MANAGED CARE June 1998. ©1998 Stezzi Communications
With one Connecticut physician calling it "the biggest thing since the Beatles," Viagra, Pfizer's popular pill for impotence, has burst onto the scene like few others. Its popularity seems to have caught insurers off guard as they scramble to develop a yardstick for coverage.
According to IMS America, which tracks pharmaceutical trends, physicians were writing close to 300,000 Viagra prescriptions a week in mid-May.
The phenomenon has forced health plans to deal with such questions as, "How much sex is enough?" No clear consensus about how many pills to cover has emerged. The old standbys of covering 30- or 90-day supplies aren't easily calculated for drugs that are taken as desired.
Though dozens of plans announced they will pay for the drug, levels of coverage differ. Some cover six pills a month; some, eight. Wellpoint says it will pay for Viagra only with a physician's statement that a patient suffers from erectile dysfunction. Cigna says its coverage applies only to men with preexisting, documented diagnoses of impotence who have been treated by other means.
That could keep more than a few closet doors shut. Viagra has not only run away with the market for sexual disorder treatments — only 5 percent of such prescriptions are for any other product — but it has expanded it, too. The market has grown more than 500 percent since Viagra's early April debut.
Still, many insurers seem to be sitting on the sidelines while the other guy figures an appropriate coverage level. IMS estimates that 53 percent of Viagra prescriptions are paid by cash.