VIAGRA: Virginia Says No, States Fear Federal Mandate

      The head of Virginia's Medicaid agency "has rejected covering the cost of Viagra for Virginia's Medicaid recipients," the Richmond Times-Dispatch reports. "This agency's policy is not to cover the drug at this time," said Robert Lauterberg, the acting director of Virginia's Department of Medical Assistance Services. He did not offer further comment on the issue (Hostetler, 5/12). An editorial in yesterday's Richmond Times-Dispatch praises the decision: "The pill's extraordinary demand suggests Viagra is being sought not just by impotent men, but also by those hoping merely to enhance sexual performance. Taxpayers should not have to pick up the tab for drugs not medically necessary. And even in cases of clinical impotence, why should they be obligated to fund treatment?" (5/12).

Pandora's Box
      The Los Angeles Times reports that "many state Medicaid directors worry that if the federal government directs them to cover Viagra, they soon will have to cover a host of 'quality of life' drugs that are not now covered." At present, states are allowed to "refuse coverage of diet and anorexia drugs, smoking cessation aids, drugs to enhance fertility or counteract baldness and barbiturates." The Times notes that "[b]eyond those exceptions ... a 1990 law required state Medicaid agencies to cover any drug approved by the [FDA] and prescribed by a physician in cases of 'medical necessity,'" though the law does permit states "to place a wide range of restrictions on their coverage." Bruce Bullen, who heads Massachusetts' Medicaid agency and the National Association of Medicaid Directors, said Viagra "raises serious medical necessity questions for a program like ours." He said, "A lot of Medicaid directors' health care dollars are limited. To require spending in areas that may be of questionable necessity may be a diversion of funds." According to the Times, several states, in discussing the Viagra issue with federal officials, "have argued that Viagra should be considered a fertility drug -- a decision that would allow states to deny coverage under the 1990 law. Though California is rejecting coverage through its Medi-Cal program, officials there "said that they believe state Medicaid agencies will be required to cover Viagra prescriptions in cases of 'medical necessity'" (Healy, 5/9).

How Many?
      "So far," the AP/Washington Post reports, "at least 11 states" and the District of Columbia are covering Viagra through their Medicaid programs. The AP/Post notes that 12 states "have rejected coverage," including New York, Illinois, California, Pennsylvania, Tennessee and Michigan (Goldstein/Melton, 5/9).

A Little Humor
      Village Voice columnist Linda Stasi concludes a humorous review of the Viagra issue with the comment: "Of course, the jokes will be endless. But, in real life, is it really OK to let an insurance company decide whether we'll have sex, or have kids, and how many? Clearly, Big Brother won't pay for anything that's going to cost him big down the line. We know that when insurance companies pay for birth control pills and condoms, it saves them mucho dinero -- on pregnancy costs, on pediatricians' fees, on German measles shots" (5/19 issue).