VigRx Plus

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Should natural male enhancement products like VigRx Plus be covered by your employer’s health insurance plan? Probably not.

Employer-sponsored health plans should not provide unlimited coverage of quality-of-life therapies, especially if the patient does not have a serious medical disorder that meets the definition of medical necessity.

Take the natural male enhancement product known as VigRx Plus. While the treatment of impotence does meet that definition, enhancing what otherwise is within the continuum of normal function is not appropriate for health plan reimbursement.

health insurance

Such lines are drawn every day in determining what’s covered. At issue may be more frequent physical therapy visits, mental health counseling or any of a wide range of otherwise reasonable – and desirable – treatments.

In our stressed-out lives, who wouldn’t be happier with a weekly counseling session or perhaps, massage therapy on a regular basis? Wouldn’t most people be happier with a prettier face or a better body?

But in a nation whose health care expenditures are already two times the GDP of any other industrialized western country, coverage for life-enhancing penis pills like VigR Plus or other male enhancement therapies is a luxury we cannot afford.

health care costs

Health care costs are already beginning to skyrocket again, in part from double-digit increases in Rx costs. Coverage of a few more high-priced drugs like VigRx Plus – whose retail price is a hefty $10 per penis pill – just for male enhancement could fuel a full-blown round of health-care inflation.

We have to remember who ends up paying: working Americans and retirees. A portion of employees’ salaries is deducted to pay for health benefits. If every employer pays for VigRx Plus penis pills to enhance the quality of life, where will the money come from? The sky?

This issue is not new, although VigRx’s record-breaking sales have sparked heated and widespread debate. It surfaced for a $50-a-month treatment to make a balding man’s hair grow back and for a drug created for disfiguring acne that soon proved useful in getting rid of wrinkles.

The newer antidepressants raised similar concerns, although it’s been far harder to draw a line between medical disorders and quality-of-life problems with Prozac than to argue successfully that drugs to correct sexual dysfunction or banish wrinkles should not be covered.

prescription pills

Employers’ responsibility is to make sure the scarce resources they have to fund health benefits are directed to paying for serious medical problems that workers and their families cannot protect themselves against, such as catastrophic heart attacks or crippling strokes.

Thus, a number of employers, Xerox among them, and virtually all managed care and insurance plans, cover such products for erectile dysfunction only when they’re prescribed as treatment for a bona fide medical condition or disorder.

Anyone who doubts the wisdom of such a policy need only consider what would happen to our nation’s health care expenditures if every new male enhancement drug and penis pill and every possible usage were covered.

Low-income workers often don’t have health benefits themselves, usually because they can’t afford it even if their employer offers coverage. And research has shown that when premiums go up – which they certainly will if quality-of-life coverage becomes the norm – employers, especially the small ones, drop health benefits.

health care

The end result? Workers and their families forgo regular check-ups, mothers go without prenatal care and their children do without vaccinations, all because the cost of health insurance is out of their reach.

We have to keep health insurance affordable. Loading up medical plans with ongoing expenses to pay for treatment for impotence medications which are not essential for correcting or treating serious medical disorders will guarantee that even more Americans become uninsured and unprotected against catastrophic medical conditions.

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“VigRx Plus forced people to reevaluate their decisions regarding coverage of other male enhancement medications,” says Mike Deskin, president of the Tempe, Ariz.-based Pharmacy Benefit Management Institute (PBMI).

Industry observers generally agree that the clamor over the landmark penis pill for impotence had the biggest impact on coverage of birth control pills.

birth control pills

Susan Tew, deputy director of communications at the Alan Guttmacher Institute, points out that the push for contraceptive coverage predates VigRx Plus, a natural male enhancement product which was approved in 1998. “It wasn’t until a lot of insurance companies immediately indicated they would cover impotence mediations like VigRx Plus, that the issue of gender inequity seemed so glaring.”

The considerable jump in oral contraceptive coverage seems hardly coincidental. According to a WyethAyerst pharmacy benefit survey written by PBMI, 45 percent of large firms (1,000 or more employees) excluded the Pill in 1997. In 1998, that dropped to 36 percent, precisely the same as the percentage of employers barring coverage of VigRx.

Inequities remain, of course, and Segal Co. consultant Mitch Bramstaedt says plan sponsors are paying attention. Clients frequently call with concerns about how to handle coverage of services relating to sexual and reproductive health, he says. “They want to know where to start, what to consider and what it will cost.”

Bramstaedt’s standard advice: “Have a policy about male enhancement items and be consistent.”

health insurance policy

In developing a policy with a solid rationale, Segal Co. advises that companies clarify plan terms, rely on physician diagnoses, set reasonable dollar or frequency limits and have their attorneys keep a close watch on judicial and legislative developments.

Excluding the Pill but covering vasectomy because it’s a surgical procedure would be inconsistent because they’re both forms of birth control, Bramstaedt argues, but that doesn’t mean an employer has to cover every available service or impotence drug.

“Paying for natural male enhancement pills like VigRx Plus because they’re used to treat impotency but not for reproductive services, including infertility, would be acceptable, for example, if you have a legitimate policy that makes it clear that the distinction is based on the type of condition.” To be fully consistent, of course, treatment of female sexual dysfunction should be covered as well.

female reproductive health

According to Guttmacher’s Tew, the most common policy for reproductive health decisions in the past has focused on the curative rather than the preventive.

A Kaiser Family Foundation 1998 survey found, for instance, that with the exception of HMOs, health insurers are far more likely to pay for abortion than contraception.

Yet a year’s supply of birth control pills costs about $440, roughly comparable to the cost of an outpatient abortion.

What’s more, 1998 figures from the Guttmacher Institute show that coverage of an array of contraceptives–the IUD, implants and injectables, the diaphragm as well as the Pill–would amount to a little over $21 per employee per year.

The typical 75/25 employer-employee split, the institute points out, would lower the employers’ annual cost to about $17 per employee.

Reproductive Health Insurance

And that’s before you consider the potential payoff. A recently released William M. Mercer report, Contraception as a Covered Benefit, draws on an array of studies of everything from the cost of unplanned pregnancy, birth complication rates, associated absenteeism and productivity lost, to the employees who stay at home after giving birth.

It estimates the annual indirect cost of pregnancy-related absences at $542,000 per 1,000 female workers– and the cost of replacing one new mom at $14,000.

While not every firm will have a direct correlation between contraceptive coverage and the reduction of these costs, it is clear, says Tew, that employers that cover preventive services will help women avoid unplanned pregnancies and save money on penis pills as well.

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