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Sparring over funding of sexual-dysfunction drugs
Scripps Howard News Service


May 27, 2005

Washington - Lawmakers' efforts to drop coverage of "lifestyle drugs" for sexual or erectile dysfunction under the new Medicare prescription-drug plan, as well as Medicaid, are seen by many caregivers and advocates as political meddling in health decisions.

The sexual-performance drugs are slated to be part of the basic package of medicines that Medicare will cover, starting in January, for senior citizens and disabled people who sign up for the voluntary prescription plan.

Congressional budget experts estimate that Medicare and Medicaid will spend about $2 billion on sexual-performance drugs between next year and 2015.

Some lawmakers want to bar coverage of "lifestyle drugs," but health providers say such a move would impose politics on medical decision-making.

Under the Medicare law, if a drug is approved for sale by the Food and Drug Administration and considered medically necessary, it must be covered, according to officials at the Centers for Medicare and Medicaid Services. However, as with many private health plans, there may be limits on the number of doses allowed a month.

That interpretation doesn't sit well with members of Congress like Rep. Steve King, R-Iowa, who has introduced a bill that would block coverage of what he terms "recreational sex drugs."

"The thought of Medicare wasting vital resources on performance enhancing drugs is unconscionable, especially at a time when the focus should be on providing life-saving medication for truly needy seniors," King said in a statement when he introduced his proposal in February.

Since then, the Congressional Budget Office has calculated that Medicare and Medicaid together would spend about $2 billion on such drugs between 2006 and 2015. The White House estimates the total cost of the Medicare drug plan for that period at around $724 billion.

This week, a fellow Iowan who was one of the chief architects of the Medicare drug plan went a step further than King. Republican Sen. Charles Grassley, chairman of the Senate Finance Committee, proposed that there be "no payment for drugs prescribed for sexual or erectile dysfunction under any federal program, period."

Medicaid payments for the drugs have come under scrutiny in recent weeks following reports that many states have been paying prescription costs for convicted sex offenders, a practice federal administrators quickly told states they should end.

Grassley argued that the new Medicare program was intended to ensure that "beneficiaries had access to life-saving and life-improving drugs. Now some certainly may argue that these 'lifestyle' drugs can improve your life. I appreciate that view. However, we live in a world of limited resources, and these dollars could be spent more wisely."

But some health providers say such legislation puts Congress in the position of dictating medical necessity.

"It's a judgment call of what 'lifestyle drugs' are, and they're singling out something that's become an easy target because of the publicity about the sex offenders," said Dr. Andrew McCullough, director of Sexual Health and Male Infertility at New York University Medical Center in New York City.

"Erectile dysfunction is a problem that adversely impacts quality of life and self-esteem of men as they get older. To disregard that, I think, is irresponsible."

A survey, released by AARP this week, found that two-thirds of men and women aged 45 and older were "extremely" or "somewhat" satisfied with their sex lives, and that sexual health was an important aspect of the quality of their lives.

"Professionals have long known that sexual dysfunction is not only a major problem for relationships and mental health, but can be a marker of life-threatening health issues, especially heart disease," said Linda Fisher, research director for AARP.

When the advocacy group for older Americans did a similar survey in 1999 - a year after Viagra was first approved -10 percent of men reported using drugs or treatments to address problems with sexual performance. In the new survey, that share more than doubled, to 22 percent.

Despite doubts raised about the drugs' side effects - including reports Friday of rare instances of blindness in men who took Viagra - sexual-performance drugs have remained highly popular and profitable.

Drugmakers are opposed to any funding restrictions.

"Products that treat erectile dysfunction are part of the overall treatment of patients," said Jeff Trewhitt, a spokesman for the Pharmaceutical Research and Manufacturers Association, adding that Medicare and Medicaid patients should not be "second-class citizens" in their care.

"We're saying that we can extend our lives through surgery and medicines, that you can have more life, but you can't have better quality of life, as well," McCullough said.

"I mean, what about arthritis drugs? If you don't cover them, the patients can still walk, they'll just be in pain. If federal officials want to pare back what they cover because the budget can't pay for all the benefits, fine, but they should look at the whole spectrum of procedures that preserve and enhance quality of life, not just these few."


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