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ED Drugs Being Dropped by Medicare Drug Plans

Seniors finding Viagra, Cialis and Levitra have disappeared

October 17, 2006 Senior citizens checking out the new Medicare drug plans for 2007 have found, what for many, is disturbing news. Erectile dysfunction, which primarily plagues senior men, is dropping off the Medicare radar and many probably most - of the plans will not cover the treatment drugs for this condition in 2007. Viagra, Cialis and Levitra are drugs seniors are just not finding on the formularies.

This news break came in a story by Mary Jo Feldstein in the St. Louis Post-Dispatch, who writes, "Most Medicare prescription drug plans will stop covering Viagra and other erectile dysfunction medications next year."

In older men, ED usually has a physical cause, such as disease, injury, or side effects of drugs, according to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). Any disorder that causes injury to the nerves or impairs blood flow in the penis has the potential to cause ED.

The American Urological Association agrees, saying, "By far, the most important cause of the development of ED is the presence of illnesses like high blood pressure, diabetes mellitus, high cholesterol levels and cardiovascular disease.

"These processes, acting over time, can lead to a degeneration of the penile blood vessels, leading to restriction of blood inflow through the arteries and also to leakage of blood through the veins during erection."

Incidence increases with age: About 5 percent of 40-year-old men and between 15 and 25 percent of 65-year-old men experience ED. But it is not an inevitable part of aging, the NIDDK says. It is more likely the result of other illnesses that frequently strike senior citizens.

ED is treatable at any age, and awareness of this fact has been growing, states NIDDK. More men have been seeking help and returning to normal sexual activity because of improved, successful treatments for ED.

But, despite the need for relief by millions of senior men suffering with this condition, the drugs are coming off the formulary list of the Medicare drug plans.

Several insurers who run the drug plans said they supported the change, according to the Post-Disptach. Dr. Charles Willey, chief executive of Essence Inc. of Creve Coeur, one of the insurers, said paying for the medications was not the best use of the nation's limited health care dollars.

"We have to decide what our priorities are," said Willey, whose Medicare Advantage plan offers drug, physician and hospital coverage under one benefit, according to the newspaper.

All plans are not dropping the drugs. The Post-Disptach says UnitedHealthcare Corp., for example, has one Medicare plan that covers the drugs but its others do not.

The newspaper article says Medicare will continue to cover the drugs if they're used to treat other conditions, such as pulmonary hypertension, for which they've been approved.

There was opposition in the first year of the Medicare drug program to adding the ED drugs to the coverage. Much of the opposition was based on the cost. The Congressional Budget Office estimated coverage of the drugs would cost Medicare almost $2 billion over 10 years. The American Urological Association and drug manufacturers encouraged the inclusion of the drugs.

The Department of Veterans Affairs, which covers erectile-dysfunction medications, negotiates discounts on drugs, a tactic Congress has denied Medicare, and they have achieved discounts of up to 50 percent for the ED pills, which usually cost $9 to $11 each. Pillsamples.com for example offers generic versions for up to 90% discount over their brand name counterpart.

Many are concerned that the lack of access to these drugs may lead men to dangerous solutions. The American Cancer Society points out that "men and women seeking help for a sexual problem often go to someone who is not really a health care professional. Sexual problems are so common and upsetting that many will try unproven remedies or cures.

"Although there is no evidence that any of the following can cure a sexual problem, they are often said to be cures: potency pills (such as poppers or Spanish fly), oysters, exercisers that fit inside a woman’s vagina, hypnotism by someone not trained as a mental health professional, or visits to an independent sexual surrogate. Pursuing such treatments not only wastes your time and money but can sometimes be harmful."