Medicare Drug Benefit To Include Coverage for Impotence Medications

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Article Date: 02 Feb 2005 - 9:00 PST

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CMS officials on Monday confirmed that the Medicare prescription drug benefit will cover impotence drugs such as Viagra, the… Los Angeles Times reports. Clinical experts said the decision to cover such medications -- what some consider "lifestyle" drugs -- follows the practices of private insurance plans and other government health programs, the Times reports. For instance, the Department of Veterans Affairs reversed a decision to omit Viagra from its drug coverage in 2001, and now about 151,000 patients receive coverage for the treatment (Zaldivar/Gellene, Los Angeles Times, 2/1). The U.S. Pharmacopeial Convention, the organization hired by Medicare to develop a formulary for the prescription drug benefit, included "impotence agents" in its guidelines for which medication classes the program would cover (Kaiser Daily Health Policy Report, 10/13/04).

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An unnamed Medicare official said, "The bottom line is that plans are allowed to provide [impotence drugs] and will have to provide them. But they can limit them only to medically necessary situations, and they can put quantity limits on them." Robert Moffit, a health care expert at the Heritage Foundation, said, "Ordinary Americans are going to be surprised," adding, "But this should not be a shock. Once you create a universal entitlement, the tendency is for the entitlement to expand." Ira Sharlip, a professor of urology at the University of California-San Francisco, said that many health insurance programs and plans cover other quality-of-life medications, so "[i]t wouldn't be right to single out (impotence drugs) as frivolous when there are so many others in the same category." Winton Gibbons, a pharmaceutical industry analyst at Chicago-based William Blair & Co., said, "I don't think Medicare coverage is going to add much to the market size or much to Medicare costs" because the prime market for the impotence treatments is 40- to 60-year-old men who do not yet qualify for Medicare (Los Angeles Times, 2/1).

"Reprinted with permission from kaisernetwork.org kaisernetwork.org. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at http://www.kaisernetwork.org/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork.org, a free service of The Henry J. Kaiser Family Foundation . © 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved.

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