It sure is good to know I can get a really stiff dick on my insurances tab…and then go knock up some poor girl that can’t afford the pill. Go team JESUS!!

It is crazy.... even contraception through my local public health office is ten dollars a month....it used to be only 20 dollars a year!

Well, we wouldn't want our tax dollars going to baby-murdering.

"Honey, my Viagra is covered finally!"

"Too bad you can only use it to masturbate to internet porn now, as my pills are not covered."

medicare is just for old people -- long past contraception use. Still it is infuriating.

anyone know if they cover hormone replacement therapy? (yes i know, not safe. but I'm still curious)

Katha, aren't old people long past viagra use?

No, old people are Viagra's major patient pool. It's supposed to be for erectile dysfunction, a problem that primarily affects older men.

While the old folks do make up a majority of Medicare's pool, Medicare is clearly not just for old people (Medicare Enrollment Stats for California 2003) -- there are plenty of people of reproductive age on Medicare getting screwed. (Screwed out of their rights to safe screwing? Or something like that.)

Arg. My link got eaten.

Anyhoo. Medicare enrollment stats (for California and other states) can be found at http://www.cms.hhs.gov/statistics/enrollment/default.asp

One thing us UK folk have going for us is the sexual health and GUM clinics which give you free birth control; treatment for STDs; thrust creams...basically fucking anything you need. My pills were free, my depo's free and if I want an IUD or implant it's free.

Pity you still have to convince two doctors that a baby will make you mentally ill before you can get an abortion.

Thrust should be thrush. My mind is on slightly more entertaining things than birth control.

medicare reform laws say that any medication that is medically necessary for health reasons (health specifically including psychological state) for a majority of medicare users must be covered.
Does anyone know if medicAid (gov’t healthcare for the poor of all ages) covers viagra and not OCs? If so, then that’s totally wrong. But taking a neutral/scientific/non-political side here, I really don’t see how OCs are medically necessary to a majority of senior citizens. By this I mean I just haven’t seen the scientific literature showing benefits over risks. Jessica correctly referred to the famous “Chen” study from the dana-farber institute in 2004 (my binder with all that stuff is at school. if anyone wants the study i'm sure i can find the link) that linked HRT to increased invasive breast carcinoma in the elderly.

"medicare reform laws say that any medication that is medically necessary for health reasons (health specifically including psychological state) for a majority of medicare users must be covered."

That's extremely peculiar. Surely a majority of medicare users can't need viagra, since presumably most medicare users are women. And does that mean that elderly people with rare illnesses are out of luck in general?

I wouldn't keep Viagra out of the hands of male Medicare patients simply because men are less in number. To my mind, that's gender discrimination. If women were the minority of elderly people, I wouldn't say, "Too bad, no hormones for you."

Oh, that wasn't what I meant at all. I'm fine with Viagra being covered by Medicare. I just don't think it can be right that the reason the pill isn't covered is that only medications that "a majority" of Medicare users need are covered. And in fact, I checked, and that's not right. (Which is good, because I imagine there are very few meds that a majority of Medicare recipients use.) In fact, it seems to be the 100 most-commonly-used drugs.

Even that's kind of fucked up, though. Why should elderly and disabled people be penalized for needing uncommon drugs, whether it's birth control or something else?

sally, "Surely a majority of medicare users can't need viagra" - the law specifically cites health reasons, and psycological health included, as criteria for a drug being approved/covered. That is, the psychological benefit that viagra has given senior citizen men (and women) who can now be sexually active again is documented and therefore seen as valid. Millions of americans don't see "psychological health" as medically significant. Perhaps you don’t either, and that’s your right. But the FDA does. Anyway, as of 2005, as I was saying above, 75 year-old women don't have a documented "need" for OCs (as HRT is now highly controversial). I really wish it did, because for a while HRT was “the next big thing,” but it ultimately proved wrong. That's why I said that this viagra-yes/OC-no makes sense (as of feb 2005), but if mediCAID covered one and not the other it'd be foolhardy, as 30 year-old (poor) women certainly have a legitimate reason for needing OCs.

That said, in a perfect world, everything would be covered. I was just in clinic and the doctor asked the 3rd year students "what tests would you run for this patient?" and I said "Well, I'd get a chest x-ray to rule out blah, an mri to rule out blah, a complete blood screen to rule out blah. maybe he has acute hiv - so order one of those tests, I’d probably admit him for observation, etc" - She said "whoa! who's gonna pay for all that? You can't order a full body exam for every patient! Pick ONE!" Bottom line is that the healthcare system in america is near-broke. As much as we'd like to set $20 million aside to research rare diseases that affect a hundred people each decade, we simply can't. So it is, as you put it, "fucked up," but yes - some uncommon drugs may not be covered.

