The Clinton administration recently issued a federal mandate through the Department of Health and Human Services that requires state Medicaid programs to cover the new potency drug, Viagra, when it is medically necessary. A number of politicians, health insurance companies and medical experts oppose the mandate because of the potential risk, high cost and use for life enhancement. Thirty-nine deaths are allegedly linked to Viagra and are still under investigation. There are many indications that both patients and doctors understand little about the drug’s risk factors. In addition, there is the fear that the mandate for insurance coverage at $10 a pill could cause premiums to skyrocket. However, erectile dysfunction, or impotence, is a medically related condition, and therefore should be covered.
Kaiser Permanente, a health maintenance organization with membership estimated at 9 million, refused coverage for the drug. Spokespersons for Kaiser said coverage of Viagra increases its pharmaceutical bills by about 10 percent, or about $100 million a year. Kaiser decided to let its members pay for the potency pill out of their own pockets. The PM Group Life Insurance Company, a subsidiary of Pacific Life, the largest life and health insurer in California, does cover Viagra. The company contends that Viagra is used to treat erectile dysfunction, considered an illness, and that insurers are not in the business of making medical treatment decisions.
At least a dozen states have chosen to cover Viagra, with the same number in opposition. Other states are waiting for further instructions from the federal government. According to a 1990 law, states must include prescription drug coverage for medications approved by the Food and Drug Administration. Officials argue that financial resources should not be used for increasing a more active sex life. However, Viagra is not a hormone or an aphrodisiac. It is a prescription medicine used for the treatment of a medical condition, namely, erectile dysfunction, the medical term for impotence. Close to 30 million American men suffer from erectile dysfunction. Erectile dysfunction can be caused by spinal-cord injuries, diabetes, vascular problems and prostate cancer, among other conditions.
James B. Regan, the head of Georgetown’s Erectile Dysfunction Treatment Program, claims he has never seen anything like the current demand for Viagra. Despite medical necessity, some men will use the drug indiscriminately. Doctors must make the ethical choice to decide if the request for the drug is medically related or simply to be used for life enhancement. Viagra also carries safety warnings. Men with heart conditions and diabetes are warned to stay away from the drug altogether. Many of the reported deaths were related to heart problems. At least six of the deaths happened with men who were also taking nitroglycerine.
If the drug is abused, insurers will be less likely to cover it. Documentation from a doctor should be required. Soaring costs through misuse is a legitimate factor in whether to cover Viagra, with strict monitoring and a high degree of medical ethics being the controlling factors. Impotence, in most cases, is the result of physical causes, as well as neurological and psychological ones, and should be covered by insurers like any other medical condition.