Politics & policy

Insight into federal and state health care legislation & CMS regulation

When It Comes to Viagra, State Medicaid Programs Vary

State Medicaid programs are weighing their options now that the Clinton administration has said they must cover medically approved uses of Viagra, Pfizer's anti-impotence medication. States retain the option oflimiting the number of doses of the drug they'll pay for, and last month New Jersey did just that. It imposed a cap of four doses a month for men who receive drug coverage from the state, including state employees, Medicaid beneficiaries and senior citizens who are in New Jersey's Pharmaceutical Assistance for the Aged and Disabled program.

New Jersey set the limit after finding that it spent $483,000 on the drug in one month. It joined Florida and Alabama in setting a four-dose monthly limit. Utah has approved up to 10 doses a month, while Arkansas, Louisiana and Maryland pay for six. Pfizer recommends that states subsidize 10 pills per month.

Prior to the federal directive, Medicaid programs in California, New York, Illinois, Pennsylvania, Tennessee, Virginia and Michigan said they would not cover Viagra.

The debate over covering Viagra centers on whether a treatment for sexual dysfunction should be considered medically necessary when public dollars are at stake. If the answer is yes, then states might have to pay for other medications aimed at improving quality of life. Viagra has an undiscounted retail price of $10 a pill, but states pay $7.70.

With a few exceptions, such as fertility drugs, antibaldness agents and diet medications, Medicaid is legally required to cover all FDA-approved medications deemed medically necessary. Some Medicaid programs are considering an effort to have Viagra defined as a fertility drug to provide a legal basis for not paying for it.

Subscribe to Our Newsletters

Monthly table of contents

Be notified as each issue of Managed Care is available online.

Biweekly newsletter

Recent topics have included:

  • Doug Jones and the ACA, Epic misses a White House meeting, and man caves for man-flu sufferers
  • CVS-Aetna deal may trigger merger mania, Johns Hopkins criticized for lack of asthma prevention, & Columbia sees free-ride future for all of its med students

PTCommunity news

New drug approvals, clinical trials, drug management. Three times per week.

UP NEXT

2018 Year in Preview
By Susan Ladika
2018 Year in Preview
By Thomas Reinke