Finally a Reuters story on the Viagra insurance coverage. I think the bottom line is that patients are willing to pay for this treatment. As the article says it's not more than a movie ticket!
Perry
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Wednesday April 29, 7:03 pm Eastern Time
N.Y. regulator asks insurers about Viagra coverage
NEW YORK, April 29 (Reuters) - The New York insurance department said Wednesday it is asking
the state's health insurers for information about whether they are going to provide coverage for
Pfizer Inc's (PFE - news) new impotence pill Viagra and the justification for their decision.
Several large insurers are adopting strict reimbursement policies for Viagra, requiring proof of a
medical cause for the problem and limiting the number of pills, according to a New York Times
report.
CIGNA HealthCare, which covers 15 million people nationwide, said Wednesday that in order to
qualify for coverage patients must be male and must have a pre-existing documented condition of
organic impotence, which is currently being treated by other medical means.
In addition, the impotence must not be the result of current drug therapy, CIGNA HealthCare
spokesman Mark Di Giorgio said.
If patients met this criteria, CIGNA HealthCare, a unit of CIGNA Corp (CI - news), would pay for
a maximum of six tablets per month.
However, that policy may change following a review by the company's pharmacy and therapeutics
committee, Di Giorgio said.
After a drug is approved by the U.S. Food and Drug Administration, he said, it is CIGNA's
standard policy to provide interim coverage while the coverage policy is reviewed by the
18-member committee.
Following the review, which may take several months, the committee will make a final
determination on coverage, he said.
''We are already seeing resistance by HMOs and insurance companies that either are not going to
pay for it out of hand, which I think is wrong, or limit the age,'' said Dr. James Barada, a urologist
in Albany, New York, who helped draw up erectile dysfunction guidelines for the American
Urological Association.
''But what about long-term diabetics? Or they might limit the number of pills, putting a cap on the
number of times people can have sex, which I also think is wrong,'' he said.
But he said men were not doing without.
''Patients are willing to pay for it out of pocket,'' he said. He compared the $10 per Viagra pill to
the price of a movie ticket and a box of popcorn
However, WellPoint Health Networks Inc. (WLP - news) and Kaiser Permanente, two of the
nation's largest health maintenance organizations, are adopting strict coverage policies, according to
the New York Times.
Men who are covered by Wellpoint Health Networks will not be reimbursed for the prescription
unless they have a doctor's written statement that they suffer from erectile dysfunction, according to
the New York Times report.
WellPoint was not immediately available for comment.
Later this week, Kaiser Permanente is expected to introduce a policy similar to CIGNA's, the New
York Times said.
Kaiser Permanente and Pfizer, the maker of Viagra, also were not immediately available for
comment.
The New York insurance department said it is telling insurers to respond to its request for
information by June 15.
Based on the responses, the department said it will determine what follow-up action may be
necessary.
''Given the potential benefits of Viagra and the overwhelming demand for the prescription drug, we
are asking health insurance companies to provide information as to whether or not they are going to
provide coverage for Viagra and justification for their decision.'' said Superintendent of Insurance
Neil D. Levin.
''We are asking companies to adopt a thoughtful policy with regard to providing coverage for this
drug.'' |
