Viagra maker faults balking insurers

Copyright 1998 USA Today
July 7, 1998


NEW YORK - Taking the offensive against insurers who say they won't cover Viagra because of safety concerns, Pfizer Inc. officials Monday called the decision "irresponsible" and said it promotes "unnecessary fear."

The company's unusual confrontation of insurers who hold the power to approve or disapprove its many drugs came after Prudential HealthCare and Humana Inc. refused to reimburse patients for the drug because they weren't sure it was safe.

Some Wall Street analysts say the insurers appear to be using safety concerns as an excuse to avoid financial strain from the pricey $10-a-pill impotence treatment.

"Any challenges to the safety of Viagra are factually and medically incorrect," Pfizer spokeswoman Mariann Caprino said. "It's irresponsible to raise the concerns of the general public over the safety of this drug ... and it's causing unnecessary fear."

At least 16 Viagra patients have died since the drug came on the market in March. Pfizer and the Food and Drug Administration point out that users of the blockbuster impotence drug are mostly elderly and often have other health problems. Both maintain that there's no evidence any of the patients would have died if they took the drug as directed.

Kaiser Permanente and other insurers have refused to cover Viagra because of the high cost. But Prudential and Humana say safety was their primary concern.

"We had some concerns about the long-term safety effects of the drug," Humana spokeswoman Valerie Kennedy said.

Neither company has contacted Pfizer to seek further safety information, Caprino said.

"We would certainly welcome an opportunity to meet with them and put these concerns to rest," she said.

Insurers are using safety concerns to mask their real reason for denying the drug - its budget-busting price, industry analyst Hemant K. Shah said.

"There's no question about it," said Shah, an independent drug industry analyst in Warren, N.J. "It's very difficult to give other reasons (besides safety) because the consumer backlash could be quite significant."

With the price of new drugs rising, insurers are drawing a line at covering what they deem to be "lifestyle" drugs, Shah said.

For instance, if an employer pays an insurer $4,000 a year to cover a patient and the patient is taking two pricey drugs - such as Viagra and a cholesterol-lowerer such as Merck & Co.'s Zocor - the insurer could spend half that amount on drugs alone.

"You're going to see that more and more, with drugs being pushed off the reimbursement list, because managed care companies can't survive like that," Shah said. "The cost has skyrocketed."

Drug makers have raised demand for drugs through aggressive direct-to-consumer advertisements on television and in news magazines after the FDA made such pitches easier last year. Insurers had held drug costs below inflation levels until this year. But now prices have began to outpace inflation and some health care observers expect drug costs to jump 10% or more in 1999.

By The Associated Press

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