Viagra/insurance discrimination because im a Female

[greatbubba]

Another Discrimination between the sexes. I went to my doctor today and after running test on me for 8 months he came to the conclusion that I needed pills to have blood flow more smoothly through my blood. Well he gave me a prescription for Viagra.... Viagra???? What he said yes it would work the same way it work for men on sending blood to the muscle...I joked with him, he agreed it was a myth in the community that Viagra was just for men. Well went to my local Rite Aid and they told me the insurance would not cover it...They said I had to pay $125.00...Keep this in mind my husband went to pick up his prescription for Viagra and they covered it but the Pharmacist said it was not covered for women. My husband blew his top and called his medical insurance, which is MEDCO. Medco stated the drug is not covered for the female gender.... They said its only covered for the male gender? Is this the worst case of discrimination? Let's see we have a doctor who has been a doctor for XX years and has 10 freaking degrees on his wall prescribe a medical pill and the insurance said they would not cover it because I’m a female. WTF.

So basically cause I don’t have a dick I cant have the medication I need.

So what’s next the cure for cancer won’t be available to women either.

[Dogmudgeon]

1. Get your physician to write a note

It should briefly describe your need for the drug.

It's like with RU-486. That one does much more than just produce abortion -- it's also an excellent anti-cancer treatment. Most of the "boner pills" are actually nitric oxide modifying drugs, which work on thr circulatory system, whether the patient has a penis or not.

If the doctor note doesn't work, then upgrade to the lawyer note.

Good luck!

--p!

[tyedyeto]

17. Why should a Dr. have to 'write a note'?

He/she prescribed the medicine.....isn't that enough?

Damn, I'm so tired of insurance companies prescribing medicine instead of doctors who have medical degrees.

[jayctravis]

23. Right!

The freaking prescription IS a note dammit!

[Dogmudgeon]

24. I agree

Plus, the very practice is infantilizing. I'm in a similar situation -- I'm a chronic-pain patient, and I have had to justify my use of painkilling medicine too many times for my sense of dignity to bear without complaint.

But I've done it.

Putting up with this kind of crap allows you a stronger voice in advocating change. You've been screwed over, and you have a moral right to demand redress and reform. Get involved, and use that voice!

--p!

[elehhhhna]

43. I hear you. My Doc treats me like Courtney Love over my monthly migraine

meds. Bet if I was a man with cluster headaches (or mister Doctor had a migraine hisownself just once) he's give me an oxy-morphine pump.

The jerk.

I finally said "look, if I wanted to abuse this crap I'd buy it on the 'net or on a Mexican vacation". That shut him up last time.

[Dogmudgeon]

54. Actually, I am a man

I've found that the main motivation isn't sexism, it's power tripping. Many people in the health care business get their kicks from infantilizing their patients. I worked in neurophysiology as both a clinical and a research tech, and I saw a lot of it happen.

The patients who came to the university lab after years of unsuccessful treatment were often both angry and "hypochondriacal" from those years of being treated like naughty children, and the effort to "sell" their providers on their illness. It's an insidious process. As a patient, this has also happened to me.

My regular physician has been writing the painkiller scrips for me now for over a decade. He's cool. And, I've never had an addiction problem, so there is no red-flag action for the FDA to pursue. But he's also got some serious rheumatoid stuff going on, himself, and he won't be in practice much longer.

I'm not sure I'd like to be on a pump. It requires a tapping into a vein or artery, and those things are difficult to deal with unless you get daily "service". I think fentanyl is available as a transdermal patch -- it could be worth looking into.

--p!

[elehhhhna]

61. So, as opposed to Courtney Love, they'll treat you like Ozzy Osbourne!

Oy.

The Power trip thing makes lots of sense to me personally, in retrospect. I've never had a female doc behave that way (not trying to flame guys--just anecdotal evidence.)

[Dogmudgeon]

69. The Prince of Darkness, Moi?

Oh, to be Ozzy Osbourne! -- as rich as Croesus, with a doting wife, three intelligent (if occasionally reckless) kids, fourteen dogs, and millions of fans!

Fun Fact: Ozzy's shakiness and "burnout" behaviors came from pharmaceutical drugs prescribed several years before the TV show. Many drugs produce a Parkinson-like effect called tardive dyskinesia. His years of boozing and drugging may have been rough on him, but the legal stuff was what really put him over the top!

