VIAGRA: Insurers Set Coverage Policies
Several major insurance companies announced this week their policies for covering Pfizer Inc.'s celebrated impotence drug Viagra, "a potential budget buster that threatens to plunge [HMOs] nationwide deep into the red," the Boston Globe reports. Boston's Harvard Pilgrim Health Care replaced its current policy of covering 10 pills a month with an allotment of four pills a month, a move that sparked protest that the health plan is "meddling into people's sex lives." Furman Selz analyst Robert Hoehn said HMOs are faced with "an extraordinarily difficult issue" in deciding how to cover Viagra. "They're almost getting into the business of rationing sex," he said. But health plans have their own bottom line to watch, the Globe reports -- after Viagra had been on the shelves for just a month, Harvard Pilgrim had racked up a $400,000 tab for the drug. Other health plans are setting similar policies -- Tufts Health Plan and Fallon Community Health Plan both cover four pills a month, while Blue Cross and Blue Shield of Massachusetts pays for 12 pills a month. Harvard Pilgrim said it will monitor public reaction to its new policy and re-evaluate its coverage in six months (Pham, 6/12).
Fighting It
The Hartford Courant reports that three Connecticut health plans announced yesterday they will cover limited amounts of Viagra for their patients. Oxford Health Plans will cover six pills a month and M.D. Health Plans and Physicians Health Services will set the limit at four pills a month. But lawyers say they will file class-action suits against insurers who do not provide unrestricted access to the impotence pill. Those suits would come on top of a similar class-action suit filed against Oxford in May in which lawyers charged that "insurers are, in effect, rationing sex by denying or limiting Viagra coverage." Lawyer Steven Cooper of New York-based Anderson Kill & Olick said Oxford's new policy "doesn't get it off the hook," adding that the limits are intended only to make the health plan's "bottom line look better." Insurers stress that their policies do not limit the number of pills a patient can buy, only the number a health plan will cover. "We're not really dictating anything; we're just saying what it is we will cover," said Oxford's Connecticut regional medical director Terence Fitzgerald (Levick, 6/12).
Urging Caution
Three days after the U.S. Food and Drug Administration announced that 16 men have died while taking Viagra, the Philadelphia Inquirer's editorial page notes that the drug "has been misused and misinterpreted." The piece blames a society that now has "medicines for conditions we used to think of as part of life" and media accounts of the drug that "were of the 'Yippee!' variety." The Inquirer urges the public to approach the drug "with the same careful skepticism that scientists and physicians use." The editorial concludes: "[L]et's admit that for all we know about the universe, we will always have a lot to learn. Perhaps we can start by learning about responsibility and caution, truth and glitz" (6/12).
Business Is Booming
Viagra is a hit in Carson City, NV, where local prostitutes are crediting the impotence drug with boosting their business. The introduction of Pfizer's blockbuster drug has brought "dozens of steamed-up seniors" to the legal brothels. "It really has done a lot for them physically, mentally and emotionally," said "Leif," a 38-year-old prostitute at the Moonlight Bunny Ranch. "They are paying more, staying longer. It totally has changed their self-esteem" (Adamson, Philadelphia Daily News/Spokane Spokesman-Review, 6/12).