Grassley Bill Would End Federal Coverage of Treatments for Erectile Dysfunction

Senate Finance Committee Chair Chuck Grassley (R-Iowa) on Tuesday introduced a bill that would end Medicare and Medicaid coverage for erectile dysfunction drugs such as Viagra, the Washington Times reports. Under the bill, federally funded programs still would cover the drugs if they were used to treat conditions other than ED (Dinan, Washington Times, 5/25). Sens. John Ensign (R-Nev.), Trent Lott (R-Miss.) and Rick Santorum (R-Pa.) are co-sponsors of the bill. Grassley said, "We live in a world of limited resources, and those dollars could be spent more wisely" (AP/Los Angeles Times, 5/25).

Grassley said in a floor statement, "It is a pretty simple piece of legislation -- no payment for drugs prescribed for sexual or erectile dysfunction under any federal program, period" (Rodeffer, The Hill, 5/25). The Congressional Budget Office last week reported that Medicare spending on ED drugs would total $1.93 billion during the first 10 years of the new Medicare drug benefit, which begins in 2006 (Washington Times, 5/25).

CMS estimated that Medicaid spends about $38 million annually on ED drugs (AP/New York Times, 5/25). Rep. Steve King (R-Iowa), who earlier this year introduced a bill (HR 712) that would prevent Medicare from covering ED drugs, said he likely will expand his bill to include Medicaid. "To have that kind of support over on the Senate side and working with my fellow Iowa colleague, I'm confident now we will get the job done," King said. The pharmaceutical industry has argued that ED drugs should be covered because they are part of overall patient treatment (Washington Times, 5/25).

In related news, Dennis Smith, director of the Center for Medicaid and State Operations, on Tuesday said in a letter to states that providing ED drugs to sex offenders could "constitute fraud, abuse or inappropriate use of Medicaid funds." Smith said each state should review its procedures for covering such drugs, adding that "failure to perform such a review and implement appropriate controls may result in sanctions" (AP/Los Angeles Times, 5/25).

The letter comes in response to an audit by New York State Comptroller Alan Hevesi's office that found that nearly 200 convicted Level 3 sex offenders in the state received Medicaid coverage for Viagra. People designated as Level 3 sex offenders have been convicted of crimes such as rape, sexual abuse and sexual conduct against a child and are classified by courts as likely to re-offend. Hevesi sent a letter urging HHS Secretary Mike Leavitt "to take immediate action to ensure that sex offenders do not receive erectile dysfunction medication paid for by the taxpayers." CMS on Monday clarified that states have the ability to block Medicaid coverage of erectile dysfunction drugs for convicted sex offenders.

CMS spokesperson Gary Karr said confusion stemmed from an apparent misunderstanding of the 1998 federal Medicaid policy that requires the program to cover any drug that is medically necessary, including ED drugs (California Healthline, 5/24). Karr on Tuesday said, "We really don't think there are going to be many states that are going to be slow about finding a way to keep convicted sex offenders from getting erectile dysfunction drugs" (AP/Los Angeles Times, 5/25).

Additional information on the Medicare drug benefit is available online.