Viagra in Today's Chicago Tribune
BigKNY3
"I don't think this old-young thing is indicative of real life in general--but it is ruining my life. Since last Christmas, three-- count 'em, three--bona fide grandfathers asked me for dates. What's going on here? I think these old guys believe they can get women in their 20s and 30s -- their children's ages -- because of what they see in the movies. And Viagra doesn't help matters."
WOMANEWS
OPINION. THEIR SAY.
IN THE AGE OF VIAGRA, A CALL FOR PRESCRIPTION PARITY
Olympia J. Snowe and Harry Reid. Special to the Tribune. Sens. Olympia J. Snowe (R
08/16/98
Chicago Tribune
Since April, America has witnessed a flurry of media coverage regarding Viagra, the promising new drug for treating male impotence.
As a result, the drug has become a part of popular culture, and doctors have been overwhelmed with requests for prescriptions. With the tremendous promise of this new drug, the media spotlight on Viagra also has served to highlight another, more disturbing issue: unequal treatment of men and women by insurers.
In the weeks since Viagra was approved by the U.S. Food and Drug Administration, insurers have focused not on whether to cover this new drug -- but rather on who will be covered, and for how many pills.
According to a study by IMS Health Research, nearly half of the 270,000 Viagra prescriptions written between March 27 and May 1 were covered by some type of insurance. By comparison, the birth control pill was first introduced in 1960, yet today, nearly four decades later, only 33 percent of typical large-group insurance plans include coverage of oral contraceptives -- the most popular form.
The speedy and positive reaction of insurers for men seeking coverage for Viagra is in stark contrast to the experience of women seeking coverage for prescription contraceptives, and helps to explain why women, on average, pay 68 percent more in out-of-pocket health care expenses than men. That translates to costs of $7,000 to $10,000 over a woman's reproductive lifetime.
Current insurance practices place effective contraceptives beyond the financial reach of many American women. Even plans that do provide some coverage typically do not cover all five of the most commonly-used forms of prescription contraceptives: oral contraceptives, the IUD, diaphragm, Norplant and Depo-Provera. While a majority of insurers cover prescription drugs, half of large group plans and preferred provider organizations exclude coverage of contraceptives.
There is no doubt that, for many Americans, the advent of Viagra is welcome news, and we have no quarrel with insurers who choose to provide coverage for Viagra. Any speedy decision to cover Viagra, however, reveals a disturbing inequity in coverage of prescriptions for men and women, which must be corrected. This inequity increases the pressure on Congress to do just that.
We introduced the Equity in Prescription Insurance and Contraceptive Coverage Act, known as EPICC, in the Senate last year. A companion bill has been introduced in the House of Representatives by Reps. Jim Greenwood (R-Pa.) and Nita Lowey (D-N.Y.).
Our bipartisan legislation, now co-sponsored by a third of the Senate, would prohibit plans that already provide coverage of prescription drugs from excluding or restricting coverage for prescription contraceptives. The bill does not seek to provide special treatment of contraceptives -- just equal treatment. In short, it seeks to establish parity for contraceptive prescriptions within the context of coverage already provided by insurance plans.
Some insurers argue that comparing treatment of Viagra and prescription contraceptives is like comparing apples and oranges, because impotence is a medical condition, while contraception is not. These critics ignore the fact that pregnancy is a life-altering condition that has broad medical implications. More than half of all pregnancies in the United States are unintended, and half of the 3.6 million unintended pregnancies each year end in abortion.
Prescription contraceptives have a proven track record of preventing unintended pregnancy, reducing the need for abortion, and enhancing the health of many women and children, and the promise of our effort has helped us earn support from senators of both parties, and with differing views on abortion. Contraception is a component of basic health care for women, yet far too many insurers exclude or limit this coverage.
While insurers currently rely on women to pay out-of-pocket for contraceptives, the reality of this practice is that financial constraints force many women to forgo (or rely on less effective contraceptives), leading to unintended pregnancies. Because the likelihood of getting pregnant when couples do not use birth control is so high, contraceptive use lowers the likelihood of pregnancy by 85 percent. In fact, more than half of unintended pregnancy occurs because no contraceptives are used.
From an economic standpoint, the failure of insurers to cover prescription contraceptives makes no sense, when 86 percent of large group plans already cover tubal ligations (sterilization) and 66 percent cover abortions. Both of these surgical procedures are more expensive than a full year's supply of oral contraceptives, and what kind of perverse incentive is sent when insurers make it more affordable for women to choose permanent sterilization or abortion over contraceptives?
Insurers have cited the low cost of Viagra -- at about $10 a pill -- compared with other treatments for impotence as a basis for coverage of the drug. That's appropriate, when treatments such as implants can cost between $15,000 and $20,000. But the same argument can be made for coverage of birth control pills, which cost $1 a day.
The time has come to eliminate the disparity between coverage of prescription contraceptives and other prescription drugs. The Snowe- Reid bill will do just that, and on July 29 the Senate took an initial step with our amendment to a 1999 appropriations bill that extends prescription contraceptive coverage to federal employees, mirroring action in the U.S. House earlier in the month to make this coverage available to 1.2 million women in the Federal Employees Health Benefits Plan. Currently, of the 350 health plans that are part of the federal plan, 10 percent do not cover any contraceptives; 81 percent do not cover the five leading reversible methods and only 19 percent cover all five, FDA-approved methods.
We hope that our efforts will succeed in encouraging insurers to provide equal coverage for prescription drugs such as Viagra and birth control pills. Doing so will strike a victory for equity in insurance coverage, and have the added benefit of reducing the incidence of unintended pregnancy and abortion.
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