VIAGRA: Administration May Require States To Cover

      The Clinton administration said that it will require state Medicaid programs to pay for "medically approved uses" of Pfizer's new impotence drug Viagra. The New York Times reports that "the decision is apparently not final," but many state officials are already complaining that "coverage of Viagra should be left to the states." The proposed mandate will not prevent states from limiting "the number of pills in a prescription or the number of refills allowed to a Medicaid patient." However, federal officials do plan to "emphasize that any limits must be reasonable and may not defeat the purpose of the drug." Pfizer has recommended a standard dosage of "10 pills a month if states insist on a limit." Currently, some states "cover the drug, some refuse to pay for it and others have yet to decide." White House health policy aide Chris Jennings "said federal Medicaid officials had told him that 'if there is a medical rationale for using Viagra, it must be covered.'"

States Weigh In
      Florida Gov. Lawton Chiles (D) and Utah Gov. Michael Leavitt (R) wrote a joint letter to the administration this week saying: "Governors believe that Viagra should be a state option, not a mandate. ... [A] nationwide mandate for coverage of Viagra through Medicaid would cost the states and the federal government more than $100 million each year." New York State Health Department spokesperson Frances Tarlton said, "New York has no plans to cover Viagra unless we are required to do so by the federal government." The Times notes that Florida is covering four pills a month, Connecticut covers Viagra for Medicaid patients under traditional fee-for-service arrangements, and New Jersey's Medicaid program covers Viagra "with no limits on the number of pills or prescriptions." When "states decide to cover prescription drugs [under Medicaid], they must follow federal rules and may not arbitrarily exclude particular medicines," the Times reports (Pear, 5/28).