COVERAGE DECISIONS: Government Should Involve Insurers, Public
Government attempts to mandate coverage of Viagra are "troubingly inconsistent" because the lawmakers simultaneously "allow cuts in basic Medicaid services" for some disabled persons, a Los Angeles Times editorial notes. The lawmakers have also ingored the "underlying problem" of the debate: determining which treatments are "medically necessary" and which ones are "lifestyle enhancing." In California, lawmakers "have threatened to prosecute insurers who don't cover Viagra under the state's Knox-Keene Act, which holds that 'medical decisions must be independent of fiscal and administrative concerns.'" The Times says that "[w]hile it may be premature to revise the Knox-Keene act, it's clearly time for state officials to encourage broad debate about which drugs -- for impotence, for infertility, for mood alteration, for birth control and so on -- are medically necessary." And "[m]edical necessity should not be determined by insurers alone." The editorial concludes: "Before imposing sweeping coverage mandates, legislators should involve both insurers and the public in a thoughtful discussion of how the health providers can best use their limited resources to offer the broadest range of basic, medically necessary care" (7/11).This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.