Reflecting a deepening split among health insurers, Kaiser Permanente, the nation's largest HMO, said Friday that it won't pay for the male impotence drug Viagra because its unprecedented popularity would make the coverage too expensive.
Kaiser also said it will cancel its existing coverage of other, less widely used therapies for treating erectile dysfunction.
Because many insurers are still wrestling with their decisions about Viagra, the position staked out by Kaiser--by far the biggest health maintenance organization in California, with more than 5 million members--could influence others to follow its lead.
Insurers that do decide to cover Viagra, moreover, may fear that a disproportionate share of impotent men will switch to their plans, leading to higher costs and more financial risk.
With unusual candor, a Kaiser official acknowledged that the company's final decision was largely influenced by economic, rather than medical, considerations. The company claimed that covering Viagra for its members would cost "at least $100 million a year."
In defending the decision, Kaiser officials had a clear message to deliver: Why should all Kaiser members have to foot the bill so some people can have more frequent sex?
One Kaiser official, Dr. Francis J. Crosson, asked rhetorically: "We could, of course, build the cost of Viagra into everyone's premium, but is that the right thing to do?"
Kaiser's decision contrasts with some other health plans, which are covering Viagra in cases where there is a demonstrated medical need. In California, at least three large HMOs plan to cover Viagra under certain circumstances.
Cigna Healthcare and Blue Cross of California are covering Viagra but limiting the number of pills that will be paid for per month. A spokesman for Health Net, another large HMO, said Friday that that plan will cover Viagra but has not developed specific coverage guidelines.
But another large national insurer, Aetna U.S. Healthcare, has said it will not pay for Viagra unless employers buy special coverage, the same policy announced by Kaiser.
Aetna told New York regulators earlier this month: "Simply put, having sexual relations is not a medical necessity."
In announcing its decision, Kaiser officials said their estimate of $100 million a year was based on the plan paying for 10 pills a month for each patient, which is more than the six to eight pills per month that several insurers are covering.
