. coronary heart disease).
Brand or Trade Name
TRENTAL
Generic Name
pentoxifylline
Drug Type
Hemorrheologic agent
Common Indicators
Primarily used to treat intermittent claudication owing to chronicocclusive arterial disease of the limbs.
Underwriting Comments
YELLOW INDICATES:
UNDERWRITING CONCERNS

This medication indicates underwriting concerns.
The primary use of the medication is for claudication of the legs (blockage of blood flow to the legs). This condition is seen more commonly in smokers. If the client continues to smoke in the face of claudication, despite treatment with Trental, the case is usually a decline.
Important Note:
Claudication of the legs may reflect a more systemic (wide spread) problem with other arteries of the body. It is not uncommon for these clients to have heart disease and cerebrovascular disease (i.e. carotid artery disease). It is important to obtain from the client the details of any other medical problems that maybe suggested by the presence of claudication.