The men gain, while the rest of us take the pain – financially speaking, of course. Belinda Beresford wonders who’s going to pay for Viagra
With fanfare and press coverage greater even than the latest Leonardo di Caprio appearance, Viagra is on its way to South Africa. Some say the latest star in the pharmaceutical firmament is already here, for a price.
But for those men who prefer more legitimate means of enjoying the hot summer nights, the little blue pill should be available on prescription in December.
International experience suggests Viagra will swiftly overtake the previous miracle pill, Prozac, in the popularity stakes. It’s justifiable to be suspicious about whether all the men suddenly confessing to impotence are really afflicted. After all, for years what is politely called “erectile dysfunction” ranked up there with stress incontinence as something to be kept as an embarrassed secret.
According to Fedsure Health, an estimated 50% of men over the age of 39 experience impotence.
Whether all these men really need Viagra, or whether they will use it to pander to male insecurity or simple hedonism, the cost is expected to be phenomenal.
A Harvard University study says that when Viagra hit the United States market earlier this year, it was the most successful drug debut in the country’s history.
So who is going to pay for it?
Medical aid schemes face a dilemma. While they don’t want to carry the potentially huge costs of such drugs, not making them available to members can lead to dissatisfied clients and a drop in market share.
Viagra is also seen as providing the sort of dilemma medical schemes are increasingly likely to face. The drug is a forerunner of a pack of “lifestyle enhancing” medicines possibly heading to market.
Such drugs include Lipitor for cholesterol reduction, Sonata for sleep enhancement, Propecia for hair loss and Detrol for incontinence.
Attitudes to Viagra differ between medical schemes. Some are willing to subsidise it for members who have a proven organic illness. Some will allow use of discretionary medical savings accounts. Some won’t pay for the drug at all, and others haven’t thought about the issue.
Fedsure Health is among the most generous. According to the company’s director of risk, Ivan Clarence, it will subsidise clients who can prove they are impotent because of an organic problem such as a prostrate operation, diabetes or spinal cord injuries. For such patients, Fedsure Health will pay for Viagra up to a monthly limit of approximately R500 a month.
While the exact costs of Viagra, which comes in different strengths, are still uncertain, Clarence says the limit is “structured around two nights of pleasure a month”.
Anyone wanting a greater number of rampant nights, as well as patients who cannot prove impotence due to organic causes, have to use their medical savings accounts. However, any money spent on Viagra will not count towards the threshold level, above which members are fully covered by the medical aid. Clarence says this means there is no cross-subsidisation from other medical aid members.
Determining when patients are truly suffering from impotence is a problem. Some doctors may be sympathetic to patients who don’t strictly fit Fedsure Health’s claim criteria, such as men who are impotent due to psychological problems. And how do you prove impotence?
Another “new generation” medical aid, Discovery, will also allow members to use their medical savings account to pay for Viagra.
Discovery itself will not pay for Viagra since it is considered a life- enhancing rather than medically necessary drug. Both these schemes say women are also entitled to claim for Viagra – as long as they have a prescription.
The largest medical aid administrator in the country is Medscheme, which looks after about 700 000 members in over 50 medical schemes. Executive chair Keith Hollis says responses vary, but most medical aids are waiting for the issue of Viagra to come to them, rather than give set guidelines in advance.
He thinks claims for Viagra are likely to be treated on a case by case basis by the more traditional medical aids, while the “new generation” schemes with medical savings accounts may follow the lead of Discovery or Fedsure Health.