Your observation about the sex issue with physicians is fairly accurate. Very few women in medicine are arrogant, but the ones who are try their best to make up for what the others lack. Fortunately, I've only ever had to work with one. I've never seen it at all in general practice medicine, but then again, the men in general practice are also humbler than the average physician. Plus, sexism in general is a tangled knot to begin with.

The real trouble I've had has been with the lower-level professionals, no matter the gender. Pharmacists, I've found, are a pack of lazy, rude, nasty S.O.B.s, at least around where I live. I'm sure there are exceptions, but they tend to get promoted real fast, leaving the pill-counting work to the jerks. (So maybe it's not the pharmacists per se, but the ones who fill my prescriptions. Dumb luck!)

My current pharmacist is pretty cool. As to the other two he works with, the less said the better.

--p!

[Terran]

44. A doctor's note won't do anything

We're talking insurance companies and their drug formularies. It would take a lot more than one doctor asking them to change their forumlary to accomplish such a thing. If millions of women were getting Viagra Rx's, that might do it, but otherwise I think the OP is out of luck. Perhaps an alternative drug? Not sure if there is one.

[Dogmudgeon]

55. Are you sure?

Things may have changed in the last year or so. It is fairly easy to get an off-label Rx covered as long as the price isn't astronomical. The consideration is almost always financial. My late grandmother was on epoetin, which was $250 for each weekly injection. Blue Cross/Blue Shield fought that one like a bobcat in a trashcan.

I think NOx modifiers will become THE heart medicine of choice within a decade. They are easier on the body and amazingly versatile. But since they have been marketed as boner pills, it's going to take a fight.

The same thing applies for "abortifacient" drugs. They are almost all excellent for cancer treatment in both sexes, but the "right to life" contingent has been erring on the side of death with their campaigns against RU-486 and misoprosol.

There is an OTC alternative to Viagra-class drugs -- the amino acid Arginine. But it's not very powerful, and must be taken a couple times a day if it is to work at all. Pilot studies have been encouraging, and there has been some interest in developing longer-acting proteins based on arginine. But that day is still years away.

--p!

[Terran]

56. Well, if something has changed recently...

I guess it's possible. I only speak from personal experience dealing with my own group health insurance carrier. They all set their prescription coverage in advance, and I believe it's only updated once per year as changes in the drug market take place (e.g., if a prescription drug goes OTC or a new generic becomes available). I say that I don't think one doctor's opinion matters much (and it sounds like a cliche) because if an insurance carrier made an exception for one client, they would be forced to make it for all clients, and it simply costs them more money. BUT, these things are also driven by demand; if a whole new area of drug therapy opens up unexpectedly, such as it may be in this case, so many people will be demanding coverage for it that it will suddenly become a money-making situation rather than a money-losing situation for the carrier. Which is, of course, all they care about.

[Igel]

68. Yes, and no.

A doctor can pretty much prescribe anything for anything. OK, that's an overstatement. But if Viagra has the expected effect on women, it would be prescribed frequently. Not in insurance company's interests.

There's likely to be a similar drug that's not Viagra. It may not work 100% as well, which usually means it works as well on 95% of the people, significantly poorly on 4%, and better on 1%.

He may either (1) get the insurance company to approve it; or, (2) have an alternative solution.

On edit: on the other hand, in light of what some people seem to reliably say below, just go with (2).

[physioex]

2. That what we get for have HMOs run this country....

Don't complain too much, most of us here don't even have health insurance because it's soo expensive......

I have been saying that we need basic catastrophic & health coverage for this entire country, but the Repukes would never let that happen.

On Edit: A belated welcome if you are new.....

[greatbubba]

4. I agree a lot of people dont have health coverage. The point that

caught us offguard was that I thought we were all equal. When a women cant get a prescription because of her gender that is a flat out slap in the face.


I can imagine going to a restaurant "Sorry we can serve you, your the female gender"

How about this..."Sorry the cure for aids is only for men not women no offense."


Were not living in the 50's are we?

[elehhhhna]

45. The cure for AIDS would be withheld from gay men, not hetero women.

Face it.

