Dr. Steven Rigatti examines how synthetic nicotine pouches are reshaping nicotine-use disclosure, testing strategies, and underwriting decisions across the life insurance industry.
In the not-so-distant past, underwriting nicotine usage was fairly simple: a couple of questions, a urine test for cotinine, and maybe some follow up discussion when things did not match up. While some companies had consideration for a small number of “celebratory” cigars, very few had specific, improved ratings for those who claimed to only use chewing tobacco or similar products. Nicotine gums and the like were considered to largely be used by cigarette smokers who were trying to quit, and therefore these generated smoker ratings more often than not.
In recent years there have been many changes in the ways that applicants use nicotine, from e-cigarettes to the newly popular synthetic nicotine pouches. To complicate this further, a few days ago the ZYN brand of nicotine pouches recently won FDA approval to begin making claims that “Using ZYN instead of cigarettes puts you at a lower risk of mouth cancer, heart disease, lung cancer, stroke, emphysema, and chronic bronchitis.”
This will likely bolster an already red-hot market for these products, which already generate over 6 billion dollars in sales annually. These products are especially popular among young people, who often use them as a “cognitive boost” or performance enhancer.
Underwriting
Because cigarette smoking is so well understood to produce large increases in mortality risk across the age spectrum and is supported by more than 50 years of experience data, it is crucial to separate inhalational, combustible, tobacco users from those who utilize alternative nicotine delivery products. Unfortunately, the industry’s most common tool, the urine cotinine test, does not distinguish the source of the nicotine from which cotinine is produced. Rather, underwriters must rely on self-attestation, medical records, or other documents to help determine the source of nicotine.
Also, there are anti-selective pressures at work, such that an applicant who knows that nicotine pouch use will be treated more favorably than cigarette use, may be tempted into providing false information. There is certainly evidence of this in studies conducted by CRL, which have shown relatively high rates of saying “no” to tobacco use questions among those testing positive for cotinine.
Recently, CRL has begun to offer a panel of tests called “NicSource” which can identify combustion products and help companies more accurately identify combusted tobacco users from non-tobacco nicotine users.
About the Author
Dr. Steven J. Rigatti is a consulting medical director with Clinical Reference Laboratory, with 12 years’ experience in the life insurance industry. He is the current chair of the Mortality Committee of the American Academy of Life Insurance Medicine.