In the Press

New York Times examines debate over medicare coverage of erectile-dysfunction medications

The New York Times on Tuesday examined the ongoing debate over whether Medicare should cover erectile-dysfunction medications such as Pfizer's Viagra. CMS officials last month said that they interpreted the policies governing the new Medicare prescription drug benefit to mean that drugs such as Viagra, Eli Lilly's Cialis and GlaxoSmithKline's Levitra must be covered if they are prescribed by a doctor. CMS' announcement prompted Rep. Steve King (R-Iowa) this month to introduce a bill prohibiting Medicare from covering drugs "prescribed for the treatment of impotence."

We do indeed live in interesting times. As advocates for our patients with erectile dysfunction, urologists are often placed into the political dilemma of having to justify government and third party payers need to cover medical acts. I practice within a socialized healthcare system in Canada where we are insulated from much of the paperwork insurnace companies demand of many American collegues. In the area of erectile function pharmacotherapy, Canada is very similar to the USA. Whereas many large multi-national employers (The auto industry) have recognized the value of providing coverage for the PDE5i, most employers and their insurers have not. The recent recognition that ED may be an early sign or marker of empending cardiovascular morbidity, the positive impact ED therapy has on quality of life and the potential endothelial benefits of the PDE5i all speak strongly in favor of therapy. In spite of tens of thousands of hours of media attention to the problem of erectile dysfunction, many couples still fail to seek therapy. The greatest hurdle many men experience preventing them from seeking treatment is embarrassment. Following closely behind however is the reality that in many cases, government and private 3rd party payors will not approve coverage. As physicians, I believe it is our responsibility to speak for our patients, be an advocate for coverage and encourage those affected to seek care.

Gerald Brock MD, FRCSC