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.
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 Los Angeles-based WellPoint Health Networks. Well-Point, 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 spokes-man 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.
Los Angeles-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.