New York Times Examines Debate Over Medicare Coverage of Erectile-Dysfunction Medications

The… New York Times on Tuesday examined the ongoing debate over whether Medicare should cover erectile-dysfunction medications, such as Pfizer's Viagra. CMS officials last month said that they interpreted the policies governing the new Medicare prescription drug benefit to mean that drugs such as Viagra, Eli Lilly's Cialis and GlaxoSmithKline's Levitra must be covered if they are prescribed by a doctor. CMS' announcement prompted Rep. Steve King (R-Iowa) this month to introduce a bill prohibiting Medicare from covering drugs "prescribed for the treatment of impotence."

Support
Kindra Strupp, a spokesperson for Lilly, said, "Erectile dysfunction is not a trivial thing for men who suffer from it. We've heard from thousands of men that it can interfere with their intimacy, erode their relationships with their partners, damage their self-esteem and lead to depression." Lilly, Pfizer and GSK are focusing efforts to retain Medicare coverage for ED drugs on three arguments: that ED is a medical condition recognized by providers and health insurers; that men seeking treatment for ED frequently are found to have underlying conditions such as diabetes and high blood pressure that otherwise would not have been detected; and that using a formulary that requires prior authorization, charges higher copayments or limits the number of pills that can be dispensed could prevent abuse of ED medications.

Medical Necessity
Daniel Callahan, co-founder of the Hastings Center bioethics research institute, said that a "possible compromise solution" might be to "set specific medical criteria allowing Medicare coverage for [the] drugs when erectile dysfunction can be traced to some identifiable medical condition other than age." Robert George, a professor at Princeton University and a member of the President's Council on Bioethics, said, "If impotence occurs in the normal course of a human life, as a consequence of aging, these drugs should not be covered. But if there is a real health problem, I am inclined to say the drugs should be covered." William Gee, chair of the health policy council of the American Urological Association, said, "For a 70-year-old man with hardening of the arteries caused by smoking, for a man with diabetes or multiple sclerosis or a man who has had pelvic surgery for cancer, there are clear medical indications for these drugs." Arthur Caplan, director of the Center for Bioethics at the University of Pennsylvania, said the issue has forced policy makers to ask, "What emphasis will we give to quality of life as a goal for pharmacological intervention?" (Pear, New York Times, 2/22).

Medicare Advantage Program
In related news, CMS Administrator Mark McClellan on Friday announced that the agency has received more than 141 applications from health plans to participate in the Medicare Advantage Program, indicating that beneficiaries will "see a robust [program] when it really gets started in January." The new Medicare law includes a provision calling for financial incentives to health plans to attract them to the MA program. According to CQ HealthBeat, the 141 applications are in addition to the 152 HMOs, 26 PPOs and seven private fee-for-service plans currently in the program. The figures also do not reflect applications for regional plans, which are due March 23 (CQ HealthBeat, 2/18).

Rising Costs
The Minneapolis Star Tribune on Sunday examined the "surprising escalation" in the cost of Medicare and experts' concerns that the program's financial outlook could necessitate reforms earlier than Social Security (Westphal, Minneapolis Star Tribune, 2/21).

Broadcast Coverage
NBR on Monday in a series of segments reported on the future of Medicare. The segments included comments from NBR on Monday in a series of segments reported on the future of Medicare. The segments included comments from Michael Carter, vice president of Hay Group; Paul Ginsberg, president of the Center for Studying Health System Change; Gail Wilensky, a senior fellow at Project Hope; Dr. Marcia Gomez, a medical director of health services at Humana; Marsha Gold, a senior fellow at the Mathematica Policy Research; McClellan; Amy Compton Phillips, care management director at Kaiser Permanente; President Bush; and parents, employers and retirees (Yastine, NBR, 2/21).

A complete transcript of the segments is available online.

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