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  Bioethics in Brief

Raising the issue of Viagra costs- who should pay?

by Jeffrey P. Kahn, Ph.D., M.P.H.
Director, Center for Bioethics
University of Minnesota
Center for Bioethics

What's your opinion?

Share your views, read others on our message board.
Related CNN stories:
  • Viagra sales seen hitting $1 billion in first year - July 7, 1998
  • Government: Medicaid must cover Viagra - July 2, 1998
  • FDA has reports of 30 deaths involving impotence drug Viagra - June 29, 1998


  • Imagine a new drug that could restore some lost physical ability, at least for a few hours. Then imagine that this new drug costs $10 a dose, and could be used by millions of people. Viagra fits this description, of course, and its magic is to restore virility to impotent men-albeit for a few hours at a time. Viagra is predicted to be a billion-dollar seller for Pfizer in its first year of sales, and that means someone is paying for all those $10 pills.

    Some managed care companies have announced that they will not pay for Viagra based on its high cost, but it is hard to imagine them making a similar decision about an equally expensive drug that cured a specific type of cancer or reversed paralysis. Would there be hesitation to cover a drug that would restore the use of paraplegics' legs, even if each pill cost $10 and its effects diminished after a few hours? No doubt we would consider it a miracle and a bargain. So why not Viagra?

    Who needs lifestyle drugs?

    Part of the motivation for denying payment for Viagra is the perception that it doesn't cure or even treat illness or disease, and that the functions it temporarily restores are not life-threatening or critical enough for it to make sense to pay for it. Since the group of patients who could use Viagra are a fast growing part of the male population (as our population ages), managed care companies see it as a bank breaker. A pill to temporarily "cure" paralysis would be a miracle to those who would use it, but their numbers would be thankfully small. That Viagra is beneficial for so many men is exactly why payers are reluctant to cover it.

    The future will likely offer many new drugs like Viagra: expensive drugs that have lifestyle benefits without actually curing an illness or disease. We might be comfortable drawing a line between paying for curative treatments and those that are "cosmetic," and asking individuals to pay for cosmetic treatments themselves. So is Viagra cosmetic, curative, or both?

    Paying for lifestyle treatments

    Fertility treatments like in-vitro fertilization (IVF) are not usually covered by insurance because it is considered medically unnecessary. But it improves life in a way that restores a normal function- offering some infertile women the possibility of having a child. Neither Viagra nor IVF are like cosmetic surgery, but both can be used in a "cosmetic" way by people who don't have a medical need for them: IVF for women who want to select specific traits for their children, and Viagra for men who think it will add vitality to their sex lives.

    The difference between using drugs or treatments for medical reasons and cosmetic purposes offers a way to decide which deserve coverage. We should feel even less worried about denying coverage for cosmetic uses when the drug is affordable to most everybody.

    Protecting access in the future

    As we live longer and healthier lives, our health care needs will become more about treating chronic effects to our health, such as Alzheimer's disease or impotence, than about treatments for heart attacks in middle age. It is important that we protect our access to drugs and treatments that improve our health by protecting normal functions. The key will be determining what counts as normal, and when the same treatments are merely enhancements. The case of Viagra represents only the beginning of what will be more difficult decisions about who pays for the promising treatments of the future.


    Who should be paying for all those $10 Viagra pills, you or your HMO?
    Post your opinion here.



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    "Ethics Matters" is a bi-monthly feature from the
    Center for Bioethics and CNN Interactive.
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