"Millions of americans don't see "psychological health" as medically significant. Perhaps you don’t either, and that’s your right."

Wow. I have no idea where that came from.

Most Medicare recipients are elderly, and they don't need birth control. But some are younger, disabled people, and some of them do need birth control, if they're going to have sex. So I guess the question is whether you think young, disabled people have the same right to have sex as elderly people do. Or have the medical benefits of sex to young, disabled people just not been studied?

Incidentally, I don't see what rare diseases affecting 100 people a year have to do with anything. There are plenty of drugs that have been around for a long time and aren't even that expensive that aren't covered. The birth control pill is one of them, but some of the drugs that I've taken recently, and that my insurance has covered, also aren't on the list.

Incidentally, if Medicare is "near broke," that's because as a society, we've decided not to fund it. If we took some of the money we spend developing weapons systems and invading other countries and devoted it to buying drugs for people who need them, it would be a whole lot less broke. This is a matter of political priorities, not "the way things are."

I agree with james that the major problem is that insurance companies and federal insurance programs need to cover everything and trust that the doctors are doing their job correctly when prescribing to patients. No good comes out of refusing to cover entire classes of drugs.

Is that what James is saying?

I think what he's saying is that in a perfect world, everything would be covered, but since programs are currently underfunded, everything can't be covered. So the minority of Medicare patients who need birth control pills (or any other medication not currently in the top 100 drugs used by people over 65) are out of luck. Sorry! But that's just the way it is!

And that's bullshit.

Ok, I read back over the thread, and I realize I misread James. He was defending Viagra being covered: I thought he was explaining why OC shouldn't be. The "majority" thing is a red herring, I think.

So I think the problem here is that a lot of people are under the impression that all Medicare recipients are over 65, and therefore that birth control isn't an issue. But that's not true. More than 10% of Medicare recipients are under 65. Some of them are women of child-bearing age. And some of them need birth control. It's probably a pretty small number, since most disabled people on Medicare are in their 50s, but there is a need.

This seems to be part of a larger problem, though. The Medicare prescription drug benefit was designed with the elderly population in mind, and it ignores younger disabled people pretty much across the board. This looks more like a disability rights issue than like a woman's issue, actually.

sally - thanks for re-reading. You got it right the second time: I think everyone SHOULD get everything, if they need it. And Amanda hit it right on the head: in a perfect world, everything would be covered, but only a DOCTOR would decide who gets what. Therefore, a 35-year old man who wants Viagra but doesn't need it would be denied by a doctor who doesnt want to give unnecessary medicine (thus saving money from the medicare pool) and a 35 year old handicapped woman WOULD, as a doctor would clearly see the difference and give appropriate medicine (money) to those who need it and deny it from those who don't.

I think that everyone has really interesting and smart things to say on this...but what's facinating to me (and this is beyond the medicare conversation) is that contraception and EC are the only things that folks are creating laws for where health care providers can decide NOT to give to patients. you don't hear of moral clause laws against viagra. but when it comes to BC, a pharmacist (in some states) can just refuse to give it up. it just seems so beyond logic to me. sorry if this is off conversation, i've just been constantly upset about this since i heard about the laws...

As women, we should probably support medicare Viagra, (and not just because of the pleasure we get from male erections). Pretty soon there will be similar drugs for women, and we will want medicare to pay for them. Also, the rapid adoption of Viagra by insurance companies and govt has been a boost to getting BC covered.
however, when you consider the govt cuts in things like dental care, and the study that showed that something like 18,000 people died last year because of insufficient medical care, funding viagra is a little strange.
I will be curious to know whether any of those anti-BC pharmacists refuse to fill the viagra prescriptions of unmarried men.

Jessica:

There was a really good article/perspective in the New England Journal of Medicine in November on the issue of pharmacist conscientious objection. Here is the link, you should be able to read the full text from here:
http://content.nejm.org/cgi/content/full/351/19/2008

Assuming that comes up as a link.... You may need to copy/paste that into your browser.

Anyway, there actually are very good arguments on both sides of the issue, from a philosophic/ethics standpoint. I personally am on the side that pharmacists shouldn't get to make moral judgements on the people coming to them, but can understand that people have a right to stand by their convictions. I am disturbed that it only seems to be an issue with women and reproductive issues, however.

i agree with you so much. this is crazy that you have to pay for birth control and you can get viagra through insurance. This is should not be covered under medicare.

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