Managed Care

More HMOs Decide Viagra Coverage; Global Frenzy Is On

MANAGED CARE July 1998. © MediMedia USA
News and Commentary

More HMOs Decide Viagra Coverage; Global Frenzy Is On

MANAGED CARE July 1998. ©1998 Stezzi Communications

Two of the nation's largest HMOs have weighed in against covering Viagra, Pfizer's anti-impotence pill that has taken the world by storm. Calling Viagra a "lifestyle drug," Aetna U.S. Healthcare said it would pay for it only if employers purchased special coverage. Kaiser Permanente flat-out refused coverage, saying the drug is "not medically necessary."

Some such decisions have not sat kindly with subscribers. One group filed a class-action suit against Oxford Health Plans and other "John Doe" insurers, claiming that coverage denial breaches their fiduciary responsibility under the Employee Retirement Income Security Act. The lead plaintiff says he suffered from diabetic-related impotence until Viagra restored his sexual function.

While HMOs have been deciding which Americans will feel the sensation, Viagra itself has become a worldwide sensation. A Japanese travel agency has put together Viagra tours to Hawaii for its countrymen who want the drug. In Canada — Viagra is months away from approval there — men have flocked to Niagara Falls, N.Y., where pharmacies are filling up to 20 Canadian prescriptions a day. And Viagra samples mysteriously disappeared at an Israeli parliamentary committee meeting while experts testified about the drug's safety.

Pfizer is aware of safety concerns — at least 16 men who took Viagra have died — but says complications, not the drug itself, are to blame. Viagra's label warns against combining use with nitroglycerin; early reports suggested many of the men had heart disease.