[LisaLynne]

3. That sucks.

It would make more sense that if the DRUG is covered, it shouldn't matter who it's for. Ugh, this stuff makes me so angry.

It's terrible that some people don't have insurance in this country. It's a crime and just sickening, but that's not the point of this thread. This really is discriminatory.

[alexisfree]

5. I agree! A slap in the face to all women.

[solinvictus]

6. Here's the rub with insurers..

When I was in the health insurance business, Viagra was covered by the local Blue, but birth control pills weren't. Since so many drugs became OTC and generic, companies can all but force you to use cheaper options. For example, Claritin became OTC so CIGNA and the local Blue would no longer cover Zyrtec, Flonase, and several other allergy meds without jumping through many hoops (letters of necessity, etc.). Claritin, to me, did nothing but give me headaches, but they refused to cover any form of Zyrtec. It's what happens when accountants, not physicians, are allowed to dictate your healthcare.

[CornField]

11. I remember feeling grateful when my BCPs were suddenly covered by ins.

Then my doctor explained to me why they were now being covered (because so many women had complained because Viagra was automatically covered). I think that was in the top 10 eye-opening experiences of my life in relation to corporate greed.

[raccoon]

41. Well, I'm glad at least one insurance company

changed their sexist policy regarding BCP and VIagra.

[elehhhhna]

46. It wasn't so much complaints as a lawsuit that changed their mind.

[Skittles]

7. I don't get this

Viagra is covered only for boner purposes?

[alexisfree]

8. Are you serious?

[TreasonousBastard]

9. Yup...

in a nutshell, the specified use is for hardons, not anything else, or much else.

Insurance companies won't cover a drug that is prescribed for something it's not approved for.

This isn't discrimination, it's just some suits saving money.

[Skittles]

31. but TB

Viagra was not developed for boner purposes - it was developed for blood circulation purposes! They only discovered the boner effect in trials.

[TreasonousBastard]

34. You may be right about that, but...

what is it approved for? Is it approved as a circulation drug, or a boner drug? Or both?

Anyway, I don't mean to say that I agree with them, I just understand what the cheap bastards are trying to do-- save a buck any way possible.

[Skittles]

36. lol

I am discussing "boner purposes" with TreasonousBastard. Only in DU! :hi:

[elehhhhna]

48. Then she's got a major discrimination case!

Google up "Classaction.com" I think--this could make a super lawsuit for one of those "evil" triel lawyers!

[WillowTree]

13. It's only approved by the FDA for treatment of ED.

[Liberal In Texas]

10. Nope, that's wrong. Damn insurance companies! n/t

[WillowTree]

12. It really isn't a matter of discrimination...

....though I can certainly understand why it would feel that way.

The fact is that even the prescribing information as published in the PDR indicates one and only one "indication" for the drug, and that is for "treatment of erectile dysfunction". See

http://pfizer.com/download/uspi_viagra.pdf

at the bottom of page ten.

Then, of course, there's this

http://www.fda.gov/cder/consumerinfo/druginfo/Viagra.htm

which indicates that Viagra has not been approved by the FDA for use by women and specifically states that it should not be taken by women (or children, but that's not at issue here).

Under the circumstances, it's highly unlikely that your insurer will cover it even with a letters from both your doctor and your lawyer.

[strategery blunder]

14. Viagra is a RECREATIONAL DRUG

There is NO reason for the insurance companies to cover it AT ALL (and I say this as a male). It is not even really marketed to people with ED who still want (emphasis on want not need) sex anymore, just the latest OMG PENILE ENLARGEMENT RAWR fad.:eyes:

The mere thought of Viagara sickens me.

Birth control has multiple valid medical functions--it used to be used for hormone replacement therapy (don't know if it still is after the fear studies came out), and is used for the regulation of periods. This is in addition to its elective use as, well, a birth control mechanism. As such, if the situation was reversed and birth control was covered and Viagara wasn't, I can't say I would complain.:)

[WillowTree]

15. Ah, but that's a case that could be won in court.

Medical insurance policies are written to pay for covered expenses related to the treatment of disease or injury. ED is, by definition, a physical dysfunction and is therefore necessarily covered by insurance.

