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The objective of this study was to estimate the risk of potential adverse drug events (ADEs) associated with drugs repurposed for coronavirus disease 2019 (COVID\u201019) treatment in a large\u2010scale population. Drug claims were used to calculate a baseline medication risk score (MRS) indicative of ADE risk level. Fictitious claims of repurposed drugs were added, one at a time, to patients\u2019 drug regimens to calculate a new MRS and compute a level of risk. Drug claims data from enrollees with Regence health insurance were used and sub\u2010payer analyses were performed with Medicare and commercial insured groups. Simulated interventions were conducted with hydroxychloroquine and chloroquine, alone or combined with azithromycin, and lopinavir\/ritonavir, along with terfenadine and fexofenadine as positive and negative controls for drug\u2010induced Long QT Syndrome (LQTS). There were 527,471 subjects (56.6% women; mean [SD] age, 47 years [21]) were studied. The simulated addition of each repurposed drug caused an increased risk of ADEs (median MRS increased by two\u2010to\u2010seven points, <jats:italic>p<\/jats:italic>\u00a0&lt;\u00a00.001). The increase in ADE risk was mainly driven by an increase in CYP450 drug interaction risk score and by drug\u2010induced LQTS risk score. The Medicare group presented a greater risk overall compared to the commercial group. All repurposed drugs were associated with an increased risk of ADEs. Our simulation strategy could be used as a blueprint to preemptively assess safety associated with future repurposed or new drugs.<\/jats:p>","DOI":"10.1111\/cts.13025","type":"journal-article","created":{"date-parts":[[2021,3,31]],"date-time":"2021-03-31T06:03:46Z","timestamp":1617170626000},"page":"1799-1809","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Adverse drug event risk assessment by the virtual addition of COVID\u201019 repurposed drugs to Medicare and commercially insured patients\u2019 drug regimens: A drug safety simulation study"],"prefix":"10.1111","volume":"14","author":[{"given":"Matt K.","family":"Smith","sequence":"first","affiliation":[{"name":"Precision Pharmacotherapy Research &amp; Development Institute Tabula Rasa HealthCare  Orlando Florida USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ravil","family":"Bikmetov","sequence":"additional","affiliation":[{"name":"Precision Pharmacotherapy Research &amp; Development Institute Tabula Rasa HealthCare  Orlando Florida USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sweilem B.","family":"Al Rihani","sequence":"additional","affiliation":[{"name":"Precision Pharmacotherapy Research &amp; Development Institute Tabula Rasa HealthCare  Orlando Florida USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Malavika","family":"Deodhar","sequence":"additional","affiliation":[{"name":"Precision Pharmacotherapy Research &amp; Development Institute Tabula Rasa HealthCare  Orlando Florida USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Matthew","family":"Hafermann","sequence":"additional","affiliation":[{"name":"Cambia Health Solutions \u2013 Case Management at Regence BlueShield  Tacoma Washington USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Pamela","family":"Dow","sequence":"additional","affiliation":[{"name":"Precision Pharmacotherapy Research &amp; Development Institute Tabula Rasa HealthCare  Orlando Florida USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jacques","family":"Turgeon","sequence":"additional","affiliation":[{"name":"Precision Pharmacotherapy Research &amp; Development Institute Tabula Rasa HealthCare  Orlando Florida USA"},{"name":"Faculty of Pharmacy Universit\u00e9 de Montr\u00e9al  Montreal Quebec Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Veronique","family":"Michaud","sequence":"additional","affiliation":[{"name":"Precision Pharmacotherapy Research &amp; Development Institute Tabula Rasa HealthCare  Orlando Florida USA"},{"name":"Faculty of Pharmacy Universit\u00e9 de Montr\u00e9al  Montreal Quebec Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2021,8,25]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamainternmed.2020.0994"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.296.15.1858"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.289.9.1107"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.18553\/jmcp.2019.25.3.402"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.3390\/pharmacy8020087"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.3390\/jcm9082591"},{"issue":"2","key":"e_1_2_9_8_1","first-page":"49","article-title":"Application of a novel medication\u2010related risk stratification strategy to a self\u2010funded employer population","volume":"34","author":"Cicali B","year":"2018","journal-title":"Benefits Quarterly"},{"key":"e_1_2_9_9_1","first-page":"281","article-title":"Statistical mining of potential drug interaction adverse effects in FDA's spontaneous reporting system","volume":"2010","author":"Harpaz R","year":"2010","journal-title":"AMIA Annu Symp Proc"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.2217\/1745509X.4.3.311"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.2165\/11597800-000000000-00000"},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.1002\/gps.846"},{"key":"e_1_2_9_13_1","doi-asserted-by":"crossref","unstructured":"MichaudV Dow P Al Rihani SB et al.Risk of drug\u2010induced Long QT Syndrome associated with the use of repurposed COVID\u201019 drugs: a systematic review. 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