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

To: BigKNY3 who wrote (7474)	4/21/1999 3:25:00 PM
From: BigKNY3	Read Replies (1) \| Respond to of 9523

Oregon Health Plan Will Pay for Impotence Drug Viagra Patrick O'Neill 05/08/1998 KRTBN Knight-Ridder Tribune Business News: The Oregonian, Portland, Ore. Low-income Oregonians can have better sex lives, courtesy of the Oregon Health Plan. Just how much better hasn't been decided. The health plan, which provides health insurance to low-income Oregonians, will make the new drug Viagra available to patients who suffer from some forms of impotence. One of the most pressing questions: How many of the pills -- which cost $10 each -- will the plan provide each month? The answer will depend on a mix of economic and social factors that health plan officials have confronted with recent controversies about coverage of physician-assisted suicide and sex-change operations for transsexuals. Assisted suicide is covered under "comfort care" on line 260 of the health plan's prioritized list of 574 covered medical treatments. The sex-change issue will be decided later this year. Decisions about Viagra will have to be made for patients who are covered by both managed care programs and fee-for-service, said Hersh Crawford, head of the Oregon Medicaid program. Health plan officials are trying to determine the number of pills a month for fee-for-service patients. But managed care organizations will have more latitude to decide how much of the drug to prescribe, he said. Exactly what the health plan covers is determined by a list of medical conditions that ranks treatments from the most to least important in terms of cost and effectiveness. The list provides coverage for 574 of a total 745 conditions. The plan does not pay for those that are lower than line 574. The list allows treatment of impotence caused by organic conditions -- such as diabetes, prostate surgery and coronary artery disease --but not those that result from mental health problems such as depression. The drug has been found effective for treatment of impotence due to depression and in patients taking a variety of drugs, including antidepressants and antipsychotics. Impotence caused by organic problems falls on line 544of the list. But impotence stemming from mental disorders is on line 583, after the cutoff point. Crawford said doctors will be asked for proof that patients who are offered Viagra suffer from an organic rather than psychological disorder. The U.S. Food and Drug Administration on March 27 approved Viagra , a drug manufactured by Pfizer Pharmaceuticals. Since then, Crawford said, state Medicaid officials across the country have been consulting with one another, trying to figure out how their programs should handle the drug. "We would require that the physician provide documentation of the diagnosis that the drug is being prescribed for," he said. "And we'd have a limitation on how many pills we pay for a month." Although studies have shown that men safely can take one Viagra pill a day, Pfizer has recommended prescription levels of 10 pills a month, based on a 1994 study, "Sex in America." Researchers found that 41 percent of married couples had sex twice a week. Crawford said health plan officials are trying to decide how many pills would be appropriate. "There seems to be a tremendous demand," Crawford said. "So it's an issue we have to deal with very soon." Managed care organizations have some freedom in deciding how to prescribe Viagra . "The way in which the drug benefit is managed under the Oregon Health Plan can vary from (managed care) plan to plan," he said. "All have formularies that limit the drugs they offer." Patty Church, corporate pharmacy director for Regence BlueCross BlueShield of Oregon, said health plan members who receive care through her organization can get Viagra . Regence operates HMO Oregon, the largest provider of managed care to health plan members. Church said physicians who prescribe Viagra must submit proof that the patient's impotence was caused by an organic -- not psychological -- condition. The reason is that the health plan pays for treatment of impotence caused by organic problems but not those of psychological origin. Church said HMO Oregon hasn't determined how many pills to provide. "We're reviewing that," she said. Kaiser Permanente is waiting for more information from the health plan before deciding whether and how much Viagra to give its health plan patients. James Gersbach, a Kaiser spokesman, said Kaiser does not include Viagra in its formulary. That doesn't mean Kaiser patients can't get the drug, only that under some contracts with Kaiser, patients must pay 50 percent of the price of the drug instead of a lower copayment. "We're taking a cautious approach to the drug," Gersbach said. "It's not a lifesaving drug. It might save your love life but not your life." Gersbach said new drugs that fight cancer are more likely to win approval than those that add only to quality of life. He said Kaiser doctors will watch for side effects of Viagra that might not be apparent in the first studies