[strategery blunder]

18. And how many people who take Viagra actually have ED?

Viagra was originally marketed to people who had ED, I'll give you that. And while I personally believe that American society is too fixated on sex, I recognize that Viagara does have a legitimate purpose.

But it is no longer marketed for that purpose. Now its ads show mostly young perky types, with a vague exhortation to "ask your doctor." The advertising has gone from "this is a treatment for ED" to "ask your doctor about enhancing your sex life" imho.

Thirtysomethings do not need Viagra. But it is marketed to all males, regardless of age, so its manufacturer can get more money. It has effectively sold out the original purpose of the drug, turning it instead into a recreational drug.

[WillowTree]

19. If it's prescribed by a doctor...

....and that doctor states that it's being given for the purpose for which the drug is approved, the insurer will cover it. They're not going to waste their time or money trying to prove that the doctor isn't really treating what he or she says he/she is treating, which would only raise more outrage on the part of the patient, doctor, and everyone they tell about it and would cost more than just paying for the damned drug.

Don't blame the insurance company for that one, or the pharmaceutical companies, either. If that's being done, the responsibility lies with the doctor who prescribes it.

[strategery blunder]

20. Oh, I'm not excusing the doctors either...

As a patient, I've had a doctor who wrote me a medical note saying that I needed an air conditioner in my university dorm room (due to old wiring in the dorms, my university requires a doctors' note for this). It was, from a purely medical standpoint, a crock of shit. I have allergies, but I'm not allergic to heat. And the stuff in the air conditioning filter isn't the same stuff that I'm allergic to. My point is the doctor fufilled my request even when there was little or no medical need to do so.

Oh, and there was little to no incentive for said doctor to do this, other than getting me to shut up (because I didn't want my dorm room to be a hundred degrees in September and May). How much more incentive do doctors have to make unnecessary prescriptions when their office supplies are pretty much provided by Big Pharma nowadays? They not only have drug samples, but now they have calenders, pens, clipboards, mugs, etc. full of pharmaceutical advertising. I can't see my doctor without seeing a pharmaceutical advertisement, and this has held true with every doctor I've had in a long time now (I tend to move around a fair bit). The entire health care system is rife with conflicts of interest, and the doctors are at fault too because they as a group refuse to put their foot down and say "NO MORE." And of course the insurance company won't investigate a frivolous prescription because it would probably cost them just as much money to do so as it would to just pay the claim and be done with it.

Edit: wrong "too"

[WillowTree]

21. I hate those "toos"...I mean "tos"...I mean "twos".

Dammit!

[strategery blunder]

22. Normally it's not a problem for me...

but it's four in the morning here. Time to go to bed.:eyes:

[Dogmudgeon]

25. Are you kidding?

Viagra and other "boner pills" work by modifying nitric oxide metabolism, which has beneficial effects on patients with hypertension, congestive heart failure, angina, and cerebrovascular problems ... among others.

Saying it's a "recreational drug" is like saying RU-486 is an "immorality drug". It elevates ignorance to the status of authority.

Take some time to get educated about this class of drugs. The wisecracks about flaccid erections and the oppression of women are doing far more harm than good.

--p!

[nothingshocksmeanymore]

52. Actually viagara has multiple medical uses as well and if a

man can't sustain an erection and wants to have kids, or simply wants to have sex, I support him in that. I want that young man to support women's medical needs as well...be it birth control pills or pregnancy termination if that is what a woman and her doctors decide.

[Fescue4u]

16. Not discrimination in this case

Doctors are free to prescribe medicine as they see fit, but medicines are FDA approved for certain illness.

Doctors can prescribe a medication for non approved conditions..theres a name for it but I cant recall it at the moment.

Anyway, most insurers cover meds for FDA approved conditions. There is no FDA approved medical condition that would apply to a women, hence no coverage.

As an example, if my doctor were to prescribe birth control pills to me (as a man), for some condition, my insurer would not cover it, even though my wife could walk it and get coverage for the exact same md.

Now if and when the the FDA approves viagra for your particular illness, then it will likely be covered.

Don't get me wrong, it still sucks and if a doc prescribes it, I think it should sure as hell be covered by your insurance.

But you are not being discriminated for being a women per se, but for having a condition not normally treated with viagra.

