Senators want to end fed’s erectile dysfunction drug payments
Legislation introduced by Senate Finance Committee chairman Chuck Grassley (R-IA) would prohibit coverage by federal programs including Medicaid and Medicare for erectile dysfunction drugs Viagra, Levitra, and Cialis. The bill would not prevent federal government coverage of those drugs for treatments not related to sexual performance.
The Congressional Budget Office has projected Medicaid and Medicare will spend $2 billion on the drugs between 2006 and 2015. "In my opinion," Mr. Grassley said, "those dollars could be spent more wisely." He said that while some would argue that the erectile dysfunction drugs can improve one’s life, and he appreciates that view, we live in a world of limited resources and in such a world, coverage of lifestyle drugs isn’t consistent with the need for balance between Medicaid and Medicare beneficiaries and the taxpayers who pay for the beneficiaries’ health coverage.
"Obviously, I’m not introducing legislation to prevent those covered by federal programs, such as Medicare and Medicaid, from obtaining prescription drugs prescribed for sexual or erectile dysfunction. Patients wanting to use these medicines to improve sexual performance are welcome to pay for them out of their own pockets." Mr. Grassley said his bill also addresses a controversy that arose in the spring regarding a report indicating that nearly 800 convicted sex offenders in 14 states were obtaining Viagra through Medicaid. State officials had said they believed they did not have authority to deny the prescription coverage.
In a May 23 letter to state Medicaid directors, Dennis Smith, Center for Medicaid and State Operations director, wrote to "remind states there are a number of options to prevent the inappropriate use of such drugs and to inform states that we believe they should restrict the coverage of such drugs in the case of individuals convicted of a sex offense."
He noted that the Medicaid law requires states to prevent fraud, abuse, gross overuse, or inappropriate or medically unnecessary care, among physicians, pharmacists, and patients — a state legitimately could find that use of certain drugs and the treatment of impotence for convicted sex offenders could constitute fraud, abuse, or inappropriate care. "We believe that, in accordance with such provisions, use of these drugs in the case of a sex offender is not appropriate, and Medicaid should not pay for the cost of such drugs in such circumstances."
The letter said states should use their drug review programs and procedures to work with physicians and pharmacists to prevent inappropriate Medicaid payment for such drugs in the case of a sex offender and cautioned that failure to perform such a review and implement appropriate controls could result in sanctions.
While Smith’s letter referred only to coverage for sex offenders, three states (New York, Florida, and Texas) went further and temporarily banned Medicaid reimbursements for Viagra for everyone, while Georgia, Louisiana, South Carolina, and Virginia proposed to remove Viagra from the list of Medicaid-covered drugs.
In New York, where an internal audit found that 198 of the state’s most dangerous sexual predators were receiving Viagra through Medicaid, Gov. George Pataki temporarily halted all payments for the drug until the legislature could adopt a law to exclude sex offenders.
New York’s finding led to an Associated Press survey of states that found that nearly 800 convicted sex offenders in 14 states were reimbursed through Medicaid for Viagra, Levitra, and Cialis. Florida and Texas accounted for the vast majority of cases along with New York, and they also moved quickly to halt payments for erectile dysfunction medications for all Medicaid recipients.
When Viagra first came on the market in 1998, governors protested a federal requirement that state Medicaid programs subsidize the drug. A July 1998 letter from then health financing administrator Nancy DePearle said governors couldn’t exclude Viagra from their Medicaid programs, but granted states broad latitude to determine the circumstances under which the drug would be dispensed. While state policy on reimbursements for drugs to treat erectile dysfunction varies, all states until now have provided some form of coverage. That is not changing as a result of the new Medicaid letter from Mr. Smith.
Advocates for the poor have expressed concerns that the controversy over taxpayer-funded Viagra for sex offenders will deflect attention from potentially deeper cuts in Medicaid that could hurt those in genuine need.
National Health Law Program attorney Steve Hitov said Mr. Smith’s letter was "just another well-orchestrated stroke toward the overall goal of discrediting the Medicaid program so that when they’re trying to gut it later this year, they won’t seem so cruel."
(Download the CMS letter at www.cms.hhs.gov/states/letters.)
Legislation introduced by Senate Finance Committee chairman Chuck Grassley (R-IA) would prohibit coverage by federal programs including Medicaid and Medicare for erectile dysfunction drugs Viagra, Levitra, and Cialis.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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