The male impotence drug Viagra has found a place in national headlines and comedy skits since its approval by the Food and Drug Administration late last March. In addition to offering many impotent men the chance for normal sexual intercourse, however, its release has renewed debate about insurance coverage of fertility options for both men and women.
Although insurance providers often at least partially cover Viagra, they will seldom pay for contraceptives. Both the Duke Managed Care Plan and Kaiser Permanente, the two insurance options for University faculty and employees, however, do cover contraceptives. But although Kaiser also pays for Viagra, the Duke Managed Care Plan does not.
Kaiser has chosen to cover Viagra by classifying it as a prescription drug, although not all drugs available by a physicianPis prescription are covered under the company's plan, said Beverly Thompson, public relations director for Kaiser. She said the company is reviewing its policy concerning the pill but coverage currently provides eligible males with a supply of six pills per month.
The Duke Managed Care Plan, which covers 95 percent of University faculty and employees, has chosen not to cover the drug, said Jane Wilburn, health plan manager. "Due to cost considerations, drugs such as Viagra, weight-loss drugs and [the skin-care drug] Retin-A are not covered under the Duke Managed Care Plan," she said.
Dr. Craig Donatucci, assistant professor of urology, said that unless a person is trying to reproduce, insurance coverage for therapies like Viagra-which allow for sexual function-is a quality of life issue.
"I think the Duke Managed Care Plan should cover it to a reasonable extent," Donatucci said. He added that approximately one to two pills per week should provide adequate converge, but obviously people would be free to purchase more if they are so inclined.
Richard Coorsh, spokesperson for the Health Insurance Association of America, said the primary consideration of whether to cover a drug is its FDA approval. He added that coverage depends on what is contained in a particular contract.
"[Coverage] is a question of whether something is being prescribed by a health care professional based on medical necessity," he said.
Dr. Ranga Krishnan, chair of the department of psychiatry and behavioral sciences, said that insurance companies will weigh the potential benefit of the drug, relative to its risk and cost. He added that Viagra is expensive. Tom Spalding, senior physician's associate for the chief of urology, said the pills cost between $8 and $10 each.
While the plans differ in their policy toward Viagra, Wilburn and Thompson both agreed that coverage of contraceptives is necessary. "We do consider [contraceptives] part of our preventive care plan," Thompson said.
Both insurance options also cover female fertility drugs and procedures, including in-vitro fertilization. Thompson explained that Kaiser's coverage includes diagnosis and treatment, although such benefits are only available when a plan featuring them is offered by an employer. She added that "we want to do something that's beneficial for the majority of the people," and many people are interested in this kind of service.
Thompson also said that as a federally qualified health maintenance organization, Kaiser is mandated to cover such fertility services. Wilburn declined to comment on why the Managed Care Plan covers fertility drugs but not Viagra.
Although over one million prescriptions have been issued since Viagra's approval, approximately thirty million men suffer from some form of impotence, said Donatucci.
Viagra dilates blood vessels and within an hour or two of taking the medication, relaxes muscles in the penis and allows them to take in more blood. The valves of the blood vessels must prevent blood from leaving the tissues so "more blood is entering than leaving," Spalding said. Specifically, Donatucci explained that Viagra stops an enzyme that breaks down the signal causing an erection. Because this protein is stopped, an erection may occur.
Spalding said that when prescribing the drug he will often dispense between 10 and 20 pills and patients can get refills whenever they want over a one-year period. Doctors currently recommend no more than one pill per day.
Like any drug, people can overdose when taking Viagra. The dilation of the blood vessels may, if used in combination with other high blood pressure medications such as nitroglycerine, lead to a stroke or heart attack by lowering the blood pressure to dangerous levels.
In fact, news headlines have reported numerous deaths that appear to be linked to the drug. Dr. Everett Ellinwood, professor of psychiatry, noted that deaths have not been definitively linked to the drugs.
Get The Chronicle straight to your inbox
Signup for our weekly newsletter. Cancel at any time.