MEDICARE List includes impotence drugs

What's more important: sexual enhancement or disease treatment?
KNIGHT RIDDER NEWSPAPERS
WASHINGTON -- Impotence drugs such as Viagra, Cialis and Levitra -- and possibly a libido-enhancing drug for women -- could all be covered under the new Medicare prescription drug plan.
U.S. Pharmacopeia, the independent drug standards agency hired by Medicare to help decide what drugs to cover, has included "impotence agents" on its draft list of recommended drug classes for the benefit, which begins in 2006.
Critics say the drugs' possible inclusion, though popular among seniors, isn't medically warranted and will increase the new drug benefit's cost, which is projected to reach $534 billion by 2014.
"If you have a certain amount of money that you want to spend on health care for the elderly, how much of a priority is covering these types of pharmaceuticals as opposed to other therapeutic interventions? I think most experts would put these types of [drugs] fairly far down on the priority list," said Robert Reischauer, the president of the Urban Institute, a Washington economic research group.
It's unclear what the demand for impotence drugs would be among the 65-and-older population if available from Medicare for a modest copayment rather than the current cost of $8 to $10 a pill. Impotence drugs for men are a $1.3 billion U.S. market today, and sales are projected to grow to between $3 billion and $3.5 billion by 2011.
Research
Impotence drug advertising today targets male baby boomers in their 40s and 50s. By the time they reach Medicare eligibility at age 65, they are likely be regular users, according to studies, which have found that prior sexual interest and activity levels predict one's sex life after 60.
Researchers at Duke University found that 80 percent of men in their late 60s remain interested in sex and that one in four men age 78 and older is still sexually active.
A drug to increase sexual desire in post-menopausal women might also be covered under Medicare if the Food and Drug Administration approves the sale of a female testosterone patch developed by Procter & amp; Gamble and Watson Pharmaceuticals Inc. Roughly 24 million of Medicare's 42 million enrollees are women.
"It is a problem that requires pharmacological intervention for many couples and for many individuals, so [the patch] should definitely be available," through Medicare, said Dr. Gloria Bachmann, the director of the Women's Health Institute at the UMDNJ-Robert Wood Johnson Medical School in New Brunswick, N.J.
Medicare officials say it's too soon to say what drugs will be covered under the new benefit. U.S. Pharmacopeia has until Dec. 31 to submit its final draft of recommended drug classes for the Medicare plan. Medicare is expected to finalize the list early in 2005.
The current roster of impotence medications for men is fairly short: Levitra by Bayer Pharmaceuticals and GlaxoSmithkline; Cialis by Lilly ICOS LLC, and the runaway industry leader, Viagra, made by Pfizer Inc. Other lesser-known medications include an injectable penile drug by Pfizer called Caverject Impulse and a medicated urethral suppository called MUSE made by Vivus Inc.
Here's the problem
Omitting coverage for impotence drugs would save money for cost-pressed Medicare, whose enrollee population is projected to grow to about 61 million by 2020.
But impotence is a recognized medical condition and drugs to treat it are covered not only by Medicaid, but also by the Veterans Administration, the Federal Employees Health Benefit Plan and many private plans.
Private and public plans typically require that a physician determine that impotence drugs are medically necessary.
Some plans require prior authorization before payment is made. Others restrict the number of prescriptions they'll cover over a certain time period. Some don't cover the drugs at all. Often, coverage is "decided on a case-by-case basis depending on your health plan and your employer," said Mohit Ghose, a spokesman for America's Health Insurance Plans, the leading trade group for health insurers.