Oh, the timing was too perfect on this one.
On the same day that the press took off on legislative debates with the Commissioner of Health on Medicaid's paying for Viagra (note that, with everything else going on it's the first paragraph in this Albany Times-Union story), Medicare was listing it as a covered drug under its new pharmaceutical program.
Here's the CMS Strategy for Affordable Access to Drugs Covered MMA (PDF). The pharmaceutical plans must submit their formularies to CMS. In abbreviated form, the guiding principles for CMS formulary review are:
- Rely on existing best practices ...
- Provide access to medically necessary drugs ...
- Flexibility ...
- Administrative efficiency ...
Sounds pretty reasonable. And that leads to Medicare's "Comprehensive Listing of Drugs in USP Model Guidelines" (.xls format). For "impotence agents" it includes the phosphodiesterase inhibitors, Sildenafil, Tadalafil and Vardenafil. Don't know which is which? Do your own damn Google search.
What's the real problem with Medicaid coverage? None really. The "acid test" of equity should apply here as well as elsewhere: "if it's included in the health plans that cover the Governor, senior agency administrators, legislators and their families, then it ought to be covered by Medicaid." Where's the press coverage of the State Employees' Health Benefit Plan? Indeed, where were the legislative questions on their own coverage? You won't find either.
But, let's admit it. This isn't just about Medicaid. It's also about our comfort levels in debating some topics in public. How ironic that the press thinks this topic is worth the attention. Too many persist in acting like a bunch of teenagers, trying to muffle their embarrassed giggles.
In 1998, shortly after the FDA's Viagra approval, I submitted my regular column to the local business weekly about covering such drugs under employee benefit plans. My editors absolutely flipped out. They left the first two lines alone:
OK, OK, I give up. I guess you really can't write about health care these days without talking about Viagra. The evening news, magazines, and the daily papers are saturated with stories about overworked urologists and the apparent plague of impotence.
It was the most heavily edited column I ever did for them. By far. Here's what was left registration may be required). Mind you, what I submitted wasn't risque. Far from it. Rather than the drug itself, I was focused on the insurance angle. Well, perhaps my saying something to the effect of ...
C'mon guys a single pill is less than the cost of a bunch of flowers or a couple of movie tickets. Rather than relying on your insurance coverage, why don't you pay for it yourself?
... was a bit off-putting and you won't find that in the published version. But the very nature of topic had the paper's staff absolutely crazed. It was, by far, the most re-written column I ever submitted.
Like way too many drugs, these are probably overprescribed and overused. There are lots of reasonable ways to deal with that. And yes, direct-to-consumer pharmaceutical ads are making me crazy just like everyone else. But all of them are making me crazy, not just the ones about topics that used to be reserved for the locker room.
But in terms of public discussion, taking these drugs is now a Republican, red-state value. It won't just be liberals watching the Super Bowl ads next week. Hell, the kiddies can even get a model NASCAR racer with Viagra ads splashed all over it.
So people, let's grow up here, OK?