HARTFORD, Conn. — Aetna U.S. Healthcare will not pay for the impotency drug Viagra unless employers buy special coverage, because company managers don't consider having sex medically necessary, the company told New York regulators.
In a 14-page letter sent Monday to the New York Department of Insurance, Aetna said Viagra could cost it more than $50 million a year and cited "the primarily recreational/lifestyle use and abuse of this drug."
"Simply put, having sexual relations is not a medical necessity," the letter said.
Aetna, like other insurers, has not been covering Viagra while it decides how to handle the wildly popular and pricey drug. Viagra, made by New York-based Pfizer Inc., costs $10 a pill.
Aetna spokeswoman Jill Griffiths said the policy will apply in New York and that she did not know whether it will apply nationwide.
Among other factors Aetna cited in its decision were serious side effects, potential fatal interactions with other drugs and "unprecedented potential for misuse, fraud and abuse."
New York's insurance department had demanded insurers file their rules on Viagra by Monday. Of the 35 responses received by midday, Hartford, Conn.-based Aetna was the only company that said it was refusing to pay for Viagra as part of its regular prescription drug rider.
Other insurers said they will cover Viagra on a limited basis. Oxford Health Plans has said it plans to limit payment to six pills per person every 30 days, and M.D. Health Plan and Physicians Health Services expect to limit coverage to four pills a month.