Alabama Medicaid pays for viagra

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From http://www.mail-archive.com/law-issuesmylist (DOT) net/msg03585.html

Ala. Footing Viagra Medicaid Costs

MONTGOMERY, Ala. (AP) -- Taxpayers are temporarily footing the cost for

impotent men on Medicaid in Alabama to get as many as four Viagra pills

each month, a benefit the agency is scrambling to stop.

The benefit is more generous than some insurance companies provide, and a

doctor who helps decide which drugs are subsidized by the state said

Wednesday that Viagra is a ``luxury'' that Medicaid can't afford.

Dr. Rick Bendinger of Abbeville also said the drug may be only temporarily

available to Medicaid recipients. Officials in the agency agreed. They are

already taking steps to get the benefit stopped.

About 650,000 Alabamians, mostly poor women younger than 21, children and

elderly people, are eligible for Medicaid-subsidized health care.

Dr. Searcy, medical director for the agency, said Wednesday that so

far only a ``few'' Viagra prescriptions have been filled for

Medicaid-eligible men. He said it's not known how many men on Medicaid

might be eligible to receive the impotence drug.

Bendinger said Medicaid had no choice but to approve Viagra when it hit the

market.

He said the drug's developer, Pfizer Inc., is involved in a rebate program

with the national Medicaid program. The rebates benefit taxpayers, and

federal law requires that as part of the rebate agreement, when Pfizer puts

a new drug on the market, it is automatically covered by Medicaid.

Searcy said Medicaid agencies in all states are trying to decide what to do

about Viagra, which some pharmacists say has become the hottest drug on the

market. He said Medicaid officials in some other states are classifying

Viagra as a fertility drug and are not paying for the prescriptions.

Medicaid officials from around the country discussed Viagra this week in

Washington and are awaiting ``further guidance'' from the federal Health

Care Financing Administration, Searcy said.

Andy McCormick, a spokesman for New York-based Pfizer, said he was unsure

how many Medicaid agencies are paying for Viagra prescriptions. He said

some private insurance companies are ``covering it in total ... some up to

10 pills a month, " and others are not covering it at all.

Industry researcher IMS Health reported recently that 51 percent of the

113,134 people who picked up new prescriptions for Viagra in the week that

ended April 17 were repaid at least in part by their insurance companies, a

figure less than the 76 percent coverage insurers offer for prescription

drugs overall.

``In general, we think erectile dysfunction is being recognized as a

medical condition and Pfizer is emphasizing that Viagra is only for those

men with a diagnosed condition. It is not to be used recreationally,''

McCormick said.

Bendinger said if the new drug becomes abused, or if there is an

over-the-counter alternative, it can be restricted for Medicaid.

One possible abuse is by men looking to enhance their sexual performance

instead of needing Viagra to produce an erection. ``I'm not going to be

prescribing it to 20- and 30-year-old people for improvement reasons,''

Bendinger said.

Searcy said the Alabama agency has notified Pfizer that there is a

potential for abuse or misuse of the drug, a procedure that a state can use

to remove drugs from coverage.

He said that if the company agrees, Medicaid intends to either stop paying

for Viagra or to require advance approval for each prescription to avoid

misuse. If Pfizer disagrees, it then has up to eight months to show

Medicaid officials why Viagra should be covered. Searcy said the limit of

four pills a month would apply during such an appeal.

Bendinger said the $10 cost of the pills makes it ``not a drug that we want

to make a priority for Medicaid recipients when the agency is struggling to

provide drugs for diseases such as hypertension, heart disease and

diabetes.''

A co-chairman of the Legislature's Medicaid Oversight Committee, Rep. Ron

, R-Sylacauga, said that even though some people consider Viagra to

be a luxury, ``the sex drive being what it is in some people, it may very

well have a lot to do with the mental well being of a person.''

``Everybody makes light of it, but it is a tremendous problem in some

individuals,'' said.

Searcy said Medicaid currently pays for a less costly, less popular,

prescription product, a ``suppository that you place in the urethra.''

He said Medicaid does not subsidize more costly urethral inserts.

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