But they'll pay for Viagra.... - page 2

Was talking to my mom tonight and discussion came up about weight loss drugs. She had seen a tv show that talked about the problem of obesity and the related health effects, and how the insurance... Read More

  1. by   colleen10
    RN2B2005 brought up an excellent point. It is up to your Employer, not the Insurance Company. I guess the fight is what is "medically necessary" and does your employer have to cover it?
  2. by   RN2B2005
    Employers frequently choose not to include prenatal vitamins in their drug benefit precisely because you (the employee) can buy something comparable OTC. Remember, every drug that is NOT on the formulary saves your employer money--and Rx prenatal vitamins are considered, like BCP's and weight-loss drugs, one of those "optional" drugs.

    Lots of OB's will give you sample boxes of Rx prenatal vitamins, if you ask. Be direct--tell them the vitamins aren't covered. When I was trying to conceive and still had insurance through that multispecialty clinic, prenatal vitamins were one of the non-covered drugs. My OB gave me almost a year's worth of Rx prenatal vitamins, for free.
  3. by   BeachNurse
    Vitamins are apparently NOT on the insurance company's Formulary List--which is on their Website...In my case, I don't believe it has anything to do with the employer, but the company itself.
  4. by   SmilingBluEyes
    Originally posted by RN2B2005
    The salient point here is, EMPLOYERS DETERMINE DRUG BENEFITS. Insurers do not.
    Point well-taken. BUT MY POINT was, that if VIAGRA is covered by employers, insurers, WHOEVER then so should BIRTH CONTROL be given equal billing! That's discrimination in it's most blatant form. And it's ironic a DRUG store would NOT see this, if you ask me!
  5. by   CountrifiedRN
    Originally posted by RN2B2005
    Remember, every drug that is NOT on the formulary saves your employer money--and Rx prenatal vitamins are considered, like BCP's and weight-loss drugs, one of those "optional" drugs.

    Is Viagra not an optional drug? My point is that they will spring for a drug that, IMO, is for "recreational" use, but they won't cover drugs that do have medical benefits, like weight loss, or as others have posted, prenatal vitamins or Iron. And surely, if they are going to pay for a man to have the ability to have/maintain an erection, they should be fair and spring for BCP too.



    I don't necessarily blame the employers for choosing plans that are cost effective, I want my insurance to be cost effective as well. It is the insurance company that determines the pricing of it's plans, and the formulary for each of its plans. The employers have to choose a plan with the right pricing and that will be beneficial to the majority of its employees, they don't get to pick and choose what drugs are going to be covered. If they did, I KNOW BCP's would be on there because then they would not have to pay for as much maternity leave!
  6. by   researchrabbit
    Perhaps the reasoning is that, without Viagra, men might fall into a deep depression and spend the rest of their lives hospitalized...or the women in their lives might turn into screaming, cranky harpies....
  7. by   micro
    oh, I don't know, I think the nascar Viagra car driven by Mark Martin is hot.....
    actually I think Mark Martin is hot........
    there is more to life than just sex,.........oh, did I say.....that.......!!!

    It is a shame, that priorities seem to get skewed in this world.....in all areas, including the vital ones of day to day living and medicine..........

    jmho, jan,
    micro
  8. by   deespoohbear
    Along the same lines, most insurance plans won't pay for infertility drugs or treatments, but will shell out for Viagra and penile implants...The reason insurance companies give for not covering infertility treatment is that infertility is not a "disorder." They say that having children is not a medical necessity, so therefore they don't have to cover the cost of infertility... Always has been a major sore point with me...

    My feeling is if an insurance company is going to pay for Viagra and penile implants, then they should pay for weight-loss meds, BCP, and infertility treatment.

    Our insurance formulary doesn't cover drugs for smoking cessation. How stupid is that? Meds to help someone overcome an addiction that could cost thousands and thousands of dollars more years later....
  9. by   nurseman
    A few of our employees have been grumbling that the over the counter anti-smoking drugs were not covered in our plan. I did some price checking today and it is $5 cheaper per week to buy the patch from the closest pharmacy than to smoke 1 pack of 20's per day (from our cafeteria). We cover $300 per lifetime for prescription anti-smoking drugs.

    As a side note our plan has been covering oral contraceptives and up to $15,000 per lifetime for fertility drugs and Viagra has only been added in the last month or two.
  10. by   Q.
    All this makes about as much sense as Medicare refusing to pay for a PSA test, unless you've already been diagnosed with prostate cancer.
    Um, duh. How do you get diagnosed anyway? Hmmm. An elevated PSA perhaps?
  11. by   micro
    but it keeps the 'health care monster' rumbling.............

    don't it.........
  12. by   TheLionessRN
    Just to toss a monkey wrench into the machine....
    Are there actually diet drugs out there that WORK? I have heard of none, but the, ummm, evidence of Viagra is pretty, ummm, obvious.
  13. by   Q.
    Originally posted by TheLionessRN
    Just to toss a monkey wrench into the machine....
    Are there actually diet drugs out there that WORK? I have heard of none, but the, ummm, evidence of Viagra is pretty, ummm, obvious.
    Good point.
    I'd rather insurance companies pay for an exercise club membership or Pilates/Yoga classes.

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