“We can’t buy everything, but, unlike a lot of advanced industrial nations, the Usa has no explicit procedure to assess the price and value of health products and services.”
The argument centers on whether or not a drug used to improve sexual performance should even qualify for Medicare coverage. Advocates of supplying the coverage say that ed usually has a physical cause and that therapy can significantly enhance the excellence of a guy’s life. Opponents state that Medicare, currently growing at an unsustainable rate, can’t actually afford to pay for “lifestyle medications.”
Government officials said lately that, under their reading of the new Medicare drug benefit, they needed to buy medications like Tadalafil 20mg, Levitra and Viagra when they were recommended.
This came as a shock to numerous members of Congress. Their issue was heightened by new estimates suggesting the complete drug benefit would cost considerably more than they were informed when they voted in the laws in November 2003.
“The emphasis must be on providing protection for needy seniors.”
Mr. King has introduced a bill that says Medicare can’t cover medications “prescribed for treating impotency.”
Representative James P. Moran, Democrat of Virginia, a cosponsor, said: “Here we’re using cash which could go to cancer, cardiovascular disease and other deadly ailments and redirecting it in the intercourse performance of males over-65. It is really a scandal.”
“Erectile dysfunction isn’t a little thing for guys who have problems with it,” Ms. Strupp said. “We have heard from a large number of guys that it may interfere with their affair, erode their relationships with their companions, harm their self-respect and cause melancholy.”
All three are driving to mention numerous factors and ensure Medicare coverage.
“Erectile dysfunction is a sickness,” recognized by physicians and by other medical insurance plans.
Physicians often find signs of underlying conditions like diabetes and hypertension that will otherwise have gone undetected, when men seek treatment for ed.
Medicare drug plans can avoid exploitation of Viagra and related medications with “prohibitive formularies,” demanding prior authorization, charging higher copay or restricting the amount of tablets that may be dispensed. The drugs are sometimes covered by private plans, with these types of limitations.
In elderly guys, ed is frequently due to disease or surgeries that damage the nerves or obstruct the flow of blood.
However the medicines are promoted to a far bigger audience. In November, the Government’s Food and Drug Administration aggressively criticized Pfizer for tv ads implying that Viagra could re-establish the sexual desire of a guy shown gazing into the window of the lingerie store. “The TELEVISION advertising omit the indicator for the drug, specifically, treatment of erectile dysfunction,” the F.D.A. stated in a letter to Pfizer.
Under the law, insurance companies must cover “drugs in all therapeutic groups and groups,” but not always every drug in every category. “Impotence agents” are among the 146 groups and groups suggested by the U.S. Pharmacopeia, a private non-profit group that advises the authorities.
Since the development of Medicare in 1965, the government has made protection decisions about services and things including PET scans, barium enemas, mammograms and implantable defibrillators.
In passing the Medicare bill, lawmakers said they needed to get away from the company of making such choices. However, the situation of Viagra demonstrates some members of Congress are reluctant to relinquish the duty.
“There isn’t any reason a working American needs to pay for that kind of drug if, for instance, Bill Gates wants it when he retires.”
Gordon B. Schatz, a Washington attorney that specializes in Medicare coverage and compensation, said: “In days gone by, Medicare officials seldom considered price as a variable in national coverage choices. However, the drug benefit, the largest growth of Medicare since its beginning, is compelling them all to consider costs in ways they never did before.”
For individuals without insurance, the retail pharmacy cost for Viagra is commonly $9 to $11 a tablet. The V.A. states it pays less-than $5 a tablet.
However, the company suggests that its physicians prescribe a maximum of four pills per month. Veterans received 1.9 million prescriptions for Viagra during the V.A. healthcare program this past year.
Drugstore.com, the internet pharmacy, bills $90.99 for 10 tablets. Costs for Tadalafil and Levitra are similar.
Savings will increase to 25 per cent in 5 years, Mr. Foster predicts.
There are sharp divisions to the issue of whether erectile dysfunction medications are medically required.
“This isn’t a great method to spend a small sum of money, at a time when other medical needs are higher. In many guys, impotency is merely a function of age, although it might still be considered an effect of disorder.”
“A potential compromise solution,” Mr. Callahan said, “would be to establish specific medical criteria enabling Medicare coverage for all these drugs when ed could be followed to some identifiable medical condition other than age.”
Robert P. George, an associate of the President’s Council on Bioethics, backed that strategy.
“If impotence occurs in the ordinary course of the human life, as a result of theging, these drugs shouldn’t be coated,” said Mr. George, a professor of jurisprudence at Princeton. “But if there’s a real medical condition, I’m inclined to say the medicines ought to be covered.”
Health authorities in UK, Germany, Sweden and other states have made similar distinctions and fought with the same problem.
Arthur L. Caplan, manager of the Center for Bioethics in the University of Pennsylvania, said the problem had compelled policy makers to inquire, “What importance will we give quality of life for a target for pharmacological intervention?”
“Erectile dysfunction medications do not save anybody’s life, but make life more purposeful,” Mr. Caplan said. “A basic principle of medical ethics is admiration for the patient’s right to selfdetermination. You will discover that sexual function is high in the list, should you ask Medicare beneficiaries what they need.