State Appeals Court Rules DMHC Cannot Force Kaiser Permanente to Cover Viagra
The Department of Managed Health Care cannot force Kaiser Permanente to cover prescription costs for the sexual dysfunction treatment Viagra, according to a decision yesterday by a state appeals court in Sacramento, the San Francisco Chronicle reports. In the decision, which upheld a July 2001 trial court ruling, the 3rd District Court of Appeal said that a regulation established by the DMHC in November 2000 to require HMOs with a prescription drug benefit to cover "all medically necessary outpatient drugs" did not apply to Viagra. The DMHC had argued that Viagra has "important quality-of-life implications" (Colliver, San Francisco Chronicle, 6/28). State law requires health plans that offer a prescription drug benefit to cover pain medications for the terminally ill, diabetes treatments, contraception and government-approved medications for life-threatening conditions. The decision yesterday could "limit patient access to prescription drugs that HMOs do not consider medically necessary," the Sacramento Bee reports (Rapaport, Sacramento Bee, 6/28). For example, as a result of the decision, the DMHC may drop an appeal in a similar case in which a court ruled that the department cannot force Blue Shield of California to cover the weight-loss treatment Xenical for morbidly obese women (San Francisco Chronicle, 6/28). Kaiser Permanente Senior Counsel Anthony Barrueta said that the HMO plans to review its state-mandated policy to cover 50% of the cost of semi-weekly doses of sexual dysfunction treatments (Silber, Contra Costa Times, 6/28).
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