KAISER PERMANENTE: Must Pay For Viagra, Rules DOC
The state Department of Corporations ruled last Thursday that Kaiser Permanente must pay for its members' Viagra prescriptions. Kaiser had petitioned the DOC to allow it to "drop coverage in 1999" of Viagra and other sexual-dysfunction treatments (Los Angeles Times, 1/1). The Wall Street Journal reports that Kaiser said the ruling would cause its rates to rise. Jim Anderson, Kaiser's spokesperson, said the decision would mean a $1-a-member-a-month increase (1/4). Under the ruling, Kaiser "must continue paying at least half of the roughly $80 it costs to provide a monthly dose of Viagra to men" (AP/Sacramento Bee, 1/4). In addition to the announcement last Thursday, the DOC announced last Monday that it had completed its investigation of Kaiser's Viagra policy. According to DOC Commissioner Dale Bonner, the agency found that the HMO "may have encouraged" its doctors to avoid prescribing the drug "between April, when the drug came on the market, and September, when Kaiser agreed to put it on" its formulary. While admitting "no wrongdoing," Kaiser agreed to pay $250,000 to cover investigation costs and to reimburse patients who paid for their own prescriptions during the five-month period in question. The San Francisco Chronicle reports that Blue Cross of California, PacifiCare, Cigna, HealthNet, Aetna and Greater Pacific have similar applications pending (Abate, 12/29). The AP/Bee reports that the DOC's decision could "affect every health plan in California." California is the third state nationwide to force Kaiser to pay for Viagra; 12 states have allowed it to drop coverage of the anti-impotence pill. Kaiser spokesperson Tom Debley said, "Given the differences between the states, I think there's still an important disagreement over whether drugs like this should be covered" (1/4). Click here for past CHL coverage of this issue.
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.