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Biotech / Medical : PFE (Pfizer) How high will it go? -- Ignore unavailable to you. Want to Upgrade?

To: Zebra 365 who wrote (3708)	6/24/1998 3:43:00 PM
From: Perry	Respond to of 9523

As far as I see it, whether you are right or wrong really isn't the real issue, but rather are the policies consistent in their application. In other words, are other ED treatments, such as Muse, being payed for by HMOs, and if so are they discriminating against certain individuals that would prefer to take a pill over a penile suppository. Can you or anyone else close to the issues comment? Thanks, Perry

To: Zebra 365 who wrote (3708)	6/24/1998 5:03:00 PM
From: Hunter Vann	Respond to of 9523

Question: Our office in the past filed quite a few claims to BCBS & Medicare for the payment of Vacuum Pumps for the treatment of ED. With the appropriate paperwork, these claims were always paid for by the carriers.(bout $400 bucks) Would it not be unfair if BC/BS and Medicare refused reimbursement for the little blue pill? Or, does it simply boil down to cost??

To: Zebra 365 who wrote (3708)	6/24/1998 5:21:00 PM
From: DT	Respond to of 9523

Zebra, Thanks for the clarification in a legal sense--I am not an lawyer but do concur with your comment that: "the employer really determines the benefits that you may receive and the HMO or TPA is just an agent of the employer in providing these benefits. That is why the language of the HMO's press releases is worded that way, "if the employer wishes to cover it" The HMO in this case, however, after agreeing to provide a benefit for prescription coverage with pre-determined limitations (coverage or lack thereof of oral contraceptives for example) does have an obligation to provide agreed upon services. In the case of an HMO with coverage of ED products, the failure to cover all products within the class (unless a valid clinical reason can be substantiated--i.e. other clinically equivalent products with economic advantages) can expose the HMO to 1) Significant member disatisfaction and 2) the potential for lawsuits (again, not a lawyer's opinion only my assessment). If a plan will cover Muse I think it would be hard pressed to deny all coverage of Viagra IMHO. A valid action by one of the HMOs would be to approve coverage only after certain clinical hurdles have been met (failed on other products) or coverage for only 1 pill per co-pay/prescription. This would reduce the financial burden of the HMO without excluding all Viagra coverage. DT

To: Zebra 365 who wrote (3708)	6/24/1998 6:05:00 PM
From: zurdo	Read Replies (1) \| Respond to of 9523

I am one of those employers you appear to be discussing in your post...I have been an employer for over twenty years, and have always felt that you owe your employees the very best in health benefits the company can afford...I have never forced an employee of mine to go with an HMO that in my opinion offers mediocre service, such as Kaiser Permanente...A handful of them, over the years, have stated Kaiser is their preference, so I have supported their wishes...But over the years we have had pretty good medical coverage - much better than KAISER has provided to my friends who have it...