Kaiser Permanente Agrees to Pay for Viagra
Julie Appleby
09/28/98
KRTBN Knight-Ridder Tribune Business News: Contra Costa Times, Calif
Sep. 26--Kaiser Permanente members filling prescriptions for the impotence pill Viagra got a surprise this week -- the HMO is now paying for it.
When the pricey pill first came out, Kaiser administrators decided the HMO would not cover the cost for its members, except in very rare circumstances where a physician sought a medical necessity exemption.
But earlier this month, Kaiser quietly added Viagra to its list of approved drugs.
Now, all a Kaiser patient needs is an ordinary prescription, not a special exemption, said Anthony Barrueta, counsel for Kaiser Foundation Health Plan.
"It's wonderful," said a 44-year-old East Bay man who asked not to have his name used. He refilled a prescription for 20 of the pills Friday and only had to cover his small co-payment.
Under the former Kaiser policy, that prescription would cost him $150.
But Kaiser patients should not get too excited. The Viagra coverage may be temporary.
The HMO has asked the state's Department of Corporations to grant it a permanent exclusion from paying for any drugs for sexual dysfunction, Barrueta said. If the DOC agrees, Viagra and several other products would be excluded starting in January.
Kaiser has argued that the drug may be medically appropriate, but is not medically necessary.
Covering the treatment nationwide could cost the HMO $100 million annually, a cost administrators said they did not want to pass along to members.
A few other HMOs agree with the Kaiser stand, while others are paying for the pills.
The DOC is currently reviewing Kaiser's request but has not made any decisions, said spokeswoman Julie Stewart.
"More than anything else they would have to convince us it was not medically necessary," said Stewart.
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