VIAGRA: Two HMOs, Two States Say ‘No’ To Coverage

      Prudential HealthCare and Humana Inc. announced last week that they will not cover Pfizer's new impotence drug, Viagra. Today's Wall Street Journal reports that the two managed care companies said "they took the action because they weren't assured of the drug's long-term safety." Prudential Chief Medical Officer Anthony Kotin said there was insufficient clinical evidence "to make the case that the drug was safe among the elderly, often sick men who are using it." He said, "This drug didn't pass what we require in terms of the check for safety." Humana Vice President of Pharmacy Management Carol McCall noted recent reports of deaths among Viagra users. "With the overwhelming attention the drug has received, we were concerned about its long-term safety," she said.
      Nonetheless, analysts "said the insurers' real concern" was Viagra's price. Drug industry analyst Hemant Shah said, "They are using this as a cover. The real reason is that managed care has become the poster child of what is wrong with health care in America ... and for these institutions to say they are denying coverage because it costs too much is very difficult to do." A spokesperson for Pfizer defended Viagra's safety, pointing out that the drugmaker "has received no reports of deaths that raise any new concerns about the drug's safety beyond warnings already noted in the drug's label" (Jeffrey, 7/6).

New York And Wisconsin Too
      "New York and Wisconsin health officials said Friday that they won't go along with a federal directive that state Medicaid programs pay for" Viagra because they are not certain the impotence drug is "safe or necessary." And Michigan officials said they are considering ignoring the order, AP/Newsday reports. Robert Hinckley, a spokesperson for the New York Health Department, said, "We're exploring what to do, but our plans are right now that we are not covering this drug. We have significant concerns about the impact this could have on the health of our Medicaid recipients." He said the state was most concerned about drug interactions for those with chronic health conditions and "about Viagra being resold illegally."

Heck No
      "Wisconsin officials said it would cost their state $11.5 million a year to offer Viagra to the poor." James Malone, a spokesperson for the Wisconsin Department of Health, said, "We just don't feel this is an expense that taxpayers of Wisconsin should be forced to bear" (7/5). The New York Daily News reports that "[i]t is not clear what steps the federal government could take to force states to pay for Viagra coverage" (Goldiner, 7/4). The New York Post reports that the "state may sue the federal government for shoving Viagra down its throat." Hinckley had no comment on a possible suit (Birnbaum, 7/4). AP/Newsday reports that Medicaid recipients "could try to sue" to obtain coverage of the drugs and that "the federal government could try to withhold Medicaid money from states that refuse to comply" (7/3).

NGA Weighs In
      On Thursday the National Governors' Association expressed its opposition to the federal government's Viagra mandate. It said that according to preliminary estimates, mandated Viagra coverage would cost state Medicaid programs $100 million annually. Jennifer Baxendell, NGA's health legislation director, said, "Individual states have already begun to weigh the advantages and disadvantages of covering Viagra. Some states have chosen to coverage Viagra. ... Others have chosen not to cover it. These decisions reflect thoughtful determinations of state program and funding priorities. ... HHS's announcement completely disregards this thoughtful process" (NGA release, 7/2).