HealthLawProf Blog

Editor: Katharine Van Tassel
Concordia University School of Law

Monday, May 30, 2005

Viagra Coverage and Who Pays?

Picking up on Tom's recent post concerning Viagra, the new revelations that Viagra may cause loss of vision and also that state governments were paying for Medicaid for a variety of individuals, including sex offenders.  Majikthise has some further analysis considering who should receive Viagra and who should pay for it.  You can read the posts here (discussing how states are ending funding of Viagra for sex offenders), here and here (discussing what items should be receive Medicaid coverage).  The following is a concluding excerpt:

The fact is that we have clinical solutions for symptoms like impotence and hyperactivity. The question we should be asking is whether it would be a good use of our finite resources to cover these treatments. What constitutes a good use of resources shouldn't depend on whether something is a disease.

The good news is that public health insurance scheme doesn't need to draw sharp a priori distinctions between treating the diseases of individuals vs. conferring other benefits to society. We still have to ask whether it's effective, expedient, or fair to address a particular problem through the health care system. Creeping medicalization is bad, but we don't need an arbitrary standard of disease to combat it. We are only vulnerable if we assume that everything that's a disease must therefore be addressed by medical care for individuals. Even if somethings a disease, it may be more appropriate to address the problem through public health, economic policy, educational reform, or some other means.

Private insurance companies want to draw as many lines as the can. Sophistry is profitable if you can convince your customers not to demand birth control coverage because contraception doesn't treat any diseases. Public health insurance needn't obsess over this boundary. It's convenient and cost-effective to include birth control in a public health insurance program, so it's irrelevant whether this kind health care meets some preconceived definition of medicine.

The same principle applies to Viagra. The drug deserves to be considered for formulary coverage because it's an effective treatment for a troublesome physical symptom. Whether Medicaid covers Viagra should depend entirely on how the costs and benefits of the drug compare to other agents competing for a finite budget.

Very interesting reads. [bm]

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