KAISER PERMANENTE: Nixes Viagra Coverage
California's largest HMO plans to announce today that it is covering Pfizer Inc.'s new anti-impotence drug Viagra, the San Francisco Chronicle reports. Following an "unprecedented" review of the coverage issue by physicians, ethicists and pharmacists, "economic factors, as opposed to medical issues, decided the question for Kaiser." The HMO concluded that the projected $100 million annual cost of covering Viagra was simply too high. In comparison, Kaiser's yearly outlay for all anti-viral medicines, including protease inhibitors that fight HIV, totals only $59 million, the Chronicle reports. Dr. Francis Crosson, head of the Permanente Federation, explained the decision: "We could, of course, build the cost of Viagra into everyone's premium, but is that the right thing to do?"
Under the new national policy, which will take "full effect when standard HMO contracts come up for renewal," Kaiser doctors will still be able to prescribe Viagra, but patients who want it and other prescribed erectile dysfunction treatments such as suppositories will have to pay full retail price.
Negative Reactions
Patients, doctors and consumer groups -- as well as Pfizer -- "roundly condemned Kaiser's decision, calling it a misguided slap." Betsy Imholz of the Consumers Union in San Francisco said the policy amounts to "a strange inconsistency. ... [Kaiser] is going to pay for very invasive and costly [impotence] procedures, and not cover a safer and less costly medication." Some medical experts, however, "took Kaiser's side, maintaining that all HMO members should not have to bear the cost of the sexual activities of a few men." Dr. Arnold Relman, a Harvard Medical School professor and former editor of the New England Journal of Medicine, said: "In today's world of limited resources, you have to draw the line somewhere." Kaiser's new policy will have an inordinate impact on Northern California, where 1 of 3 residents are insured by Kaiser Permanente, the Chronicle notes (Hall, 6/19).