Medicaid coverage of Viagra halted

Medicaid coverage of Viagra haltedSex offenders' use gives state pauseBy AMY GARDNER, Staff WriterThe state has stopped paying for Viagra and other drugs that treat erectile dysfunction after finding that 15 convicted sex offenders received the pills through Medicaid.
State health officials discovered the offenders after news accounts of similar discoveries in other states. They suspended the coverage last week, and state lawmakers quickly began drafting legislation to keep Viagra and similar therapies off-limits to sex offenders.
"It is just abhorrent that we would run the risk of any sex offender receiving the drug," said Carmen Hooker Odom, North Carolina's secretary of health and human services.
Last fiscal year, North Carolina's Medicaid program -- which provides health insurance for poor residents -- filled more than 41,000 prescriptions for erectile-dysfunction drugs at a cost of nearly $800,000.
That figure is a small fraction of the $1.4 billion that North Carolina and the federal government spent on prescription drugs for Medicaid patients in the state last year.
Still, it warrants closer attention, lawmakers said, particularly in a year when legislative leaders ordered up to $100 million in cuts in Medicaid to offset the program's spiraling spending increases.
Some lawmakers were surprised to learn that taxpayers were helping pay for erectile dysfunction drugs at all. Edd Nye, a Bladen County Democrat and co-chairman of the House Appropriations Committee, said such "recreational" drugs ought not be covered.
"I didn't know we were paying for it, and I'm glad we stopped it," Nye said. "Maybe we could keep it stopped."
State Sen. Linda Garrou, a Democrat from Winston-Salem and a co-chairwoman of the Senate Appropriations Committee, is drafting a bill that would ban Medicaid coverage of erectile-dysfunction drugs for sex offenders.
State officials say it is too cumbersome for medical providers to distinguish patients who are sex offenders from other Medicaid recipients. To keep from supplying the drugs to sex offenders, the state would have to ban Medicaid coverage for all patients, including law-abiding men with medical conditions that cause dysfunction, such as prostate cancer or diabetes.
Hooker Odom said she's comfortable banning all coverage. Medicaid paid for only two pills a month before the temporary suspension. At about $10 apiece, Hooker Odom is willing to pass along that cost to those men who wish to continue using the drug.
Pharmacy benefit managers often classify Viagra as a lifestyle drug that does not treat a life-threatening disease. According to a study published in 2000 in the Archives of Internal Medicine, only 40 percent of men taking Viagra for the first time have previously been treated for erectile dysfunction. Such data suggest that not all men receiving Viagra or similar drugs through Medicaid have a medical condition warranting it.
Controlling costs
Overall, North Carolina spends $7.1 billion a year on Medicaid. The program's prescription drug costs have been difficult to rein in. Among the reasons: the political influence of the pharmaceutical industry, and evidence that spending more on drugs can reduce other costs such as emergency room visits and hospitalizations.
For example, the state spent $11 million on contraceptives last year -- but would have spent even more on pregnancy care and childbirth if contraceptives weren't covered.
Contraceptives, like drugs for erectile dysfunction, have always been covered under federal Medicaid laws.
It was only last month, after news reports that taxpayers were paying for sex offenders to take impotence pills, that federal Medicaid officials authorized states to put a stop to the practice.Staff writer Amy Gardner can be reached at 829-8902 or agardner@newsobserver.com.

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