Judge Rules Kaiser Not Required to Cover Viagra, Prompting Questions about Other ‘Lifestyle’ Drugs
A Sacramento Superior Court judge ruled late Friday that the state cannot force Kaiser Permanente to pay for Viagra, possibly opening the door for health plans to rescind coverage of other "so-called lifestyle drugs," the Sacramento Bee reports. The decision, issued by Judge Lloyd Connelly, forces the Department of Managed Health Care to reverse a decision that required Kaiser to cover Viagra and other sexual dysfunction treatments. Some state officials say the decision "could shape coverage" for other lifestyle drugs for conditions such as obesity or baldness. "Practically speaking, we think this decision only affects Viagra, but it may have implications in the future," DMHC spokesperson Steven Fisher said. Currently, there are four classes of drugs that health plans must cover by state law: pain medications for the terminally ill, diabetes drugs, contraception and government-approved drugs that treat life-threatening or serious conditions. The ruling, however, says that nothing in state law requires health plans to "provide coverage for all medically necessary prescription drugs, including drugs for sexual dysfunction" nor does it find a law "obligating HMOs to authorize the use of drugs that treat conditions excluded from coverage in the insurance contracts signed by health plan members." As a result of the ruling, Kaiser said it does not anticipate any changes in prescription benefits "beyond its coverage of Viagra." Other health plans contacted by the Bee declined comment or had not seen the ruling. Fisher said the department is "keeping [its] options open in terms of an appeal or other actions" (Rapaport, Sacramento Bee, 7/10).
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.