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BOOSTER SHOTS: Oddities, musings and news from the
health world

Officially, Medicare Part D doesn't pay for Viagra; unofficially ...

March 15, 2011|By Tami Dennis, Tribune Health
  • Medicare Part D isn't supposed to pay for drugs to treat erectile dysfunction. That doesn't mean it won't.
Medicare Part D isn't supposed to pay for drugs to treat erectile dysfunction.… (Mark Boster / Los Angeles…)

Cialis, Viagra, Levitra and other erectile dysfunction drugs are not considered  
necessary by the U.S. Department of Health & Human Services. Apparently many men disagree. Hence the $3.1 million charged to Medicare Part D for the drugs in 2007 and 2008.

A new report from the department's Office of Inspector General chides the Centers for Medicare & Medicaid Services, which runs the labyrinthian Medicare program, for the error. Sure, the drug can be covered when prescribed for non-sexual reasons. But that doesn't seem to have been the issue.

Not that it's anyone's fault really. The report blames ... yes, a software problem!

Actually, what it says is this: "According to CMS officials, the software edit in place in CMS’s Medicare Drug Data Processing System during our audit period enabled CMS to identify and reject PDE data that sponsors submitted for ED drugs prescribed for the treatment of sexual or erectile dysfunction. However, according to the officials, the edit did not prevent CMS from accepting PDE data for some ED drugs in CY 2007 and most of CY 2008 because the Part D program used an incomplete list of excluded drugs as the basis for the edit."

The Centers for Medicare & Medicaid Services agreed with some of the report's recommendations. The agency said that yes, it would try to get money back from insurers, and yes, it would take all sorts of actions to ensure such problems don't happen again. You know the routine. But when it comes to working with the Food and Drug Administration to keep a list of prohibited drugs ... the agency doesn't think that's necessary.

The full report, with a summary of the response, can be found here. It's fun reading. Not really -- but some of the headlines about the report have been fun. Not this one, of course. We're a family newspaper/website/media empire.

Medicare.gov offers a primer on Part D (prescription drug) plans.

But for easier reading, you might want to skip to the Drugs.com explainer. Here's the relevant portion:

"Not all drugs available in the United States are covered by Part D. The most notable exclusion is the class of anti-anxiety medications known as benzodiazepines: Valium (diazepam) and Ativan (lorazepam), to name two. Drugs used for purely cosmetic purposes, as well as ED remedies such as Viagra and Cialis, are also excluded. Finally, some plans refuse to cover drugs on the basis of prohibitive cost or lack of a rebate from the manufacturer.

Sorry about the Valium news, guys. But now you know. (And the "software" excuse has been used already.)

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