Ban proposed on Medicare coverage for impotence drugs

Some physicians question the logic of restricting federal funding for a major class of life-enhancing medications.

By David Glendinning — Posted June 13, 2005

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Washington --One of the lawmakers who fought the hardest to add prescription drugs to Medicare is now working on making sure that certain "lifestyle drugs" are not included on that list.

Senate Finance Committee Chair Charles Grassley (R, Iowa) introduced legislation last month that would bar federal payments for any drugs prescribed to treat erectile or sexual dysfunction. The prohibition would extend to Medicaid, which already covers such medications, and any other public health program that uses government dollars.

If the bill is to become law, physicians who prescribe drugs such as Viagra, Cialis and Levitra to their elderly and disabled patients would need to inform them that the highly anticipated Medicare drug benefit would not pay for such medications. The Congressional Budget Office recently estimated that if Medicare begins to cover erectile dysfunction drugs as planned in January 2006, Medicare and Medicaid would spend roughly $1.93 billion on the medications over the next 10 years.

"Some certainly may argue that these lifestyle drugs can improve your life," Grassley said in a speech on the Senate floor. "I appreciate that view. However, we live in a world of limited resources, and in that world of limited resources, coverage of these lifestyle drugs under Medicare -- or any other federal program, in my opinion -- is inconsistent with that goal of balance."

But impotence medications are just one of many drugs that do not actually treat a life-threatening condition, said Ira Sharlip, MD, a urologist in San Francisco and a spokesman for the American Urological Assn. For instance, Medicare plans to cover drugs for incontinence, which he says also largely address lifestyle conditions.

"It makes no sense to single out drugs that are used for the treatment of erectile dysfunction for discontinuation of coverage," Dr. Sharlip said. "This can be a devastating medical condition, and the drug has the potential to restore an essential bodily function."

With costs running at about $9 per pill, many patients are unable to afford to pay out-of-pocket for such a drug regimen. If Medicare does not step in to provide coverage, some seniors will continue to go without treatments that can alleviate serious medical problems and greatly enhance quality of life, Dr. Sharlip said.

A matter of priorities

Grassley, who is one of the primary architects of the Medicare reform measure that added the drug benefit, was prompted to introduce his legislation when CBO released its cost estimate and after New York State officials reported that a number of convicted sex offenders had received coverage for Viagra through Medicaid.

Grassley is joined in his effort by Rep. Steve King (R, Iowa), who introduced his own bill to ban federal payments for erectile dysfunction drugs after the Centers for Medicare & Medicaid Services announced earlier this year that the upcoming Medicare benefit would include the coverage.

"The thought of Medicare wasting vital resources on performance-enhancing drugs is unconscionable, especially at a time when the focus should be on providing life-saving medication for truly needy seniors," King said. "Seniors should never be denied life-saving drugs at the cost of providing nonessential drugs for others."

King said the money saved would become useful as physicians treat increasing numbers of seniors with heart disease, cancer and other conditions. A year's worth of Medicare dollars for a single senior's erectile dysfunction drugs, for instance, could instead be used to pay for another beneficiary's cholesterol-lowering medications for one year or diabetes medications for three years, he said.

Both Grassley's and King's bills leave open the possibility that beneficiaries can receive federal coverage for the medications if a physician prescribes them for a medical purpose other than treating impotence. Erectile dysfunction drugs have shown some promise in treating pulmonary arterial hypertension and certain urinary tract conditions, Dr. Sharlip said.

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