WASHINGTON (AP) -- State Medicaid programs must pay for Viagra, the popular but expensive new impotency pill, the federal government said Thursday.
Use of the drug will be closely monitored, however, and abuse could land it on a list of drugs states can choose to exclude from coverage by the health insurance program for the poor.
"The law requires that a state's Medicaid program cover Viagra when medical necessity dictates" said Medicaid administrator Nancy-Ann Min DeParle in a letter Thursday to the National Governors' Association.
However, DeParle said that Health and Human Services Secretary Donna Shalala "is greatly concerned about the potential for clinical or financial abuse of Viagra."
State Medicaid programs that include prescription drug coverage are required to pay for any drug prescribed for purposes approved by the FDA. The Health and Human Services Secretary can add to a list of exceptions only when there is evidence a drug is subject to inappropriate use, such as with some diet drugs.
DeParle said pointedly that Medicaid "intends to establish a rigorous system to monitor utilization of Viagra."
She also recommended that states take steps to discourage Viagra abuse, such as limiting the quantity of prescriptions or number of refills, requiring documentation by doctors of impotence diagnoses and disciplining those who promote inappropriate use.
The governors' association calculated that covering the $10 Viagra pill would add up to more than $100 million each year, given its immense popularity. In a May letter to Shalala, Govs. Lawton Chiles, D-Fla., and Michael O. Leavitt R-Utah, argued coverage should be an option, not a mandate.
Some of the largest states, including California and New York had been saying no to Viagra pending the federal ruling. Others have been covering it, however.
DeParle said in her letter that about 90 percent of the nation's 37 million Medicaid beneficiaries are women and children, saying, "The number ... that could be diagnosed with erectile dysfunction is very small."
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