Sexual performance drugs like Viagra will be covered by Medicare's new prescription benefit beginning next year, along with medications for other conditions like high blood pressure and heart disease, Health and Human Services officials said Tuesday.
And like those other drugs, prescriptions for Pfizer Inc.'s Viagra will be tightly controlled. The law, which takes effect Jan. 1 at a cost of more than $500 billion over a decade, says Viagra can be prescribed only when medically necessary, and in limited quantities.
"The law says if it's an (Food and Drug Administration)-approved drug and it is medically necessary, it has to be covered," said Gary Karr, spokesman for the Centers for Medicare and Medicaid Services, which administers the health insurance program for older Americans.
Since it was approved by the FDA in 1998, about 16 million men have tried Viagra, according to Pfizer.
President Bush two years ago signed into law the new voluntary drug benefit, which is expected to cover the drug expenses of 11 million low-income older and disabled people. The government contends the program also could cut drug costs in half for most seniors.
Medicare issued final rules last month for the prescription program, for which low-income people begin registering in June. Other recipients are to sign up in November. The Los Angeles Times first reported Medicare's coverage of sexual performance drugs.
Conservatives say the law opens the door to precisely the kind of big government bureaucracy that they — and Bush — campaigned against.
There was never a discussion of what drugs would be covered during Congress's all-night debates on the issue, one analyst pointed out.
"You cannot have a universal entitlement like this without extreme micromanagement," said Robert E. Moffit, a health care analyst at the Heritage Foundation.
"Members of Congress, frankly, are not competent to make these decisions. Is Congress going to start writing prescriptions?" he added. "Micromanagement will institutionalize incompetence."
The signature component of last year's Medicare law, the prescription drug benefit, will vary widely in its impact on the 29 million older and disabled Americans that the Congressional Budget Office projects will enroll, the study said. The CBO said the average savings will be 37 percent in 2006.