But they'll pay for Viagra....

  1. 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 companies won't pay for weight loss meds, but for some reason they will pay for men to have viagra. As if that is a medically necessary drug. I checked my insurance plans formulary of prescription drugs, and sure enough, viagra is listed, but not one weight loss drug.

    I was wondering if it might be related to the phen phen problems that surfaced a few years ago. Is it too big a liability to offer those types of meds?

    Any thoughts?
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  2. 26 Comments

  3. by   2banurse
    Well, though I think it may have changed now, it used to be that you couldn't get birth control pills unless you paid out of pocket. So I can't really be surprised about no support of some diet meds.
  4. by   hoolahan
    Sigh, it's still a man's world!!!
  5. by   flowerchild
    I have no expert opinion but my thoughts are that No r/t Phen Phen. It's probably r/t the MAN who makes the decisions in the insurance company and the amount of goodies HE received from the marketing people that work for the manufacturer. A trip to the islands? Use of a caddy? Who knows what he got from Viagra but I'll bet it is a lot more than he ever got from any diet pill manufacturers marketing reps.
  6. by   flowerchild
    Or perhaps the kickbacks that HE gets every time a patient on the plan gets Viagra.
  7. by   CountrifiedRN
    Or maybe they offered him his own lifetime supply of viagra??

    It really ticks me off because there are a lot of people with weight problems that might benefit from the meds, and being obese is definately a health risk.
  8. by   mario_ragucci
    I know. It does seem strange. Just like no health care covers fitness centers. I would be nice to introduce fitness without trying to sell it. I'm sorry :-(
  9. by   ShandyLynnRN
    when I took phen-fen it wasn't covered under my insurance either. I have never seen a diet drug on any plan I have had that is covered. The last insurance I had was through a catholic hospital, and birth control pills were'nt even covered...I'll betch viagra wasn't either, but I DO AGREE that obesity is a major health concern, and meds should be covered.
  10. by   SmilingBluEyes
    Originally posted by mario_ragucci
    I know. It does seem strange. Just like no health care covers fitness centers. I would be nice to introduce fitness without trying to sell it. I'm sorry :-(
    Mario, that would be a HUGE step in the right direction. I hear tell of a woman here in WA who sued her HMO for NOT covering her BC pills yet carried those who used VIAGRA. A righteous suit, if you ask me. Oh and is a pharmacist. (what a hoot). Never heard how it turned out, tho.
  11. by   colleen10
    I remember as a teenager being prescribed BC pills not for contraception but for use in treating Acne. Blew my mind that they wouldn't cover it but they would cover anti-biotics used for Acne. Seemed to me even if a woman was using them as contraception it would be better for the Insurance Companies to pay for it rather than have a woman become pregnant and then have to pay for all of the doctor's visits, hospital stay L/D and then pay for pediatricians etc. for the life of that child.

    I think there was a Federal or Supreme Court ruling that said all Insurance companies have to cover Birth Control Pills for women now. Maybe someone more in the know like Karen would have info.

    I have worked for companies that at least get you a discount at gyms, etc. I hope that will change in the future. I do feel that eventually weight loss drugs will have to be covered by Insurance. It's just a matter of getting enough people fighting the system. It doesn't make much sense to me that if you don't smoke, work-out, etc. you get a discount on Life Insurance but not Health Insurance. I guess Health Insurance CEO's are really just concerned with today's bottom line.
  12. by   Furball
    At one point in the 80's, my health insurance covered abortions but not birth control........
  13. by   RN2B2005
    The pharmacist here in Seattle sued her employer, Bartell Drugs (a local pharmacy chain) on behalf of herself and other female employees, charging sex-discrimination. Bartell Drugs employees are covered under a PPO (not HMO) programme through Regence BlueShield. The pharmacist won, and now all Bartell's employees are provided with BCP coverage.

    The salient point here is, EMPLOYERS DETERMINE DRUG BENEFITS. Insurers do not. The insurer or insurance broker simply offers a list of plans to the employer, at varying prices, and the EMPLOYER decides how much the company is going to spend--and that decides what drugs end up on your formulary and what drugs you have to pay for out-of-pocket. Some plans--like mine--don't even HAVE a formulary. My husband's employer chose a "Cadillac" type plan for their employees, and thus ANY drug prescribed by a licenced physician--including BCP and diet drugs--is covered under the pharmacy benefit. This is why the pharmacist sued her EMPLOYER, not Regence BlueShield; Regence was happy to provide BCP benefits if Bartell's was willing to pay for it.

    Sorry to disappoint, but there are no backroom-deals between Pfizer, Schering-Plough, or whatever and insurers. The bottom line is, how cheap is your employer? Most employers, and employees, find it easier to blame the big 'ol insurance companies when the pharmacy or hospital bill comes, rather than admit to the reality, which is that YOUR EMPLOYER SCREWED YOU.

    Incidentally, I worked at a multispecialty clinic that put out a newsletter quarterly for its employees. One quarter, we got the happy news that "although insurance premiums have risen, the [clinic name] has been able to avoid passing on these costs to employees, with little change in benefits." Guess what that "little change" was? Yup. Our drug copay leapt from $5.00 to $35.00 per Rx. The clinic had avoided DIRECTLY passing on the costs to employees, but any employee who had to have any prescription filled paid for that decision in a very direct way.
  14. by   BeachNurse
    Well MY insurance company (expensive PPO) won't pay for VITAMINS! I can get my Prenatal vitamins cheaper at GNC than at the pharmacy. I was recently diagnosed with anemia and given a script for Anemagen (Iron supplement, supposedly Generic). My insurance company won't pay for that either and it cost me---get this---$20.00 for a 30 day supply at Eckerds!

    So..prenatal vitamins and iron are not medically necessary either?! Go figure...

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