Debate rages over Medicare coverage of sexual dysfunction drugs

April 1, 2005

Washington--A controversy is brewing over whether Medicare should pay for erectile dysfunction drugs, which boiled over in the midst of heated discussions over the cost of the new Medicare drug benefit. Now estimated at $720 billion, the expected cost of the program is nearly double the government's original 2003 projections.

In early February, Rep. Steve King (R-IA) introduced legislation to prohibit Medicare payment for such "lifestyle drugs" as sildenafil and vardenafil. His bill says Medicare cannot cover drugs "prescribed for the treatment of impotence."

"We are promoting abstinence for young people with raging hormones, and yet we are going to ask them to pay taxes for sex-enhancing drugs for seniors? In good conscience, I cannot support that," King told the Los Angeles Times. "We have only a finite amount of money. When Medicare covers Viagra pills, you are taking money away from someone else's life-saving drugs.

In many cases, such drugs are medically necessary, some experts say.

William F. Gee, MD, chairman of AUA's Health Policy Council, explained that in older men, erectile dysfunction is often caused by disease or surgical procedures that damage the nerves or obstruct the flow of blood.

"For a 70-year-old man with hardening of the arteries caused by smoking; for a man with diabetes or multiple sclerosis; or a man who has had pelvic surgery for cancer, there are clear medical indications for these drugs," he told the New York Times.

Dr. Gee's comments followed a Feb. 1 cautionary statement by AUA, which said that erectile dysfunction could be an indicator that heart disease is on the way.

The statement pointed out that recent studies of men diagnosed with ischemic heart disease showed a significant number reported having ED an average of more than 4 years prior to developing heart disease.

"Erections depend on blood flow. So if there is a problem with blood flow to the penis, reduced blood flow due to arteriosclerosis may exist in other parts of the circulatory system and could lead to heart disease or heart attack," said Ira Sharlip, MD, assistant clinical professor at the University of California, San Francisco.

"Men need to recognize that the circulatory system is responsible for many components of overall health, and that ED should be taken seriously because it may be a warning sign of even more serious illness," Dr. Sharlip added.

Since the new estimate of the Medicare drug program's cost over the next decade was disclosed, it has been clear there will be efforts to trim back the program in some fashion-and President Bush quickly promised a veto.

"I signed Medicare reform proudly, and any attempt to limit the choices of our seniors and to take away their prescription drug coverage under Medicare will meet my veto," the president declared.

That threat even stirred Republicans to take issue, signaling there may be difficult days ahead for the president if he intends to keep the drug benefit intact.

"I cannot imagine the president would veto a bill that would more closely resemble what he originally wanted, a means-tested benefit to help low-income seniors who cannot afford their medicines," said Rep. Jeff Flake (R-AZ). "I hope he would not cast his first veto if Congress now acts more fiscally responsible."