Medicare Prescription Drug Benefit Might Cover Erectile Dysfunction Treatments

The new Medicare prescription drug benefit scheduled to take effect in 2006 might include coverage of erectile dysfunction medications for men, the Philadelphia Inquirer reports. The U.S. Pharmacopeial Convention, the organization hired by Medicare to develop a formulary for the prescription drug benefit, has included "impotence agents" in proposed guidelines for which medication classes the program will cover (Pugh, Philadelphia Inquirer, 10/13). The proposed guidelines, released earlier this year, list 146 classes of medications that Medicare should cover, such as antidepressants, HIV/AIDS medications, anti-cholesterol treatments and anti-inflammatory medications (California Healthline, 10/8).

Under the proposed guidelines, the Medicare prescription drug benefit might include coverage for erectile dysfunction medications -- such as Viagra, Cialis and Levitra -- and a new testosterone patch that can improve sexual desire for women, provided that the treatment receives FDA approval. However, opponents maintain that such medications are "not medically warranted and will increase the new drug benefit's cost," the Inquirer reports. USP will release final guidelines by Dec. 31, and the federal government in early 2005 likely will decide which medication classes the prescription drug benefit will cover.

Urban Institute President Robert Reischauer said that most health care experts likely would consider erectile dysfunction medications "fairly far down on the priority list" for coverage under the Medicare prescription drug benefit. He added, "If you have a certain amount of money that you want to spend on health care for the elderly, how much of a priority is covering these types of pharmaceuticals as opposed to other therapeutic interventions?"

However, Gloria Bachmann, director of the Women's Health Institute at the Robert Wood Johnson Medical School, said that the Medicare prescription drug benefit should include coverage for such medications because "it is a problem that requires pharmacological intervention for many couples and for many individuals." Many private health insurers -- as well as Medicaid, the Federal Employees Health Benefits Program and the Department of Veterans Affairs -- consider erectile dysfunction a medical condition and provide coverage for treatments (Philadelphia Inquirer, 10/13).