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HMOS DECLARE VIAGRA SUPPORT.

Byline: Ben Sullivan Daily News Staff Writer

Perhaps it's empathy for their members, or recognition of the role sexuality plays in the Southern California lifestyle.

Whatever the impetus, a majority of local HMOs say they already do, or soon plan to include the anti-impotence drug Viagra in their coverage. That's in sharp contrast to Friday's announcement by Oakland-based Kaiser Permanente Group that it will not pay for the pill.

Kaiser, which with 9.1 million members is the nation's largest HMO, said that at $10 a dose Viagra is just too expensive. Kaiser is also the biggest health plan in Southern California, with more than 1 million members in greater Los Angeles, including 440,000 in the San Fernando and San Gabriel valleys.

In its announcement, Kaiser said it will exclude coverage of Viagra and other drugs for sexual dysfunction when it renews benefit contracts with employer groups. The nonprofit health organization lost $270 million last year and in addition to raising rates, is looking for ways to cuts costs.

Kaiser said it will stock Viagra in all of its pharmacies and will allow doctors to prescribe the medicine. But patients with impotence must pay for the pills themselves.

Earlier this week, Aetna U.S. Healthcare similarly announced it would not pay for Viagra, saying the drug was not a medical necessity.

The outlook is decidedly different at Woodland Hills-based WellPoint Health Networks. WellPoint, which operates the Blue Cross of California HMO and preferred provider organization, has not only covered Viagra since its April launch by drug maker Pfizer Inc., but also pays for suppositories and several other drugs on the market to treat impotence.

``The rationale for coverage is simple: We've always covered impotence,'' said WellPoint spokesman Peter O'Neill. In general, WellPoint stipulates that the impotence must be caused by an underlying condition such as diabetes or prostate problems, but it will also cover dysfunction resulting from certain anti-depressants.

There is a limit to the group's generosity: Because of Viagra's cost, patients are limited to six doses per month, after which they must pony up for the pills themselves.

``If we decided to cover one pill a month, our members would be pretty dissatisfied with that. But 30 pills would be cost-prohibitive,'' O'Neill said.

Woodland Hills-based CareAmerica Health Plans similarly pays for six Viagra pills a month for its MediCare members and commercial members whose plans normally include drug costs.

Woodland Hills-based Foundation Health Systems, which operates the Health Net HMO, does not cover Viagra yet, but will, ``Sooner, rather than later,'' said spokesman Ron Yukelson.

``Sexual function is an important part of both mental and physical health,'' Yukelson said.

Prudential HealthCare said it has just completed a study on Viagra and will announce a policy within a few weeks. A Prudential spokesman said in general the company is sympathetic to coverage of sexual dysfunction and already pays for surgery, vacuum devices to help attain an erection and other drugs besides Viagra.

L.A. Care, the non-profit HMO created to care for Los Angeles County's Medi-Cal population, does not formally cover the drug, but spokesman Keith Malone said some physicians are informally prescribing the medicine on the government tab. Roughly half of state-run Medicaid programs pay for Viagra and the Clinton administration has proposed making coverage mandatory.

Since its introduction in early April, Viagra has become one of the best-selling U.S. drugs in history, with 1.1 million prescriptions filled in May alone. Consumer advocates say a health plan's decision on whether or not to cover the drug raises larger issues about how HMOs accept new technology and treatments.

``The yellow flag that's being raised is how will new treatments be covered in the future if it's clear they're medically necessary?'' said Peter Lee, head of consumer protection at the Los Angeles-based Center for Health Care Rights. If new treatments like Viagra are dismissed by health plans out of hand, ``It means you're being insured for what works today, not what's discovered tomorrow. And that's not what insurance should be about.''
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Title Annotation:BUSINESS
Publication:Daily News (Los Angeles, CA)
Geographic Code:1USA
Date:Jun 20, 1998
Words:673
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