Some Medicaid Plans To Cover Viagra
MAY 07, 18:19 EDT
BY JOHN HENDREN
AP Business Writer
NEW YORK -- For those who can't afford it, at least ten
states now guarantee satisfying sex for the impotent
poor.
Among the health insurers that cover the wildly popular
new pill for impotence, Viagra, are the Medicaid
programs in Arkansas, Alabama, Florida, Louisiana,
Maryland, Montana, Rhode Island, Texas, Utah and
West Virginia.
The blue, diamond-shaped potency pill from Pfizer Inc.
has forced several states to weigh the importance of
sex against other pressing public policy concerns that
require funding.
The unprecedented demand that met the pills took
many states by surprise. Alabama's Medicaid agency,
fearing footing the bill for many of the state's 650,000
Medicaid recipients, is already taking steps to revoke
coverage, prompting concern among state legislators.
''The sex drive being what it is in some people, it may
very well have a lot to do with the mental well-being of
a person,'' said Alabama state Rep. Ron Johnson, a
Republican who heads the Legislature's Medicaid
Oversight Committee.
States that agree to pay disagree on how much of the
potent pill is enough. While Alabama and Florida allow
the impoverished impotent four state-funded liaisons a
month, Utah covers 10. Several, including Arkansas,
Louisiana and Maryland, cover six, the number Pfizer
used in its research.
The Utah limit was based on the cost of the drug and
what the limited literature on impotency has found to
be the ''normal patterns of men,'' said Duane Park,
drug utilization review manager for the state's Medicaid
office.
''It's nice to know there are drugs that deal with
these type problems and people can approach
normality,'' said Park, a pharmacist by profession.
Several states, including many with larger populations,
have drawn the line at paying for potency. Among the
states declining blanket coverage: Arizona, California,
Idaho, Illinois, Kansas, Michigan, Minnesota, New
Hampshire, New York, Pennsylvania, South Dakota,
Tennessee and Vermont.
The reason for rejecting coverage is usually the cost of
covering the $10 pill, although states routinely get
discounts of about 15 percent.
''We are faced every day with making life and death
decisions in this program ... and clearly, paying for
impotency drugs is not one of them,'' said Mary Ellen
Fritz of the Pennsylvania Department of Public Welfare,
which decides which drugs are subsidized by the state.
Some states, such as Illinois, say they'll pay for the
drug on a case-by-case basis only after finding Viagra
would allow the patient to avoid more costly treatment
or hospitalization.
Others require a copayment, like the $2 patients must
pay for each prescription in Montana.
Although Viagra has only been available for about a
month, the toll for the drug adds up fast.
''We've paid for $23,000 worth of Viagra since it was
approved,'' said. Bob Johannessen, spokesman for the
Louisiana Department of Health and Hospitals.
''That's a lot.''
To curb the rising toll, the state plans to require
handwritten prescriptions -- not the stamps more
prolific urologists use to spare their hands while
prescribing popular drugs.
Viagra has swept the market, accounting for 19 of
every 20 prescriptions now written for impotence
treatments and sextupling the number of men seeking
cures.
But as anxious men seek the drug in Louisiana and
elsewhere, Rhode Island remains strangely silent. The
state quietly began offering coverage for Viagra last
week, and nobody has yet applied for coverage, said
Jane Hayward, associate director of Human Services.
Several states say that is because very few men qualify
for Medicaid, a national health care program for the
poor funded by state and federal governments.
While many states see no requirement for them to pay
for the drug, Texas supplies it in the belief that the
rules that govern the program require it to. Bob Harris,
director of Texas' Medicaid Vendor Drug Program, said
the federal Omnibus Reconciliation Act of 1990 lets
states qualify for rebates from drug companies only if
they cover a company's full line of drugs with a few
exceptions, such as diet pills and reproductive
medication.
Some states skirt coverage by considering impotence
treatments as fertility drugs.
Reimbursement rules may be critical for recipients of
Medicaid, but most patients are willing to pay
themselves, said University of Tennessee Medical
Center urologist Robert Wake.
''The cost is such that it is fairly affordable for most
of the patients who need it and most of the patients
are willing to pay for it themselves if they have to,'' he
said. |
