Erectile dysfunction drugs won't be covered

The new law's supporters say Medicare and Medicaid should not pay for "lifestyle" drugs, but doctors argue the same drugs treat a real health problem.

By — Posted Nov. 21, 2005

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Washington -- Physicians who prescribe drugs such as Viagra, Levitra and Cialis to their elderly and disabled patients may want to tell them that the federal government soon will stop footing any part of the bill.

Medicaid, in some states, covers erectile dysfunction drugs for patients with impotence, and Medicare will begin paying for the meds when the prescription drug benefit launches next year. But under a bill that President Bush signed into law last month, Medicaid beneficiaries will stop receiving federal help in buying the pills starting in January 2006, and Medicare coverage will end one year later.

The new law means that by the beginning of 2007, no federal Medicaid or Medicare dollars can go toward paying for medication to treat any sexual dysfunction. Sponsors of the legislation estimate that the government will save nearly $700 million over five years by cutting off what bill supporters call government subsidization of seniors' recreational sex.

The move was designed to help pay for expansions of health and unemployment benefits that lawmakers included in the final legislative package for the benefit of low-income people and Hurricane Katrina survivors, said Senate Finance Committee Chair Charles Grassley (R, Iowa).

"This legislation extends very important benefits for people who live on the edge of poverty," he said. "And the provision included to offset the cost of these programs recognizes that taxpayers shouldn't have to pay for certain lifestyle prescription drugs through Medicare and Medicaid."

But physicians counter that sexual dysfunction drugs are necessary to treat a very real health problem that is often the result of more serious diseases and that affects millions of seniors and men with disabilities. Doctors who treat such patients can see how crippling the underlying conditions can be, said Ira Sharlip, MD, a urologist in San Francisco.

"There's no logic in singling out drugs that can restore an essential bodily function, especially for patients who have erectile dysfunction because of something like prostate cancer," said Dr. Sharlip, a spokesman for the American Urological Assn. "Sexual function is really important to overall health and well-being, and I strongly disagree with the view that it is a lifestyle drug."

If the congressional move were fair and consistent, lawmakers would also have to ban coverage of myriad vital medications and procedures that do not actually save lives or prolong longevity, he said. Doctors often prescribe treatment for urinary incontinence and for skin disorders that are mostly cosmetic, for example, drugs that have no direct effect on how long people live but are covered by Medicare and Medicaid.

Dr. Sharlip predicted Medicare drug plans would experience a run on impotence drugs toward the end of 2006 as physicians aim to get subsidized medications to senior patients before the prohibition kicks in. After that, patients who use the medications twice a week, for example, would pay about $80 a month, he said.

Exceptions to the rule

Not all patients will be out of luck when it comes to financial help for these drugs.

States deciding that the treatments are medically necessary may continue to cover them, but they will not be able to claim federal matching funds. The Medicare drug plans launching in January 2006 also may decide to continue paying for the drugs through supplemental coverage that does not use federal health dollars.

Already it appears that many Medicare insurers will need to make a decision on erectile dysfunction drug coverage next year. In Florida alone, more than 270 drug plans will cover Viagra starting in January 2006, according to the Centers for Medicare & Medicaid Services.

The statute also provides an exception for cases in which the impotence drugs are used for treating conditions other than sexual dysfunction. Bill sponsors said they left this door open for essential applications of the drugs.

But Dr. Sharlip said erectile dysfunction drugs have only one FDA-approved use in this area -- to treat pulmonary arterial hypertension -- and physicians already prescribe them, under a different trade name, for this relatively rare condition.

Doctors will bear the burden of proof when it comes to getting coverage for the medications for treatment of other conditions for which the drugs have shown promise, he said.

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