[Ilsa]

37. "Off-label" use? Is that what you are thinking of?

Maybe there is another term but I cannot remember it now.

[One_Life_To_Give]

26. Thought the FDA rejected it's use in Women

The last report I saw was the FDA rejected the use of Viagra in Women as it had not proven any benefit compared to placebo. (This was posted over at Dr. Berman's website newshe.com

Getting your insurance company to pay for this treatment may be difficult without the FDA authorizing this use. It's like a man being treated for cancer in semi-dormant ovaries.

[elehhhhna]

49. IIRC they were studying it for female -horniness enhancement, not

congestive heart failure, etc.

[One_Life_To_Give]

67. FDA Hasn't approved it for CHF either.

The only FDA approved application is ED. And the simplest way to get insurancve to cover it for off label use would be to list the OP as having ED. Except that would be little obvious to the Ins.

[elehhhhna]

72. Got a point there!

[alexisfree]

27. remember FDA also said bextra was safe, i trust my doctor

he isn't looking for intrest of pill manuft.

[Tsiyu]

28. But there is NO discrimination against women!

You just have a chip on your shoulder. You hate men, that's what it is. You are just trying to make trouble, Missy, and we don't allow little uppity wymmin to make trouble ( or sense.)

You are abusing a man, TERRIBLY, by reducing the supply of erectile dysfunction meds so that some guy with a REAL, ACTUAL PENIS ( the true thing these drugs were designed for, Little Missy) won't have as many erections as he could have had if you'd left his manly drugs alone. Are you happy now? Are you?

Don't you realize that woodies are more important than female wellness? I am so shocked at your man-hating rant here....

Damn you militant females. You want everything don't you? What? You can't have your own member so now you make up for it by reducing the supply of our meds for our members? HOW DARE YOU?

:sarcasm:

[TexasSissy]

29. I'd question the dr. about that Rx instead of the ins. co. on this one.

It sounds a little too weird, IMO. What was prescribed before Viagra? Surely there's a medication that does that function that is gender neutral or made for women? And your dr. just doesn't know it? Are his patients mainly male?

If I were you, I'd do some research on the Internet about all the approved uses of Viagra. Never never never never just take a medication that a dr. has prescribed, w/o verifying for yourself that that is the best medicine for you. Only YOU know about your body more than others....only YOU care about your body more than others.

Example: I was given samples of Celebrex (cox inhibitor arthritis medication) to take for back pain. I went home, researched on the Internet, and discovered (in medical sites, etc., including www.mayoclinic.com) that Celebrex is no more effective than an over the counter pain medication, and that you only take Celebrex and cox medications if there's a problem with your taking Aleve or whatever. So why would I get started on a medication that is costly and has to be prescribed, when OTC medications would actually, according to some studies, work better? So I took Aleve. Shortly afterward, you know what hit the fan on all the heart problems caused by the cox inhibitors. Best thing of all....I don't have to go to drs. to get Rx for pain...I just buy generic Aleve. A cheap and very effective way to go. (Drs. have their own agenda sometimes.)

[TexasSissy]

30. Oh, and don't forget....drs. get kickbacks from big pharma.

A good question to ask a dr.: Besides this medication, is there a generic form, or is there a second medication that you'd recommend if this one doesn't work out for me?

There is rarely only ONE medication for a specific purpose.

[elehhhhna]

50. Tell him to fork over a load of samples. I'm sure the salesmen

are throwing those around like beads at Mardi Gras.

[TexasSissy]

57. True! Great point. n/t

[elehhhhna]

58. Boy Howdy I LOVE your screen name! LOL! (also in TX)

[VTMechEngr]

75. Lucky You. i'm allergic to Aleve.

knocks one major pain med right out of my reach.

[ArkDem]

32. My blood won't flow through my blood either.

[greatbubba]

33. The pill was issued for blood circulation purposes

This is an issue that should be between doctor, patient not doctor, patient, insurance, company.

[elehhhhna]

59. SHUT. UP. that was mean.

but funny.

[NAO]

35. My health insurance will not cover Viagra, even if it was life or death

They have a specific exclusion clause, reads something like,

"Viagra will not be covered under any circumstances, regardless of indication, irrespective of the consequences of not treating with Viagra, including but not limited to death."

