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Medicaid must pay for Viagra, government says
04:57 p.m Jul 02, 1998 Eastern
By Maggie Fox, Health and Science Correspondent
WASHINGTON (Reuters) - The federal government Thursday ordered states to
pay for Viagra prescriptions under the Medicaid program.
The Health and Human Services (HHS) Department said the law requires
Medicaid to pay for all drugs prescribed for medical reasons -- and said
the blockbuster anti-impotence drug clearly came under that category
when prescribed properly by a doctor.
Some states have argued that Viagra could cost Medicaid, the
state-federal health care program for the poor, a lot of money.
Too bad, says the HHS.
''The law requires that a state's Medicaid program cover Viagra when
medical necessity dictates such coverage for the drug's medically
accepted indication,'' Nancy-Ann DeParle, administrator of the HHS's
Health Care Financing Administration (HCFA), wrote in a letter to
Florida Gov. Lawton Chiles, Utah Gov. Michael Leavitt and the National
Governor's Association.
Leavitt and Chiles are the lead governors on Medicaid for the
association.
The letter said there were exceptions, but Viagra was not one of them --
unless the state suspected it was being misused or prescribed
improperly.
''The FDA (Food and Drug Administration) has approved Viagra only to
treat erectile dysfunction in men,'' DeParle wrote. ''Viagra does not
fall within any of the allowable exclusions or restrictions,'' she
added.
The reaction was quick and outraged.
''This administration is making a substantial, premature and unilateral
policy decision without the benefit of consultation with the states,''
Jennifer Baxendell, head of health legislation for the National
Governor's Association, said in a statement.
''This announcement preempts state authority to determine what is
appropriate for their unique populations, increases state costs, and
hampers their ability to run state Medicaid programs,'' the statement
added.
''Preliminary estimates indicate that a nationwide mandate for coverage
of Viagra through Medicaid would cost the states and the federal
government more than $100 million each year. In the months since this
drug has been widely available, it has become the most popular
prescription product in history.''
This is no exaggeration. Pfizer, which makes Viagra, says more than a
million prescriptions have been written since it hit the market in
April. Viagra costs between $7 and $10 a dose.
DeParle had some comfort for the states. ''It is important to remember
that 90 percent of Medicaid beneficiaries are women and children,'' she
wrote. ''Because only about 10 percent of Medicaid beneficiaries are
adult males, my understanding is that the number of Medicaid
beneficiaries that could be diagnosed with erectile dysfunction is very
small.''
She said HHS was worried Viagra could be misused, and would monitor
carefully to see if it was. There have been reports of men taking the
drug to enhance normal sexual performance.
She urged all states to make sure that Medicaid only pays for Viagra
when it is indeed medically necessary. Steps could include making sure
doctors diagnose impotence and prescribe the drug properly, make sure it
goes only to those men who are supposed to get it, and perhaps even a
limit to refills.
In a separate notice, HCFA said states could ''ensure the appropriate
use'' of Viagra. ''States may require proper authorization reviews
before they pay for Viagra prescriptions, conduct medical reviews, limit
the maximum quantities per prescriptions and/or limit the number of
refills,'' it said.
Copyright 1998 Reuters Limited. |
