Sue Hartigan <[EMAIL PROTECTED]> writes:
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. John 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 Johnson, 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,'' Johnson 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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