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What can generic Viagra teach us about Medicare Part D?

By on July 27th, 2011
Filed: Advice, Medicare, Seniors

Find a 2012 update to this post here on our blog.

The patent for Viagra, the popular medication for erectile-dysfunction, will expire on March 27, 2012.

Right now, even if your doctor prescribes Viagra for erectile dysfunction, a patient on the Medicare Part D prescription drug benefit would have to pay the out of pocket cost for the drug.

Why? Because a rule enacted in 2007 made erectile-dysfunction drugs like Viagra ineligible for the Medicare Part D prescription drug benefit program, unless they’re prescribed by a physician for pulmonary hypertension.

And, a Wall Street Journal article reported that the Department of Health and Human Services (HHS) is cracking down on Medicare payments for these drugs. A report from the HHS’s Office of Inspector General found that in 2007 and 2008, the Centers for Medicare and Medicaid Services paid over $3.1 million for Viagra, Levitra and Sanofi-Aventis’s Cialis. Don’t expect those same mistakes again.

People can debate whether or not Medicare should cover erectile dysfunction drugs. But, there’s no debating the fact that some Medicare beneficiaries were unhappy about the decision. And, with the sildenafil (Viagra’s active ingredient) patent expiring in 2012, some people may be wondering if generic Viagra will end up on Medicare Part D formularies mid-way through 2012 or in 2013. Others may be wondering if they can enroll in such plans during the  2013 Medicare enrollment period for prescription drug plans and Medicare Advantage prescription drug plans.

What’s the answer? Not likely, according to our Medicare experts at PlanPrescriber.com.

They say the reason you’re unlikely to see generic Viagra on a formulary is not budget related, or politically motivated. Viagra is unlikely to gain CMS approval for Medicare Part D in 2012 or 2013, they say, because it would be the only FDA approved drug for erectile dysfunction available in generic form at that time. The Medicare Modernization Act requires every Medicare Part D prescription drug plan to cover at least two drugs in each category and class.

Levitra and Cialis, and any other popular erectile-dysfunction treatments don’t go generic in 2012. So, even if a generic equivalent for Viagra was put on formularies, insurers would also have to list at least one branded treatment, which would cost a lot more.

Perhaps a bigger, more important question is; would it be medically sound? There are documented health benefits to sexual activity. But, that’s a topic for another blog post.

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Medicare has neither reviewed nor endorsed this information

About Nate Purpura


Nate Purpura is a 15-year veteran of print and broadcast journalism, corporate communications, PR and internet marketing. He’s spent the last decade working in the health care and insurance industries. Over fifteen years he’s covered numerous areas of health care including pharmaceuticals, health and wellness programs, chronic disease management programs, cutting-edge diagnostic tools, Medicare and health insurance, and online marketplaces (exchanges).

6 Comments Add Your Comment

Cestyswothbob on Friday, February 3 @ 12:49 pm

Готовим на вине – http://pro-viticulture.ru

Tony @ Cialis on Tuesday, June 19 @ 1:54 am

Oh…great man thanks a lot for sharing such a wonderful information about viagra so here I am also aware about one drug name Cialis, it is also helpful to cure the erectile dysfunction.

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