So even if Viagra was the only thing that would keep me from keeling over dead, my health insurance will not cover it. They don't cover it for men, women, children, or anyone, for any reason, period.

[Ilsa]

38. Ask your doc if there is another drug available for your condition.

Even if it is less effective, you might be able to do well on it and without the expense of using an ED drug.

Have your husband go see your doctor and tell him he has a ED disorder. Maybe a script in his name will work. Your doctor will have to feign stupidity, but maybe he'll cooperate if he trusts you.

[elehhhhna]

51. Boy is he gong to get a look at the pharmacy when he turns in a

scrip for 3 v's per day (or whatever!)

The ins. co probabbly has a limit on how many a month a man can get with a co-pay.

[alexisfree]

64. cialis, levitra????

all of them are for the guys only....

[Ilsa]

71. I was thinking she could request a drug whose use is not off-label,

something intended for "better circulation" (very vague diagnosis). Maybe there is nothing better than Viagra for her problem, but maybe something else could work well also. Sildenafil is contraindicated in present of heart or kidney disease.

I feel sympathy for her though, as once upon a time I had to get a letter from my doc to get my birth control pills paid for by insurance because I wasn't using them for birth control, but to ease symptoms of PMS.

[proud2BlibKansan]

39. My insurance company spent $35,000

on a hysterctomy for me after they refused to pay for a medication my doctor recommended. The medication was a fertility treatment that also helped treat the problems I was having. My doctor wrote three letters. I was in my late 40s and had had a tubal ligation so there was no way I could get pregnant. But the insurance company refused to pay for medication that cost under $100 and instead recommended an operation to remove a body part for 350 times as much.

Anyone who doesn't see that the insurance companies are the real evil party in this health care crisis is just not looking at all the dirty details.

[elehhhhna]

63. Look , they'll pay for delivery etc. but not birth control. That's weird.

They will also, however, pressure pregnant women into unwanted, invasive pre-natal testing as they'd rather pay for a "theraputic" abortion than a child with neonatal problems.

Nice.

[Arugula Latte]

40. This sounds like something your local media might cover.

Maybe it's worth a few calls to TV stations, a letter or call to an editor or two or three?

I can see the media covering it because it has a Viagra angle :eyes:.

Who knows, maybe the company will change its policy as a result.

[alexisfree]

65. we need to get the news

in our side...

[elehhhhna]

42. Appeal it. V is commonly desribed for circulation probs & Medicare covers

it for that purpose, so its' not like nobody's ever heard of that use.

[WillowTree]

53. Where is it "commonly described"...

....for that use? Not in the PDR or by Pfizer, the manufacturer, in the prescribing information for physicians or on the Viagra web site.

And where is it "commonly described" for any use by women? Not by the FDA, which specifically says it should not be used by women.

[elehhhhna]

60. Dunno but I have a good pal who's a Home Heathcare case manager /

and she has a couple female patients (and they are poor & elderly) on viagra right now. That's where I first heard of this use. Evidently the senior gals got a large charge when it was prescribed (as opposed to "described"--my bad.).

[elehhhhna]

47. ALERT THE MEDIA! Katie, Matt & Al would have a field-day with this

story! It's got it all! Seriously.

[alexisfree]

62. we are working on it....

it gets better...the insurance comes from a verizon wireless benefits...

[elehhhhna]

66. Ya might pm Andy Stephenson--his surgery's been delayed and

he's got media contacts he may be willing to share...he's a DU memeber who's had his own challenges w/ the medical community.

[MsTryska]

70. Okay....wait a second.....

imo when you're a male over a certain age, due to nature, hardons become optional. (i'm not saying they should be - just that that's how nature apparently works).



So my guess is if a woman is prescribed viagra - it's prolly for soem valid medical reason - not for a boner.

so in closing....


sue the pants off 'em.

[Name removed]

73. Deleted message

Message removed by moderator. Click here to review the message board rules.

[Cash]

74. Can your husband use his script for you?

Maybe it's a different strength so you can't. If it's the same strength, why not have hubby claim that Mr. Happy's needed more action lately, intends to stay more active for the time being, and he needs to get his script filled more often.;-) ;)